Plasma and cerebrospinal fluid amino acid patterns in hepatic encephalopathy

Cascino, A.; Cangiano, C.; Fiaccadori, F; Ghinelli, F; Merli, Manuela; Pelosi, Giorgio; Riggio, Oliviero; Fanelli, Filippo Rossi; Sacchini, D.; Stortoni, M.; Capocaccia, L.

doi:10.1007/bf01391377

Cited by 74 publications

(22 citation statements)

References 19 publications

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“…The changes in the plasma and cerebrospinal fluid amino acid pattern after portacaval anastomosis reported here are in accordance with previous reports on plasma aminograms in dogs with PCS [1,13,25] and amino acid changes in CSF following PCS in animals [11,29] and in patients with cirrhosis of the liver [4]. After ammonium acetate infusion into the dogs with PCS the plasma levels of phenylalanine and tyrosine increased, as has been reported in patients with liver cirrhosis after an oral load of ammonium chloride [14].…”

Section: Changes In Plasma and Csf Amino Acid Patternssupporting

confidence: 93%

“…Tryptophan is the precursor of serotonin, an inhibitory neurotransmitter, and is found in high concentrations in CSF during hepatic coma both in patients with liver cirrhosis and in animals with PCS [22,28,29]. It has been assumed that the plasma level of free tryptophan shows a good correlation with the neurologic status of patients with cirrhosis of the liver [4,19].…”

Section: Changes In Plasma and Csf Amino Acid Patternsmentioning

confidence: 99%

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Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

et al. 1985

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To elucidate the possible connection between ammonia-induced changes of plasma and cerebrospinal fluid (CSF) amino acid levels and the development of hepatic encephalopathy in dogs, beagle dogs were given an ammonium acetate infusion both before and following portacaval shunt (PCS). During ammonia-induced coma and after recovery in the dogs prior to PCS the plasma and CSF concentrations of most amino acids were decreased. Following PCS the plasma and CSF concentrations of the aromatic amino acids (AAA), phenylalanine and tyrosine, increased and the levels of the branched chain amino acids (BCAA), valine, leucine, and isoleucine, decreased during ammonia-induced coma. The CSF/plasma molar ratio for the AAA exhibited a marked increase after recovery as compared to the value during coma in the Eck-fistula dogs. With respect to the AAA, no correlation was observed between signs of neurologic impairment in the animals and the following parameters: glutamine and methionine levels of CSF, and the plasma molar ratio (Formula: see text). The data obtained do not support the hypothesis that high concentrations of phenylalanine and tyrosine in the brain may be primarily responsible for altered neurotransmission leading to the development of hepatic encephalopathy.

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Section: Changes In Plasma and Csf Amino Acid Patternssupporting

confidence: 93%

Section: Changes In Plasma and Csf Amino Acid Patternsmentioning

confidence: 99%

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

et al. 1985

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“…The elevation of these aromatic amino acids leads to increased synthesis of 5HT, DA, and NA in the brain (Cascino et al, 1982;Bernardini and Fischer, 1982;Fanelli et al, 1986). This process may play a role in the pathogenesis of HE (Lozeva-Thomas, 2004).…”

Section: Discussionmentioning

confidence: 99%

Behavioral and biochemical characterization of rats treated chronically with thioacetamide: proposal of an animal model for hepatic encephalopathy associated with cirrhosis

et al. 2012

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-Hepatic encephalopathy (HE) is a syndrome observed in patients with liver dysfunction such as hepatitis and cirrhosis, and is characterized by cognitive impairment, personality changes, and a depressed level of consciousness. The detailed mechanism underlying the pathogenesis of HE remains unclear. In the present study, our aim was to establish an animal model for HE with cirrhosis. Therefore, we carried out behavioral and biochemical analysis of cirrhotic rats after treatment with thioacetamide (TAA) for 20 weeks. The rats subjected to chronic TAA treatment (TAA rats) showed reduction of cognitive scores in the novel object recognition test (NOR), and a decrease in immobility and an increase in swimming in the forced swim test (FST). In biochemical analyses, the TAA rats exhibited elevated blood levels of ammonia, and increased metabolic activities of serotonergic and noradrenergic neurons in the brain, while the levels of Glu and GABA were not affected. Post-oral treatment of lactulose, a clinically utilized drug for HE, effectively reduced the elevated blood ammonia levels, and restored the reduced cognitive scores and the decreased immobility, without any effects on neurotransmitter contents in the brain, compared with the control. These results indicated lactulose-restorable memory disturbance and irritated mood in the TAA rats. In other words, rats treated chronically with TAA are a potential model for cirrhosis-HE, and the combination of NOR and FST in TAA rats may be useful as a simple assay system for the screening and development of anti-HE agents.

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“…Abnormal protein and amino acid metabolism are hallmarks of cirrhotic-stage liver disease, caused by a loss of the ability of the liver to regulate the metabolism of both circulating and tissue proteins and amino acids. [28][29][30] Diminished BCAA concentrations have been reported in association with malnutrition in hemodialysis patients. 31 However, we found that in patients with end-stage liver disease, circulating amino acid values are poorly indicative of nutritional status.…”

Section: Discussionmentioning

confidence: 99%

Utility of Standard Nutritional Parameters in Detecting Body Cell Mass Depletion in Patients With End-Stage Liver Disease

Figueiredo

2000

Liver Transplantation

140

101

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Protein-calorie malnutrition, best measured by body cell mass (BCM) depletion, has been associated with adverse outcomes in patients with end-stage liver disease. We prospectively measured BCM and multiple standard nutritional parameters in patients with end-stage liver disease to determine which, if any, of the traditionally measured nutritional parameters correlate with BCM. A detailed nutritional assessment, including BCM analysis, subjective global assessment, anthropometry, handgrip dynamometry, laboratory tests, and body composition measured by dual-energy X-ray absorptiometry was performed in 69 sequential patients awaiting liver transplantation. The frequency of abnormalities of specific parameters of nutritional status varied between 19% and 99%. Most of the commonly measured parameters of nutritional status correlated poorly with BCM. Patients with depleted BCM (lowest quartile for sex) had midarm circumference (P < .01), arm-muscle circumference (P < .001), handgrip strength (P < .001), blood urea nitrogen (P < .01), and creatinine (P < .01) values less than those for patients with greater BCM (highest 3 quartiles for sex). In multivariate analysis, arm-muscle circumference and handgrip strength were the best predictors of BCM. The combined criteria of handgrip strength less than 30 kg and arm-muscle circumference less than 23 cm have a sensitivity of 94% and a negative predictive value of 97% in identifying patients with depleted BCM. Although abnormalities of nutritional parameters are highly prevalent among patients with end-stage liver disease, most parameters of nutritional status do not correlate with BCM. In patients with end-stage liver disease, armmuscle circumference and handgrip strength are the most sensitive markers of BCM depletion. (Liver Transpl 2000; 6:575-581.)

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Plasma and cerebrospinal fluid amino acid patterns in hepatic encephalopathy

Cited by 74 publications

References 19 publications

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

Effect of ammonia on plasma and cerebrospinal fluid amino acids in dogs with and without portacaval anastomoses

Behavioral and biochemical characterization of rats treated chronically with thioacetamide: proposal of an animal model for hepatic encephalopathy associated with cirrhosis

Utility of Standard Nutritional Parameters in Detecting Body Cell Mass Depletion in Patients With End-Stage Liver Disease

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