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Sarin Zacharia G, Jacob A. Ammonia in liver diseases: A glimpse into the controversies and consensus. Arab J Gastroenterol 2024:S1687-1979(24)00078-9. [PMID: 39294031 DOI: 10.1016/j.ajg.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/20/2024] [Accepted: 07/26/2024] [Indexed: 09/20/2024]
Abstract
Ammonia is a byproduct of the metabolism of nitrogen-containing micro and macromolecules. The key source of bodily ammonia in humans is the small intestine, from diet, luminal bacterial activity, and deamination of glutamine in enterocytes. It is disposed of from the system, mainly in the liver, through the urea cycle. Physiologically, ammonia plays a minor role in acid-base homeostasis. It is the critical molecule implicated in the pathogenesis of hepatic encephalopathy. Liver disease is the most common cause of hyperammonemia, while others include urea cycle defects, infections, and drugs. The diagnostic utility of ammonia in liver diseases has met with increasing skepticism but holds good in urea cycle defects. Additionally, the accuracy of ammonia assay depends on a myriad of patient and technical factors, making the test unreliable if not performed meticulously. Most scientific societies currently fall short of recommending ammonia for diagnostic purposes in chronic liver disease. Despite this fact, ammonia continues to be one of the most frequently requested assays in patients with suspected hepatic encephalopathy, contributing to significant non-productive health expenditure. However, ammonia level does have a prognostic role in liver diseases, especially in acute liver failure. Ammonia-lowering strategies are the cornerstone of the management of hepatic encephalopathy. These strategies include medications that attenuate ammoniagenesis and ammonia scavengers. This review examines the role of ammonia in hepatic encephalopathy, its diagnostic and prognostic implications in liver diseases, challenges associated with ammonia assay, and current therapeutic strategies for ammonia-lowering in clinical practice.
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Zhang X, Li J, Jiang L, Deng Y, Wei L, Li X. Serum Cytokeratin-18 levels as a prognostic biomarker in advanced liver disease: a comprehensive meta-analysis. Clin Exp Med 2024; 24:160. [PMID: 39023658 PMCID: PMC11258177 DOI: 10.1007/s10238-024-01423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
Cytokeratin-18 (CK-18) is a marker of hepatic cell death. Serum CK-18 could serve as a prognostic marker for patients with advanced liver disease (ALD). This meta-analysis aims to explore the association between total CK-18 (M65) and caspase-cleaved CK-18 (M30) levels with the prognosis of ALD patients. Relevant longitudinal observational studies were identified through comprehensive searches of the Medline, Web of Science, and Embase databases. A random-effects model was utilized to synthesize the findings, accommodating heterogeneity among studies. The analysis included 14 datasets from 11 studies. Elevated serum CK-18 levels at admission were linked to a higher risk of death or liver transplantation during follow-up. This association was consistent for both M65 (risk ratio [RR] 1.99, 95% confidence interval [CI] 1.65 to 2.40, p < 0.001; I2 = 43%) and M30 (RR 1.94, 95% CI 1.57 to 2.40, p < 0.001; I2 = 46%). Subgroup analysis revealed that the relationship between serum M65 levels and adverse outcomes was attenuated in studies using multivariate analysis compared to those using univariate analysis (RR 1.78 vs. 2.80, p for subgroup difference = 0.03). Further subgroup analyses indicated that the prognostic significance of CK-18 for ALD patients was not significantly influenced by study design, methods of determining CK-18 cutoff values, or follow-up durations. Elevated serum CK-18 levels at admission indicate a poor prognosis in patients with ALD. This finding holds for both M65 and M30.
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Affiliation(s)
- Xin Zhang
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha City, Hunan Province, 410006, People's Republic of China
| | - Jiangguo Li
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha City, Hunan Province, 410006, People's Republic of China
| | - Li Jiang
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha City, Hunan Province, 410006, People's Republic of China
| | - Yuexia Deng
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha City, Hunan Province, 410006, People's Republic of China
| | - Licheng Wei
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha City, Hunan Province, 410006, People's Republic of China
| | - Xing Li
- Department of Critical Care Medicine, Changsha Hospital of Traditional Chinese Medicine (Changsha No. 8 Hospital), 22 Xingsha Avenue, Changsha City, Hunan Province, 410100, People's Republic of China.
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Liu Q, Ba X, Han L, Yan J, Chen Z, Qin K, Tu S, Shen P. Dahuang-Wumei decoction protects against hepatic encephalopathy in mice: Behavioural, biochemical, and molecular evidence. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 128:155419. [PMID: 38522314 DOI: 10.1016/j.phymed.2024.155419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Disturbance of the blood‒brain barrier (BBB) and associated inflammatory responses are observed in patients with hepatic encephalopathy (HE) and can cause long-term complications. Dahuang-Wumei decoction (DWD) is a renowned traditional Chinese herbal medicine with a long history of clinical use and has been widely employed as an effective treatment for hepatic encephalopathy (HE). Despite its established efficacy, the precise mechanisms underlying the therapeutic effects of DWD have not been fully elucidated. PURPOSE The present study aimed to comprehensively explore the potential effects and underlying molecular mechanisms of DWD on HE through an integrated investigation that included both in vivo and in vitro experiments. METHODS In the present study, carbon tetrachloride (CCl4) and thioacetamide (TAA) were used to establish an HE model in mice. The therapeutic effects of DWD on liver injury, fibrosis, brain injury, behaviour, and consciousness disorders were evaluated in vivo. C8-D1A and bEnd.3 cells were used to construct a BBB model in vitro. The effects of DWD on proinflammatory factor expression, BBB damage and the Wnt/β-catenin pathway were detected in vivo and in vitro. RESULTS Our results showed that DWD can improve liver injury and fibrosis and brain damage and inhibit neurofunctional and behavioural disorders in mice with HE. Afterwards, we found that DWD decreased the levels of proinflammatory factors and suppressed BBB disruption by increasing the levels of junction proteins in vivo and vitro. Further studies verified that the Wnt/β-catenin pathway may play a pivotal role in mediating the inhibitory effect of DWD on HE. CONCLUSION These results demonstrated that DWD can treat HE by preventing BBB disruption, and the underlying mechanisms involved were associated with the activation of the Wnt/β-catenin pathway and the inhibition of inflammatory responses.
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Affiliation(s)
- Qiong Liu
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Xin Ba
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Liang Han
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Jiahui Yan
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Zhe Chen
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Kai Qin
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Shenghao Tu
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China
| | - Pan Shen
- Department of Integrated Chinese Traditional and Western Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030, China; Department of Rheumatology and Immunology, Zhongnan Hospital, Wuhan University, China.
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Colalillo EA, Rogu PJ, Wierzbicki J. Recurrent Mental Status Changes in a Patient With Chronic Alcoholic Cirrhosis Taking Diuretics: A Case Report. Cureus 2023; 15:e48221. [PMID: 38050499 PMCID: PMC10693899 DOI: 10.7759/cureus.48221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Cirrhosis of the liver, characterized by fibrous tissue replacing normal cells, disrupts physiological function and blood circulation. A further consequence of this is hepatic encephalopathy (HE), a neuropsychiatric syndrome that can range in severity from mild cognitive disturbances to full coma. This case follows the course of a 63-year-old Caucasian female with chronic liver cirrhosis who presents with recurrent episodes of mental status changes. Although each episode was treated with first-line pharmacologic interventions of lactulose, her HE recurrence persisted. This case report underscores the significance of early diagnosis and management, emphasizing the role of alcohol cessation, pharmacotherapy, and lifestyle adjustments. It also aims to address the delicate balance of diuretic use, focusing on dosage adjustments to address electrolyte imbalances and minimize risks associated with HE. The findings highlight the complexity of managing alcoholic liver disease and offer insights into tailored approaches for optimizing patient outcomes.
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Affiliation(s)
- Emily A Colalillo
- Medicine, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, USA
| | - Peter J Rogu
- Medicine, New York Institute of Technology (NYIT) College of Osteopathic Medicine, Old Westbury, USA
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Mínguez B, Lledó-Navarro JL. Foreword. Clin Drug Investig 2022; 42:1-2. [PMID: 35532834 PMCID: PMC9205797 DOI: 10.1007/s40261-022-01148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Beatriz Mínguez
- Liver Unit, University Hospital Vall d'Hebron, Barcelona, Spain.
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