Branched-chain amino acids and sepsis: from pathological mechanisms to clinical interventions

Sepsis is a life-threatening organ dysfunction syndrome triggered by infection, characterized by profound metabolic disturbances and multisystem dysfunction throughout its clinical course. Branched-chain amino acids not only participate in protein homeostasis and energy metabolism but also regulate the pathophysiological processes of sepsis through multiple signaling pathways. This review systematically synthesizes current research advancements on BCAAs in sepsis, with particular emphasis on the correlation between BCAA metabolic alterations and clinical outcomes, as well as their impacts on nutritional metabolism, muscular homeostasis, and immune function in septic patients. Furthermore, we critically analyze the limitations of current clinical interventions involving BCAAs and propose future research directions, highlighting the necessity for in-depth exploration of precision BCAAs supplementation strategies tailored to different sepsis stages and their underlying mechanisms.