Table 1.

Efficacy of 5-ALA/SFC in treatment of metabolic disorders and its mechanisms

Metabolic disorder	Mechanism of action of 5-ALA	Reference
T2DM conditions in Otsuka Long-Evans Tokushima Fatty rats	5-ALA ameliorates diabetic abnormalities in rats by reducing visceral fat mass (in the retroperitoneal region) through a decrease in adipocyte mitochondrial content	Sato et al.111
Lipid accumulation in hepatocytes and hyperglycemia during obesity and T2DM	5-ALA administration with ferrous citrate increases aerobic glycolysis, lipolysis and leads to higher expression of HO-1 and UCP1	Kamiya et al.20
Muscle and mitochondrial abnormalities during T2DM	5-ALA administration with ferrous citrate changes skeletal muscle transcriptome leading to increased expression of glucose uptake and mitochondrial oxidative phosphorylation-related genes	Kitamura et al.112
Decreased glucose tolerance during high-fat diet	5-ALA administration with ferrous citrate increases GLUT1 translocation in the plasma membrane without affecting GLUT1 expression	Kuroda et al.113
Increased fasting blood glucose level and decreased glucose tolerance in the patients with mitochondrial diabetes mellitus	5-ALA administration with ferrous citrate reduces blood glucose levels and improves glucose tolerance by enhancing mitochondrial function	Nakamura et al.18
Increased intensity of anaerobic glycolysis during breast cancer	5-ALA administration leads to increased heme synthesis, which destabilizes Bach1 and decreases anaerobic glycolysis in favor of TCA cycle activation through AMPK	Kaur et al.125
Endoplasmic reticulum stress caused by excessive intake of palmitic acid	5-ALA induces HO-1 expression and decreases Bach1 expression	Hamada et al.126