Treatment of nonalcoholic steatohepatitis with vitamins E and C: a pilot study

Miwa Kawanaka,1 Ken Nishino,1 Jun Nakamura,1 Mitsuhiko Suehiro,1 Daisuke Goto,1 Noriyo Urata,1 Takahito Oka,1 Hirofumi Kawamoto,1 Hajime Nakamura,2 Junji Yodoi,3 Keisuke Hino,4 Gotaro Yamada11Department of Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama, 2Department of Experimental Therapeutics, Translational Research Center, Kyoto University Hospital, Kyoto, 3Department of Biological Responses, Institute for Virus Research, Kyoto University, Kyoto, 4Department of Hepatology and Pancreatology, Kawasaki Medical School, Okayama, JapanBackground: Nonalcoholic steatohepatitis (NASH) is a common liver disease that can progress to cirrhosis. Oxidative stress is one of the central mechanisms causing hepatocellular injury in the disease. In this study, antioxidant therapy using both vitamins C and E was conducted in patients with NASH.Methods: Vitamin E 300 mg/day and vitamin C 300 mg/day were administered orally to 23 patients with NASH for 12 months. Body mass index was measured during therapy. Serum levels of alanine aminotransferase, thioredoxin (an oxidative stress marker), and high-sensitivity C-reactive protein were measured before treatment and after 12 months in all patients. Ten of the 23 patients underwent liver biopsy before and after treatment.Results: Body mass index remained unchanged during treatment with vitamins C and E. Serum alanine aminotransferase, thioredoxin, and high-sensitivity C-reactive protein levels were decreased significantly at 12 months compared with pretreatment. Liver biopsies showed improved necroinflammatory activity in eight cases and improved fibrosis staging in 4.Conclusion: Serum alanine aminotransferase, thioredoxin, and high-sensitivity C-reactive protein levels, and liver histology were clearly improved with vitamin C and E therapy. These findings suggest that combination therapy using these vitamins may be useful in patients with NASH to minimize damage from oxidative stress and slow the processes leading to cirrhosis.Keywords: vitamin E, vitamin C, nonalcoholic steatohepatitis, oxidative stress