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Sepehrinezhad A, Stolze Larsen F, Ashayeri Ahmadabad R, Shahbazi A, Sahab Negah S. The Glymphatic System May Play a Vital Role in the Pathogenesis of Hepatic Encephalopathy: A Narrative Review. Cells 2023; 12:cells12070979. [PMID: 37048052 PMCID: PMC10093707 DOI: 10.3390/cells12070979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Hepatic encephalopathy (HE) is a neurological complication of liver disease resulting in cognitive, psychiatric, and motor symptoms. Although hyperammonemia is a key factor in the pathogenesis of HE, several other factors have recently been discovered. Among these, the impairment of a highly organized perivascular network known as the glymphatic pathway seems to be involved in the progression of some neurological complications due to the accumulation of misfolded proteins and waste substances in the brain interstitial fluids (ISF). The glymphatic system plays an important role in the clearance of brain metabolic derivatives and prevents aggregation of neurotoxic agents in the brain ISF. Impairment of it will result in aggravated accumulation of neurotoxic agents in the brain ISF. This could also be the case in patients with liver failure complicated by HE. Indeed, accumulation of some metabolic by-products and agents such as ammonia, glutamine, glutamate, and aromatic amino acids has been reported in the human brain ISF using microdialysis technique is attributed to worsening of HE and correlates with brain edema. Furthermore, it has been reported that the glymphatic system is impaired in the olfactory bulb, prefrontal cortex, and hippocampus in an experimental model of HE. In this review, we discuss different factors that may affect the function of the glymphatic pathways and how these changes may be involved in HE.
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Affiliation(s)
- Ali Sepehrinezhad
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad 9919191778, Iran
| | - Fin Stolze Larsen
- Department of Gastroenterology and Hepatology, Rigshospitalet, Copenhagen University Hospital, 999017 Copenhagen, Denmark
| | | | - Ali Shahbazi
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran 1449614535, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Sajad Sahab Negah
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad 9919191778, Iran
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran 1449614535, Iran
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Chen X, Bai M, Sun S, Chen X. Severe postoperative hyperbilirubinemia in congenital heart disease. Open Med (Wars) 2021; 16:1276-1285. [PMID: 34541326 PMCID: PMC8409460 DOI: 10.1515/med-2021-0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/09/2021] [Accepted: 06/05/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of our present study was to explore the characteristics and outcomes of congenital heart disease (CHD) patients with severe postoperative hyperbilirubinemia. METHODS All patients who underwent cardiopulmonary bypass surgical treatment for CHD and had severe postoperative hyperbilirubinemia (total bilirubin [TB] ≥85.5 μmol/L) in our center between January 2015 and December 2018 were retrospectively screened. Univariate and multivariate analyses were employed to identify risk factors for the study endpoints, including postoperative acute kidney injury (AKI), in-hospital mortality, and long-term mortality. RESULTS After screening, 86 patients were included in our present study. In-hospital mortality was 10.9%. Fifty-one (59.3%) patients experienced AKI, and four (4.7%) patients received continuous renal replacement therapy. Multivariate analysis identified that the peak TB concentration (P = 0.002) and duration of mechanical ventilation (P = 0.008) were independent risk factors for in-hospital mortality, and stage 3 AKI was an independent risk factor for long-term mortality. The optimal cutoff value for peak TB concentration was 125.9 μmol/L. Patients with a postoperative TB level ≥125.9 μmol/L had worse long-term survival. CONCLUSION Hyperbilirubinemia was a common complication after CHD surgery. CHD patients with severe postoperative hyperbilirubinemia ≥125.9 μmol/L and AKI had a higher risk of mortality.
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Affiliation(s)
- Xiaolan Chen
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi, China
| | - Xiangmei Chen
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi, China
- Department of Nephrology, State Key Laboratory of Kidney Disease, Chinese People’s Liberation Army General Hospital and Military Medical Postgraduate College, 28th Fuxing Road, Beijing 100853, China
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Su G, Wang H, Bai J, Chen G, Pei Y. A Metabonomics Approach to Drug Toxicology in Liver Disease and its Application in Traditional Chinese Medicine. Curr Drug Metab 2019; 20:292-300. [PMID: 30599107 DOI: 10.2174/1389200220666181231124439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The progression of liver disease causes metabolic transformation in vivo and thus affects corresponding endogenous small molecular compounds. Metabonomics is a powerful technology which is able to assess global low-molecular-weight endogenous metabolites in a biological system. This review is intended to provide an overview of a metabonomics approach to the drug toxicology of diseases of the liver. METHODS The regulation of, and relationship between, endogenous metabolites and diseases of the liver is discussed in detail. Furthermore, the metabolic pathways involved in drug interventions of liver diseases are reviewed. Evaluation of the protective mechanisms of traditional Chinese medicine in liver diseases using metabonomics is also reviewed. Examples of applications of metabolite profiling concerning biomarker discovery are highlighted. In addition, new developments and future prospects are described. RESULTS Metabonomics can measure changes in metabolism relating to different stages of liver disease, so metabolic differences can provide a basis for the diagnosis, treatment and prognosis of various diseases. CONCLUSION Metabonomics has great advantages in all aspects of the therapy of liver diseases, with good prospects for clinical application.
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Affiliation(s)
- Guangyue Su
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Haifeng Wang
- Department of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Jiao Bai
- Department of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Gang Chen
- Department of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
| | - Yuehu Pei
- Department of Traditional Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, China
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García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade? Ann Intensive Care 2018; 8:109. [PMID: 30443736 PMCID: PMC6238018 DOI: 10.1186/s13613-018-0453-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Abstract
The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.
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Affiliation(s)
- Juan José García Martínez
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
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Wei W, Huang XH, Liang D, Zeng YY, Ma C, Wu YB, Li YT, Zhang X, Zeng JH, Liu JF. A proteomic analysis of transplanted liver in a rat model of chronic rejection. Clin Res Hepatol Gastroenterol 2015; 39:340-50. [PMID: 25468549 DOI: 10.1016/j.clinre.2014.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/29/2014] [Accepted: 10/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic rejection (CR) is an important cause of liver allograft failure. In the latter condition, re-transplantation of the liver (ReLT) is the only option for survival. Unfortunately, with the current state of knowledge, it is difficult to diagnose and treat early CR. OBJECTIVE To explore the biomarkers of the chronic rejection in orthotopic liver transplantation (OLT). METHODS A rat model of chronic liver allograft rejection was established, and the differential protein expression in chronic allograft rejection (CR) was analyzed by iTRAQ-MALDI-TOF/TOF. RESULTS Expression of sixty-two proteins was found to be significantly changed in CR rats. In the present study, CLU, Lcn2 and Krt19 were identified and quantified as early and reliable biomarkers for chronic rejection. CONCLUSION Analysis of differential protein expression by iTRAQ-MALDI-TOF/TOF is a potentially effective method to help understand the mechanism of CR in orthotopic liver transplantation. The proteins CLU, Lcn2 and Krt19 might be potential prognostic markers for predicting chronic rejection after liver transplantation.
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Affiliation(s)
- Wei Wei
- The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xin-Hui Huang
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Dong Liang
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yong-Yi Zeng
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chuang Ma
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yan-Bin Wu
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yun-Tong Li
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiang Zhang
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jin-Hua Zeng
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jing-Feng Liu
- Liver Disease Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
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Contributions of microdialysis to new alternative therapeutics for hepatic encephalopathy. Int J Mol Sci 2013; 14:16184-206. [PMID: 23921686 PMCID: PMC3759906 DOI: 10.3390/ijms140816184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 02/07/2023] Open
Abstract
Hepatic encephalopathy (HE) is a common complication of cirrhosis, of largely reversible impairment of brain function occurring in patients with acute or chronic liver failure or when the liver is bypassed by portosystemic shunts. The mechanisms causing this brain dysfunction are still largely unclear. The need to avoid complications caused by late diagnosis has attracted interest to understand the mechanisms underlying neuronal damage in order to find markers that will allow timely diagnosis and to propose new therapeutic alternatives to improve the care of patients. One of the experimental approaches to study HE is microdialysis; this technique allows evaluation of different chemical substances in several organs through the recollection of samples in specific places by semi-permeable membranes. In this review we will discuss the contributions of microdialysis in the understanding of the physiological alterations in human hepatic encephalopathy and experimental models and the studies to find novel alternative therapies for this disease.
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Prazak J, Laszikova E, Pantoflicek T, Ryska O, Koblihova E, Ryska M. Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs. BMC Gastroenterol 2013; 13:98. [PMID: 23758689 PMCID: PMC3691596 DOI: 10.1186/1471-230x-13-98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cerebral edema is a well-recognized and potentially fatal complication of acute liver failure (ALF). The effectiveness of treatments that address intracranial hypertension is generally assessed by measuring intracranial pressure (ICP). The aim of this study was to determine the role of cerebral microdialysis in monitoring the efficacy of fractionated plasma separation and adsorption (FPSA) treatment for ALF. We hypothesized that in ALF cerebral microdialysis reflects the benefits of FPSA treatment on cerebral edema before ICP. METHODS A surgical resection model of ALF was used in 21 pigs. We measured plasma ammonia concentration, brain concentrations of glucose, lactate, pyruvate, glutamate and glutamine, and ICP. Animals were randomized into three groups: in one group eight animals received 6 hours of FPSA treatment 2 hours after induction of ALF; in another group 10 animals received supportive treatment for ALF only; and in the final group three underwent sham surgery. RESULTS The ICP was significantly higher in the ALF group than in the FPSA group 9 hours after surgery. The lactate/pyruvate (L/P) ratio was significantly lower in the FPSA group than the ALF group 5 hours after surgery, before any significant difference in ICP was detected. Indeed, significant changes in the L/P ratio could be observed within 1 hour of treatment. Glutamine levels were significantly lower in the FPSA group than the ALF group between 6 hours and 10 hours after surgery. CONCLUSIONS Brain lactate/pyruvate ratio and concentration of glutamine measured by cerebral microdialysis reflected the beneficial effects of FPSA treatment on cerebral metabolism more precisely and rapidly than ICP in pigs with fulminant ALF. The role of glutamine as a marker of the efficacy of FPSA treatment for ALF appears promising, but needs further evaluation.
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Affiliation(s)
- Josef Prazak
- Department of Anaesthesiology and Intensive Care, University Hospital, Basel, Switzerland.
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Bjerring PN, Larsen FS. Changes in cerebral oxidative metabolism in patients with acute liver failure. Metab Brain Dis 2013; 28:179-82. [PMID: 23099996 DOI: 10.1007/s11011-012-9346-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Acute liver failure patients with a persistence of hyperammonemia are at an increased risk of intracranial hypertension due to development of brain oedema. In vitro studies of brain tissue and cell cultures that indicates that exposure to ammonium inhibits enzymatic activity in the tricarboxylic acid cycle, induces substrate depletion through marked glutamate utilization for glutamine synthesis and leads to mitochondrial dysfunction. In patients with acute liver failure cerebral microdialysis studies show a linear correlation between the lactate to pyruvate ratio and the glutamine concentration, as well as to some of the adenosine triphosphate degradation products. However, clinical observations of cerebral exchange rates of oxygen, glucose, lactate and amino acids challenge the interpretation of these findings. In this review the conflicting data of cerebral metabolism during acute liver failure is discussed.
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Affiliation(s)
- P N Bjerring
- Department of Hepatology, Rigshospitalet, Copenhagen, Denmark.
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