History and Applications of UDCA
Ursodeoxycholic acid (UDCA) was first isolated from bear bile in the late 1960s. It was later synthesized as a pharmaceutical product and approved by the FDA for the treatment of Primary Biliary Cholangitis (PBC) in 1997. Over the past few decades, research has shown UDCA's potential in addressing various other liver conditions beyond PBC.

Mechanism of Action
Ursodeoxycholic acid works by replacing toxic bile acids in the liver that can cause damage. Specifically, it replaces chenodeoxycholic acid (CDCA) which is known to be more toxic than UDCA. By replacing the more toxic bile acids, UDCA helps in protecting the liver cells from damage and promotes the removal of cholesterol from the liver. This dual mode of action makes it effective for different liver diseases characterized by bile acid toxicity and cholesterol build-up in the liver.

Efficacy in Primary Biliary Cholangitis
Ursodeoxycholic Acid is an autoimmune disease where the bile ducts in the liver are slowly destroyed. UDCA has been found to delay disease progression and liver transplant requirement in PBC patients. Multiple double-blind clinical trials have confirmed UDCA's efficacy in improving biochemistry markers, slowing histological progression, and providing overall symptom relief in PBC. It is now considered the first-line standard of treatment for PBC. However, not all patients respond adequately to UDCA monotherapy, necessitating additional therapies.

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