Article
Gastroenterology & Hepatology
Rajiv Jalan, Christopher F. Rose
Summary: The clinical progress in managing hepatic encephalopathy lags behind basic research, making current criteria for definition, classification, diagnosis, and grading difficult to apply reproducibly. Studies suggest that hepatic encephalopathy may be irreversible in many patients, requiring further research into neuronal injury and death mechanisms for future drug development. Lactulose, currently considered the standard of care, has poor clinical evidence for all severity levels of hepatic encephalopathy, and ethical consideration should be given to placebo-controlled trials.
JOURNAL OF HEPATOLOGY
(2022)
Review
Immunology
Zefeng Chen, Jingsheng Ruan, Dinghua Li, Min Wang, Zhiwei Han, Wenxia Qiu, Guobin Wu
Summary: Hepatic encephalopathy is a neurological disorder that occurs in patients with liver insufficiency, and its pathogenesis has not been fully elucidated. Pharmacotherapy is the main therapeutic option for HE, which targets the pathogenesis of HE by reducing ammonia levels, improving neurotransmitter signal transduction, and modulating intestinal microbiota. The intestinal microbiota is closely associated with multiple links in the pathogenesis of HE, and restoring the homeostasis of intestinal bacteria or providing specific probiotics has significant effects on neurological disorders in HE.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
Review
Gastroenterology & Hepatology
Dominique Thabut, Charlotte Bouzbib, Lucy Meunier, Manon Haas, Nicolas Weiss, Alexandre Louvet, Francois Imbert-Bismut, Fanny Mochel, Yann Nadjar, Antoine Santiago, Thierry Thevenot, Veronique Duhalde, Frederic Oberti, Claire Francoz, Audrey Coilly, Marie-Noelle Hilleret, Pascal Lebray, Amelie Liou-Schischmanoff, Louise Barbier, Christophe Duvoux, Georges-Philippe Pageaux, Michael Bismuth, Damien Galanaud, Thomas De Broucker, Jean-Francois Cadranel, Vincent Leroy, Vincent Di Martino, Dominique Larrey, Christophe Camus, Olivier Scatton, Victor De Ledinghen, Ariane Mallat, Marika Rudler, Christophe Bureau
Summary: Hepatic encephalopathy (HE) is a frequent and severe complication of liver disease that often goes undiagnosed due to a lack of understanding and consensus on diagnosis. Non-specific symptoms and comorbidities in cirrhotic patients make differential diagnosis challenging. Guidelines are provided to assist clinicians in diagnosing and treating HE. Liver transplantation may be indicated for HE, but its reversibility post-transplantation and the consequences in patients with other neurological disorders remain controversial.
LIVER INTERNATIONAL
(2023)
Review
Gastroenterology & Hepatology
Leen Z. Hasan, George Y. Wu
Summary: Hepatic encephalopathy is a devastating complication of chronic liver disease with high mortality rates, and current treatment modalities, while promising, are limited by study design and lack of safety data.Various treatment options targeting gut microbiota, oxidative stress, and neurotransmitter modulation have shown promise but more research is needed to address their limitations.
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
(2021)
Article
Biochemical Research Methods
Katerina Kroupina, Chantal Bemeur, Christopher F. Rose
Summary: Hepatic encephalopathy is a decline in brain function caused by liver insufficiency. The liver's reduced ability to clear ammonia plays a crucial role in the development of hepatic encephalopathy. Cirrhotic patients require high protein intake, but this can increase the accumulation of ammonia, worsening hepatic encephalopathy. Finding a nutritional solution that provides sufficient protein doses without increasing the risk of hepatic encephalopathy is necessary.
ANALYTICAL BIOCHEMISTRY
(2022)
Review
Biochemistry & Molecular Biology
So Yeong Cheon, Juhyun Song
Summary: Hepatic encephalopathy and diabetic encephalopathy are emerging types of neurological diseases characterized by cognitive and motor impairments. The relationship between metabolic organs and the brain plays an important role in the pathogenesis of neurological diseases.
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
(2021)
Article
Physiology
Christoph Siebenmann, Henrik Sorensen, Thomas Christian Bonne, Morten Zaar, Niels Jacob Aachmann-Andersen, Nikolai Baastrup Nordsborg, Henning Bay Nielsen, Niels Henry Secher, Carsten Lundby, Peter Rasmussen
Summary: Exercise facilitates cerebral lactate uptake by increasing arterial lactate concentration and the diffusion gradient across the blood-brain barrier. Although propranolol may reduce cerebral lactate uptake, it is due to the drug-induced reduction in arterial lactate concentration instead of inhibition of a beta-adrenergic mechanism within the brain. This suggests that during exercise, cerebral lactate uptake is primarily driven by the increasing arterial concentration with work rate.
JOURNAL OF APPLIED PHYSIOLOGY
(2021)
Review
Endocrinology & Metabolism
Anne Catrine Daugaard Mikkelsen, Karen Louise Thomsen, Rajeshwar Prosad Mookerjee, Anna Hadjihambi
Summary: Hepatic encephalopathy is a common complication of chronic liver disease, and its pathogenesis is complex, involving peripheral and brain inflammation as well as blood flow abnormalities. Non-invasive assessments of neurophysiological parameters and inflammatory/metabolic pathways can provide insights into these mechanisms and help identify new therapeutic targets and diagnostic markers.
METABOLIC BRAIN DISEASE
(2023)
Article
Gastroenterology & Hepatology
Stefania Gioia, Lorenzo Ridola, Ludovica Cristofaro, Manuela Merli, Jessica Faccioli, Oliviero Riggio, Silvia Nardelli
Summary: This study found that after TIPS procedure, not only muscle mass but also adipose tissue underwent changes. Improvement in subcutaneous adipose tissue, sarcopenia, and myosteatosis were associated with cognitive impairment improvement, independently of liver function. The correlation between adipose tissue and ammonia modification suggests a potential role of adipose tissue in ammonia trafficking between organs.
LIVER INTERNATIONAL
(2021)
Review
Medicine, General & Internal
Daniele Bellafante, Stefania Gioia, Jessica Faccioli, Oliviero Riggio, Lorenzo Ridola, Silvia Nardelli
Summary: Hepatic encephalopathy (HE) is a common complication in advanced liver disease, characterized by neurological and psychiatric symptoms. Malnutrition and portosystemic shunts have recently been identified as new precipitating factors for HE, in addition to known factors such as infections and gastrointestinal bleeding. It is crucial to identify, manage, and correct these factors for effective treatment of HE, along with pharmacological therapy.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Endocrinology & Metabolism
Anne Catrine Daugaard Mikkelsen, Karen Louise Thomsen, Hendrik Vilstrup, Niels Kristian Aagaard
Summary: Patients with cirrhosis are prone to electrolyte disorders, including hypokalaemia, which can lead to an increased risk of hepatic encephalopathy. Hypokalaemia stimulates renal ammonia production and reduces hepatic ammonia elimination, resulting in hyperammonaemia. Furthermore, hypokalaemia facilitates the entrance of ammonia into the central nervous system and increases the amount of gaseous ammonia passing the blood brain barrier. Correcting low potassium levels is crucial in the management of cirrhosis patients to prevent hepatic encephalopathy.
METABOLIC BRAIN DISEASE
(2023)
Article
Biochemistry & Molecular Biology
Hanan A. Ogaly, Rehab F. Abdel-Rahman, Marawan Abd Elbaset Mohamed, O. A. Ahmed-Farid, Marwa S. Khattab, Reham M. Abd-Elsalam
Summary: This study found that thymol has a neuroprotective effect against neurotoxicity and cognitive deterioration caused by hepatic encephalopathy. Thymol supplementation improved liver function, reduced serum ammonia levels, and improved locomotor and cognitive deficits. It modulated oxidative stress, neurotransmitters, and brain ATP levels, and ameliorated histopathological damage, astrocyte swelling, and brain edema. Thymol also downregulated NF-kB and upregulated GFAP expression, and promoted CREB and BDNF expression, as well as increased brain cAMP levels.
Article
Environmental Sciences
Min Jung Kwon, Ashley Ballantyne, Philippe Ciais, Ana Bastos, Frederic Chevallier, Zhihua Liu, Julia K. Green, Chunjing Qiu, John S. Kimball
Summary: In 2020, Siberia experienced an unprecedented heatwave, leading to dynamic changes in seasonal carbon fluxes and a seasonal compensation between CO2 uptake and release. The highly dynamic response of carbon fluxes to extreme temperature anomalies at high latitudes may limit carbon sink capacity in these regions.
ENVIRONMENTAL RESEARCH LETTERS
(2021)
Article
Biochemistry & Molecular Biology
Juliana Camacho-Pereira, Leonardo Osbourne Lai de Souza, Marina Santos Chichierchio, Camila Rodrigues-Chaves, Luiza de Sousa Lomba, Manoel Fonseca-Oliveira, Daniel Carvalho-Mendonca, Thaia Silva-Rodrigues, Antonio Galina
Summary: Aging is a time-related functional decline accompanied by mitochondrial dysfunction. CD38 plays a novel role in brain energy metabolism and aging by regulating hydrogen peroxide generation.
FREE RADICAL BIOLOGY AND MEDICINE
(2023)
Article
Gastroenterology & Hepatology
Koos de Wit, Ulrich Beuers, Anna Mukha, Edwin C. A. Stigter, M. Can Gulersonmez, Jose Ramos M. Pittol, Sabine Middendorp, R. Bart Takkenberg, Saskia W. C. van Mil
Summary: This study investigated the effects of rifaximin on the biotransformation machinery in the small intestine, uncovering its role in promoting ammonia detoxification by increasing glutamine and asparagine concentrations.
LIVER INTERNATIONAL
(2023)
