Abstract
<jats:p>Clinical and experimental data indicate that SARS-CoV-2 is hepatotropic and can induce reactive hepatitis, steatohepatitis and fibrotic changes, which is particularly relevant in patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). COVID-19 complicated by viral-bacterial pneumonia and repeated antibacterial courses increases hepatotoxic burden and accelerates MASLD progression. This randomized study involved 62 patients with MASLD and grade I obesity (BMI 30–34.9 kg/m2) hospitalized for moderate community-acquired viral-bacterial pneumonia associated with COVID-19. The mean age of participants was 52.5±3.31 years and all had PCR-confirmed SARS-CoV-2 infection 7–10 days prior to admission. Patients were randomized into two matched groups (n=31): control—standard empirical antibacterial therapy plus alpha-lipoic acid; intervention—the same regimen with added Livodinol® MAX (adenosylmethionine, N-acetylcysteine, reduced glutathione) administered orally for 30 days. Dietary correction with moderate caloric restriction was applied. Clinical status was monitored daily; laboratory, ultrasound and elastography assessments and steatotest were performed at baseline and on day 30. Compared with controls, the Livodinol® MAX group showed significant clinical improvement: astheno-vegetative syndrome decreased 2.45-fold, dyspeptic complaints 4.20-fold, abdominal pain 4.33-fold and hepatomegaly 2.42-fold (p<0.05). Biochemical improvement included greater reductions in ALT and AST, normalization of total bilirubin and γ-GT, and diminished mesenchymal inflammation on laboratory indices. Metabolic outcomes improved: fasting glycemia fell by 12.2 %, two-hour post-load glucose decreased with normalization in a larger share of patients, fasting insulin concentration dropped 1.9-fold and HOMA-IR declined 2.2-fold (p<0.05), reflecting improved insulin sensitivity and carbohydrate regulation. No serious adverse events attributable to Livodinol® MAX were recorded; the regimen was generally well tolerated. The observed benefits are mechanistically plausible: adenosylmethionine supports methylation, phospholipid turnover and mitochondrial fatty-acid transport; N-acetylcysteine replenishes glutathione and scavenges oxidants; reduced glutathione enhances detoxification and stabilizes cellular membranes. These complementary actions reduce oxidative stress, attenuate antibiotic-related hepatotoxicity and promote hepatocyte repair and metabolic stabilization. Inclusion of such a multicomponent amino acid complex may decrease the hepatic adverse impact of multiple antimicrobial courses and improve metabolic outcomes in related clinical settings. In conclusion, a 30-day adjunctive course of Livodinol® MAX in patients with MASLD, obesity and COVID-19-associated community-acquired pneumonia produced superior clinical, biochemical and metabolic benefits compared with standard therapy including alpha-lipoic acid. The findings substantiate consideration of this amino acid derivative complex as an effective hepatoprotective and metabolic-corrective adjunct in comprehensive treatment protocols. Larger multicenter randomized trials with extended follow-up are recommended to confirm reproducibility and long-term safety.</jats:p>