AIDS TREATMENT NEWS No. 002 - April 25, 1986
Two separate bodies of medical research suggest that lecithin
may be helpful in the treatment of AIDS or ARC.
The first information comes from the development of AL 721, now
being tested as an experimental treatment against AIDS in drug
trials. AL 721 has been shown to reduce AIDS virus infection
of human T-cells in the laboratory (Sarin and others, New
England Journal of Medicine, November 14, 1985). It works by
changing the cell membrane so that the virus cannot attach
itself to receptor sites, and therefore cannot infect the cell.
The active ingredient of AL 721 is lecithin; the rest of the
mixture apparently makes the delivery of the lecithin more
effective. Much evidence suggests that ordinary lecithin can
produce the same "membrane fluidization" effect, which is
believed to be the basis of the antiviral action of AL 721,
though probably to a lesser degree.
Unfortunately, AL 721 is tied up in the corporate and regu-
latory red tape of new-drug approval. Doctors and patients
cannot get it, and they may not be able to get it for years.
Lecithin could be tried now, at least as a stopgap until AL
721 becomes available.
Meanwhile, different research teams have found purified lec-
ithin useful in the treatment of viral hepatitis. A computer
literature search turned up four clinical papers; three of them
are not readily accessible, and therefore easily overlooked.
All four papers reported controlled studies which found strong
evidence of effectiveness, and definitely recommended the
treatment. Since the antiviral effect of AL 721 is not believed
to be specific to AIDS, the hepatitis results may demonstrate a
practical clinical use of the same effect shown to prevent
AIDS infection of cells in the laboratory.
No published work so far has discussed lecithin and AIDS. A
Medline computer search found over 3800 papers concerning AIDS,
and over 4100 concerning phosphatidylcholines (lecithin and
related substances), but only a single item which discussed
both - the AL 721 letter cited above.
While the information collected here cannot prove whether or
not lecithin could be useful in the treatment of AIDS or ARC,
it certainly suggests that lecithin be tried - especially
since it is safe, inexpensive, and readily available.
AL 721 BACKGROUND
AL 721 is an experimental AIDS treatment derived from lec-
ithin. It was developed from several years' research on "mem-
brane fluidity" by dozens of scientists, work spearheaded by
Meir Shinitzky, an immunologist doing cancer research at The
Weizmann Institute of Science in Israel. AL 721 is known to be
safe for human use, and is known to reduce AIDS infection in
laboratory cultures, as mentioned above. Unfortunately, clini-
cal tests have barely begun and no results are yet available,
so we have no direct evidence one way or the other on whether
AL 721 will prove useful in the treatment of AIDS or ARC.
AL 721 is a mixture of three lipids (fats), in a 7: 2: 1
ratio; hence the name (the 'AL' stands for "active lipid").
The three ingredients are phosphatidylcholine (purified
lecithin - called 'PC' in this article -- which makes up 20
percent of AL 721), phosphatidylethanolamine (PE -- 10 percent
-- a related substance also contained in commercial lecithin
preparations), and neutral lipids which apparently serve as a
carrier to present the active ingredients to the cell membrane
more effectively. The particular 7: 2: 1 ratio proved to
be the most effective proportion.
All of the ingredients of AL 721 are extracted from ordinary
AL 721 increases the "fluidity" of cell membranes -- the degree
to which proteins can move around. It does this by removing
cholesterol and increasing the ratio of phospholipids (lec-
ithin and related compounds) to cholesterol in the membrane.
Increasing the fluidity apparently makes it harder for viruses
to attach to receptor sites, which are proteins in the
membrane. Unless it can attach to a receptor site, the virus
cannot enter and infect the cell.
Incidentally, membrane fluidity decreases with age; and AL 721
has been found to restore certain functions lost with aging.
Since increased fluidity should make it harder for the AIDS
virus to infect the cell, this theory would predict that
susceptibility to AIDS might increase with age.
AL 721 does cross the blood-brain barrier.
For more background on AL 721, see my summary "AL 721:
Experimental AIDS Treatment", AIDS Treatment News #1; or check
the references at the end of this article.
AL 721 AND LECITHIN
A number of published articles outline the science behind AL
721. These papers contain fragmentary but extensive
indications that lecithin has the same membrane fluidization
effect as AL 721, although to a smaller degree.
No one has collected and organized this evidence; the scien-
tists working with AL 721 have, not surprisingly, sought to
highlight how that preparation is special. Instead of
marshaling the information here, which would turn this short
section into a separate paper, we refer the reader to papers by
Shinitzky, Lyte, Heron, and the co-authors who appear with them
in the References section, below. Also see Physiology of
Membrane Fluidity, edited by Shinitzky, for a thorough
presentation of the scientific background behind the membrane
fluidity theory and the development of AL 721.
The prospectus of Praxis Pharmaceuticals, Inc., of Beverly
Hills, CA (the licensee and commercial developer of AL 721),
provides other information about this preparation and its
relationship to lecithin. In human trials, AL 721 has been
shown to restore immune function (lymphocyte proliferative
capacity) lost due to the aging process; the restored immune
functions were comparable to those of young adults. Animal
studies have shown that AL 721 may also be useful for treating
alcohol and morphine withdrawal, and to prevent relapses in
the treatment of dependency on these drugs. Both these effects
are believed due to membrane fluidization. AL 721 also shows
promise for treating cystic fibrosis in children, but through a
different mode of action.
The prospectus also suggests AL 721 as "a more efficient source
of lecithin" for treating bipolar affective disorder, compared
to soybean-derived lecithin, which earlier studies had shown
might be effective for this condition.
And aside from these therapeutic uses, "AL is a relatively pure
form of lecithin derived from egg yolk and may be used as a
PREVIOUS LECITHIN THERAPY
We have examined dozens of abstracts from nearly 200 studies of
lecithin administration or therapy published in medical jour-
nals during the last ten years. Most of these studies were
based on very different theories of lecithin's mode of action.
They used the substance either to increase the amount of
choline in the brain, or to reduce fat deposits in blood
vessels. For a review of these studies, see Wood and
Conspicuously absent from almost all work so far have been
studies of lecithin to help the body fight viral diseases.
Until the AL 721 study published last November (cited above),
there was little or no reason to look for an antiviral effect.
LECITHIN AND VIRAL HEPATITIS
Our literature search found four papers on use of lecithin or
related substances to treat hepatitis.
Jenkins and others, 1982, reported a double-blind trial on 30
patients with non-A non-B hepatitis. This study compared 15
patients given three grams per day of polyunsaturated phospha-
tidylcholine ("Essential Phospholipid", Nattermann & Cie, Ger-
many) for one year with those given a placebo; all patients
simultaneously received other hepatitis therapy. The study
concluded that the phosphatidylcholine definitely helped in
the treatment of this condition. In addition, two of the
controls but none of the treatment group suffered relapses
during the study.
This paper did not consider the possibility of an antiviral
effect, but suggested prevention of autoimmune damage as a
possible mode of action. It did mention the membrane
fluidity work, but no antiviral effects of increased membrane
fluidity were expected at that time.
Atoba and others, 1985, in a study in Nigeria, used matched
treatment and control groups, each with 30 patients with acute
hepatitis B. The treatment group used 1.8 grams of "essential
phospholipid choline", and the control group used vitamin-B
complex. The treatment group showed faster improvement on
almost all measurements. For example, the initial bilirubin
and transaminases were comparable for both groups, but after
four weeks, 77 percent of the treatment but only 37 percent of
the control patients showed normal serum transaminase levels.
After six weeks, 93 percent of the treated patients but only 53
percent of the controls had normal levels of both bilirubin and
This study was not double blind, as the patients had to buy
their own drugs. Cost was a problem, and may have contributed
to the decision to use the smaller dose; Jenkins and others,
who used three grams, mentioned that they had done a pilot
study in which 1.8 grams had proved effective.
(Incidentally, it is difficult to find the Atoba paper, as it
was published in an Indian journal received by only four
medical libraries in the United States. Copies can be obtained
through a commercial research service.)
Kosina and others,1981, found improvements in clinical signs,
laboratory tests, and number of relapses in 80 patients with
hepatitis A or B, compared to controls. This study used
"essential cholinephospholipids (Essentiale forte)"; we don't
know the dose. The paper is in Czech and we have read only an
English abstract; we would appreciate any help with
We have read only the English summary of Visco, 1985. This
Italian study reported successful treatment of viral hepatitis
with phosphatidylcholine, in a controlled trial.
How is the potential usefulness of lecithin against viral
hepatitis relevant to AIDS? The membrane fluidity theory is
not specific to the AIDS virus -- the theory just happened to
be tried first against it in the laboratory. It is quite
possible that membrane fluidization is the mechanism of action
of lecithin in these hepatitis trials. If so, it would show
that oral lecithin can produce in the body an effect already
found to prevent infection by the AIDS virus in the
laboratory -- an effect clinically useful against another virus
Even if the effect of lecithin against hepatitis is not due to
any antiviral action but rather to the prevention of auto-
immune damage, as some of the authors of the papers suggested,
there might still be a use against AIDS. A number of
researchers suspect that AIDS has an autoimmune component.
DOSAGE AND SIDE EFFECTS
As lecithin has yet to be studied as a treatment for AIDS or
ARC, we can only review dosage levels used to treat other
conditions. Fortunately, the doses used in the hepatitis
studies turn out to be within the range which has long been
recommended by the manufacturers of the lecithin granules which
have been sold in health-food stores for years.
Jenkins and others, 1982, used three grams of phosphati-
dylcholine per day. Most commercial lecithin granules contain
about 22 percent PC, so three grams is equivalent in PC content
to about 14 grams of the granules. This amount happens to be
about the same as the two tablespoon maximum daily dose tradi-
tionally recommended by commercial vendors of lecithin
Some studies have used higher doses, as much as 100 grams per
day of commercial lecithin. These high doses produced unwanted
side effects, such as nausea, diarrhea, depression, and loss of
appetite, but apparently no lasting ill effects. Therapists
giving high doses of lecithin should monitor the patients,
particularly for depression (Wood and Allison, 1982).
Most patients could tolerate up to 25 grams of commercial
lecithin per day without side effects. Also, most patients
could tolerate up to 40 grams of purified (85 percent) PC,
meaning that several times as much PC can be administered in
the purified form.
On the other hand, a very small dose would probably be inef-
fective, because many foods already supply lecithin; adding
only a little more would not change much. The amount of
lecithin supplied by food varies with diet, but is in the range
of one to five grams per day (Wood and Allison, 1982).
Ultimately the only way to determine a dose might be by trial.
If T-cell counts are being monitored, they might be the first
place to look for an effect, since membrane fluidization (with
AL 721) was found to prevent the infection of human T-cells in
the laboratory. For those who don't wait for a scien-tific
trial, which might or might not take place, the obvious
approaches would be to try the maximum dose recommended for the
product (equivalent to the dose used in the Jenkins hepatitis
study), or to try larger doses to see what seemed to work.
Lecithin is classified as GRAS (generally recognized as safe).
In the Medline database since 1980, out of over 4000 references
concerning phosphatidylcholines, only five concerned adverse
effects. Still, we should note possible problems. Long-term
feeding of large doses to pregnant animals has interfered
with the development of the fetus (Bell and Lundberg, 1985).
And one study of commercial lecithin preparations found that
all of the ones tested were contaminated with potentially
dangerous methylamines, probably from spoilage (Zeisel and oth-
ers, 1983). It would seem reasonable to store lecithin
properly, refrigerated in small bottles, to keep it away from
moisture, light, and air, and to discard any with a rancid
taste or smell.
An alternative source of lecithin is egg yolk. Egg yolk
contains all the ingredients of AL 721. It also contains much
cholesterol, which might counteract the effect of AL 721; we
don't know whether or not this would be a practical problem,
and would appreciate advice from nutritionists.
There are slight chemical differences between the PC in egg
yolk, and the PC in soy lecithin (the kind sold in health-food
stores). We don't know whether or not this difference has any
practical effect. The scientific work which developed AL 721
used egg lecithin, while most other studies of lecithin therapy
used the soybean variety.
The published information collected here suggests that lec-
ithin might be useful in the treatment of AIDS or ARC. This
possibility seems to have been overlooked; a computer
literature search turned up no papers which discussed it.
We hope that researchers will examine this information, and run
clinical tests if justified. There is little danger of harm,
and some chance of benefit.
Atoba MA, Ayoola EA, Ogunseyinde O. Effect of essential
phospholipid choline on the course of acute hepatitis-B
infection. Tropical Gastroenterology, April-June 1985; 6(2),
Bell, JM, Lundberg PK. Effects of commercial soy lecithin
preparation of development of sensorimotor behavior and brain
biochemistry in the rat. Developmental Psychobiology 1985;
18(1), pages 59-66.
Heron D, Shinitzky M, Samuel D. Alleviation of drug withdrawal
symptoms by treatment with a potent mixture of natural lipids.
European Journal of Pharmacology 1982; 83, pages 253-261.
Jenkins PJ, Portmann BP, ddleston ALWF, Williams R. Use of
polyunsaturated phosphatidyl choline in HBsAg negative chronic
active hepatitis: results of prospective double-blind
controlled trial. Liver, 1982(2), pages 77-81.
Kosina F, Budka K, Kolouch Z, Lazarova D, Truksova D. Essential
cholinephospholipids in the treatment of virus hepatitis.
(English translation of title.) Casopis Lekaru Ceskych August
13, 1981; 120 (31-32) pages 957-960.
Lyte M, Shinitzky M. A special lipid mixture for membrane
fluidization. Biochimica Et Biophysica Acta 1985; 812, pages
Praxis Pharmaceuticals, Inc. Prospectus, January 17, 1985.
Sarin PS, Gallo RC, Scheer DI, Crews F, Lippa AS. Effects of a
novel compound (AL 721) on HTLV-III infectivity in vitro. New
England Journal of Medicine, November 14, 1985; 313 (20), pages
Shinitzky, M. (ed) Physiology of Membrane Fluidity, Vols. 1
and 2, CRC Press, Boca Raton, FL 1984.
Shinitzky M, Samuel D, Antonian L, Lippa AS. AL 721, a novel
membrane fluidizer. Drug Development Research (in press).
Visco, G Polyunsaturated phosphatidylcholine in association
with vitamin B complex in the treatment of acute viral
hepatitis B. Results of a randomized double-blind study.
(English translation of title). Clinica Terapeutica August 15,
1985; 114(3), pages 183-188.
Wire-service reports on AL 721: UPI September 2 and November
14, 1985; AP November 13 and 14, 1985.
Wood JL and Allison RG. Effects of consumption of choline and
lecithin on neurological and cardiovascular systems.
Federation Proceedings 1982; 41, pages 3015-3021.
Zeisel SH, Wishnok, JS, and Blusztajn JK. Formation of
methylamines from ingested choline and lecithin. The Journal
of Pharmacology and Experimental Therapeutics, 1983; 225(2)