Hepatoprotective therapy: the role of s-adenosylmethionine in modern liver disease treatment tactics

This article presents an overview of modern approaches to hepatoprotective therapy with an emphasis on the role of S-adenosylmethionine (ademetionine) in the treatment of liver diseases. The main groups of hepatoprotectors are considered, and data on their main mechanisms of action and indications for use are provided. Particular attention is paid to the mechanisms of biosynthesis and catabolism of S-adenosylmethionine, along with its metabolic pathways, including transmethylation, transsulfuration, and polyamine synthesis. Its role in glutathione formation is also considered. The article presents current data on the mechanisms of action of this drug in the context of its use in the treatment of liver diseases. Key aspects of the drug’s use in various nosological entities are analyzed: intrahepatic cholestasis, alcoholic liver disease, non-alcoholic fatty liver disease, cirrhosis of the liver, and drug-induced liver injury. The article also presents data on the role of S-adenosylmethionine in the correction of asthenic syndrome and cognitive impairment in patients with liver diseases. The evidence base for the use of ademetionine is presented, based on the results of clinical studies, including an assessment of the efficacy, safety and duration of therapeutic effect.