1
|
Li S, Zhua Y, Liu X. Parkinsonism in liver diseases or dysfunction. Med Clin (Barc) 2024:S0025-7753(24)00356-7. [PMID: 38955605 DOI: 10.1016/j.medcli.2024.04.022] [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: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 07/04/2024]
Abstract
Parkinsonism in liver diseases or dysfunction, mainly including neurological manifestations in hereditary liver diseases and neurological complications of advanced liver diseases, occur in isolation or in combination with other movement disorders, and progress along disease course. Prominent akinetic-rigidity syndrome, various onset and progression, poor levodopa response and metabolism abnormalities reflected by serum biomarkers and neuroimaging, make this atypical parkinsonism recognizable and notable in clinical practice. Different susceptibility of brain areas, especially in basal ganglia, to manganese, iron, copper, ammonia overload, together with subsequent oxidative stress, neurotransmitter alterations, disturbed glia-neuron homeostasis and eventually neurotoxicity, contribute to parkinsonism under the circumstances of insufficient liver clearance ability. These mechanisms are interrelated and may interact collectively, adding to the complexity of clinical manifestations and treatment responses. This review summarizes shared clinical features of parkinsonism in liver diseases or dysfunction, depicts their underlying mechanisms and suggests practical flowchart for differential diagnosis.
Collapse
Affiliation(s)
- Sichen Li
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxia Zhua
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Liu
- Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
2
|
Custodio RJP, Hobloss Z, Myllys M, Hassan R, González D, Reinders J, Bornhorst J, Weishaupt AK, Seddek AL, Abbas T, Friebel A, Hoehme S, Getzmann S, Hengstler JG, van Thriel C, Ghallab A. Cognitive Functions, Neurotransmitter Alterations, and Hippocampal Microstructural Changes in Mice Caused by Feeding on Western Diet. Cells 2023; 12:2331. [PMID: 37759553 PMCID: PMC10529844 DOI: 10.3390/cells12182331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the most common chronic liver disease in Western countries. It is becoming increasingly evident that peripheral organ-centered inflammatory diseases, including liver diseases, are linked with brain dysfunctions. Therefore, this study aims to unravel the effect of MASLD on brain histology, cognitive functions, and neurotransmitters. For this purpose, mice fed for 48 weeks on standard (SD) or Western diet (WD) were evaluated by behavioral tests, followed by sacrifice and analysis of the liver-brain axis including histopathology, immunohistochemistry, and biochemical analyses. Histological analysis of the liver showed features of Metabolic Dysfunction-Associated Steatohepatitis (MASH) in the WD-fed mice including lipid droplet accumulation, inflammation, and fibrosis. This was accompanied by an elevation of transaminase and alkaline phosphatase activities, increase in inflammatory cytokine and bile acid concentrations, as well as altered amino acid concentrations in the blood. Interestingly, compromised blood capillary morphology coupled with astrogliosis and microgliosis were observed in brain hippocampus of the WD mice, indicating neuroinflammation or a disrupted neurovascular unit. Moreover, attention was impaired in WD-fed mice along with the observations of impaired motor activity and balance, enhanced anxiety, and stereotyped head-twitch response (HTR) behaviors. Analysis of neurotransmitters and modulators including dopamine, serotonin, GABA, glutamate, and acetylcholine showed region-specific dysregulation in the brain of the WD-fed mice. In conclusion, the induction of MASH in mice is accompanied by the alteration of cellular morphology and neurotransmitter expression in the brain, associated with compromised cognitive functions.
Collapse
Affiliation(s)
- Raly James Perez Custodio
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Zaynab Hobloss
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Maiju Myllys
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Reham Hassan
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
| | - Daniela González
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Julia Bornhorst
- Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany; (J.B.); (A.-K.W.)
| | - Ann-Kathrin Weishaupt
- Food Chemistry, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany; (J.B.); (A.-K.W.)
| | - Abdel-latif Seddek
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
| | - Tahany Abbas
- Histology Department, Faculty of Medicine, South Valley University, Qena 83523, Egypt;
| | - Adrian Friebel
- Institute of Computer Science & Saxonian Incubator for Clinical Research (SIKT), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany; (A.F.); (S.H.)
| | - Stefan Hoehme
- Institute of Computer Science & Saxonian Incubator for Clinical Research (SIKT), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany; (A.F.); (S.H.)
| | - Stephan Getzmann
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Christoph van Thriel
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
| | - Ahmed Ghallab
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Ardeystrasse 67, 44139 Dortmund, Germany; (R.J.P.C.); (Z.H.); (M.M.); (R.H.); (D.G.); (J.R.); (S.G.)
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena 83523, Egypt;
| |
Collapse
|
3
|
Diesing TS. Neurologic Manifestations of Gastrointestinal and Nutritional Disorders. Continuum (Minneap Minn) 2023; 29:708-733. [PMID: 37341328 DOI: 10.1212/con.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE A tie between nutritional or gastrointestinal and neurologic disease has been recognized for centuries. Many gastrointestinal disorders are associated with neurologic disease through nutritional, immune-mediated, or degenerative pathophysiologies. This article reviews neurologic disorders in patients with gastrointestinal disease and gastrointestinal manifestations in their own neurologic patients. LATEST DEVELOPMENTS Development of new gastric and bariatric surgical procedures and the widespread use of over-the-counter gastric acid-reducing medications continue to create vitamin and nutritional deficiencies despite modern diet and supplementation. Some supplements, such as vitamin A, vitamin B6, and selenium, themselves are now found to cause disease. Recent work has shown extraintestinal and neurologic manifestations of inflammatory bowel disease. Chronic brain damage in liver disease has been recognized, and the opportunity to intervene may exist in the covert beginning stages. The characterization of gluten-related neurologic symptoms and differentiation from those of celiac disease is an evolving body of work. ESSENTIAL POINTS Gastrointestinal and neurologic diseases related to common immune-mediated, degenerative, or infectious mechanisms are common and can coexist in the same patient. Furthermore, gastrointestinal disease may cause neurologic complications because of nutritional inadequacies, malabsorption, and hepatic dysfunction. In many cases, the complications are treatable but have subtle or protean presentations. Therefore, the consulting neurologist must be current in knowledge of the growing ties between gastrointestinal and neurologic disease.
Collapse
|
4
|
Nascimento H, Malaquias MJ, Pinto CM, Sá Silva J, Rochate D, Fraga C, Alves JE, Ramos C, Gandara J, Ferreira S, Lopes V, Cavaco S, Pessegueiro Miranda H, Almeida A, Magalhães M. Trace Element Imbalances in Acquired Hepatocerebral Degeneration and Changes after Liver Transplant. BIOLOGY 2023; 12:804. [PMID: 37372089 DOI: 10.3390/biology12060804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
Brain manganese (Mn) accumulation is a key feature in patients with acquired hepatocerebral degeneration (AHD). The role of trace elements other than Mn in AHD needs to be clarified. In this study, using inductively coupled plasma mass spectrometry, we aimed to evaluate blood levels of trace elements in patients with AHD before and after liver transplantation (LT). Trace element levels in the AHD group were also compared with those of healthy controls (blood donors, n = 51). Fifty-one AHD patients were included in the study (mean age: 59.2 ± 10.6 years; men: 72.5%). AHD patients had higher levels of Mn, Li, B, Ni, As, Sr, Mo, Cd, Sb, Tl and Pb and a higher Cu/Se ratio, and lower levels of Se and Rb. Six patients (two women; mean age 55 ± 8.7 years) underwent LT, and there was an improvement in neurological symptoms, a significant increase in the Zn, Se and Sr levels, and a decrease in the Cu/Zn and Cu/Se ratios. In summary, several trace element imbalances were identified in AHD patients. Liver transplantation resulted in the improvement of neurological manifestations and the oxidant/inflammatory status. It is possible that observed changes in trace element levels may play a role in the pathophysiology and symptomatology of AHD.
Collapse
Affiliation(s)
- Henrique Nascimento
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Maria João Malaquias
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Catarina Mendes Pinto
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - José Sá Silva
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Dina Rochate
- Hematology Service, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - Cristina Fraga
- Hematology Service, Hospital do Divino Espírito Santo, 9500-370 Ponta Delgada, Portugal
| | - José Eduardo Alves
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Cristina Ramos
- Neuroradiology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Judit Gandara
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Sofia Ferreira
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Vítor Lopes
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Sara Cavaco
- Neuropsychology Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Helena Pessegueiro Miranda
- Hepatic Pancreatic Transplantation Unit, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| | - Agostinho Almeida
- Laboratório Associado para a Química Verde (Associated Laboratory for Green Chemistry) of the Network of Chemistry and Technology (LAQV/REQUIMTE), Department of Chemical Sciences, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal
| | - Marina Magalhães
- Neurology Service, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal
| |
Collapse
|
5
|
Canhão B, Trigo A, Madaleno J. Extrapyramidal dysfunction in cirrhosis: Is hepatic encephalopathy the only answer? Eur J Intern Med 2022; 99:99-100. [PMID: 35153122 DOI: 10.1016/j.ejim.2022.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Bernardo Canhão
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - André Trigo
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - João Madaleno
- Internal Medicine Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Liver Transplant Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Portugal
| |
Collapse
|
6
|
Fu J, Gao Y, Shi L. Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis. PLoS One 2022; 17:e0267647. [PMID: 35471992 PMCID: PMC9041837 DOI: 10.1371/journal.pone.0267647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Rifaximin and lactulose are widely used in patients with hepatic encephalopathy (HE); however, data on whether the combined use of rifaximin and lactulose could yield additional benefits for patients with HE are limited and inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the treatment effectiveness of rifaximin plus lactulose versus lactulose alone in patients with HE. Electronic databases (PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure) were searched for eligible RCTs from their inception until November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to calculate pooled effect estimates for the treatment effectiveness of rifaximin plus lactulose versus lactulose alone by using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. We included 7 RCTs enrolling 843 patients with HE. We noted that the use of rifaximin plus lactulose was associated with an increased incidence of effective rate than lactulose alone (RR, 1.30; 95% CI, 1.10–1.53; P = 0.002). Moreover, the use of rifaximin plus lactulose was associated with a reduced risk of mortality as compared with lactulose alone (RR, 0.57; 95% CI, 0.41–0.80; P = 0.001). This study found that the use of rifaximin in combination with lactulose could provide additional benefits in terms of increased effective rate and decreased mortality than lactulose alone in patients with HE.
Collapse
Affiliation(s)
- Jian Fu
- Department of Infection, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
- * E-mail:
| | - Yi Gao
- Department of Infection, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Li Shi
- Department of Infection, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| |
Collapse
|
7
|
Liang X, Wen L, Wu Y, Hao Y, Wang S, Hu X. Retention enema with traditional Chinese medicine for hepatic encephalopathy: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22517. [PMID: 33019454 PMCID: PMC7535768 DOI: 10.1097/md.0000000000022517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Hepatic encephalopathy (HE) is one of the common complications of many serious liver diseases. Western medicine treatment is mainly symptomatic treatment such as neutralizing blood ammonia and protecting liver, which has poor curative effect, easy repetition and high mortality. Retention enema with traditional Chinese medicine (TCM) has been used on treatment of HE in China for many years. And it has been clinically proved that retention enema with TCM is effective and safe. But there is absent convincing evidence-based medicine to confirm the efficacy of retention enema with TCM for HE. Thus, we aimed to conduct this meta-analysis to summarize the efficacy of retention enema with TCM in patients with HE. METHODS The study only selects clinical randomized controlled trials of retention enema with TCM for HE. We will search each database from the built-in until December 31, 2020. The English literature mainly searches Cochrane Library, Pubmed, EMBASE, and Web of Science. While the Chinese literature comes from CNKI, CBM, VIP, and Wanfang database. Meanwhile, we will retrieve clinical trial registries and gray literature. Two researchers worked independently on literature selection, data extraction and quality assessment. The dichotomous data is represented by relative risk (RR), and the continuous is expressed by mean difference (MD) or standard mean difference (SMD), eventually the data is synthesized using a fixed effect model (FEM) or a random effect model (REM) depending on the heterogeneity. The total effective rate, blood ammonia and the total bilirubin were evaluated as the main outcomes. While several secondary outcomes were also evaluated in this study. The statistical analysis of this Meta-analysis was conducted by RevMan software version 5.3. RESULTS This study will synthesize and provide high-quality evidence based on the data of the currently published retention enema with TCM for the treatment of HE. CONCLUSION This meta-analysis aims to evaluate the benefits of retention enema with TCM for the treatment of HE reported in randomized controlled trials, and provide more options for clinicians and patients with HE. REGISTRATION NUMBER INPLASY202080107.
Collapse
Affiliation(s)
- Xiao Liang
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine
- National Integrative Medicine Clinical Base for Infectious Diseases, Chengdu 610072
| | - Lihong Wen
- Emergency Department, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072
| | - Yifang Wu
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine
- National Integrative Medicine Clinical Base for Infectious Diseases, Chengdu 610072
| | - Yanmin Hao
- Intensive Care Unit, Anyang District Hospital, Anyang 455000, PR China
| | - Shaobo Wang
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine
- National Integrative Medicine Clinical Base for Infectious Diseases, Chengdu 610072
| | - Xiaoyu Hu
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine
- National Integrative Medicine Clinical Base for Infectious Diseases, Chengdu 610072
| |
Collapse
|