Modulation of soluble guanylate cyclase (sGC) by nitric oxide (NO) is altered in brain from experimental animals with hyperammonemia with or without liver failure. The aim of this work was to assess the content and modulation of sGC in brain in chronic liver failure in humans. Expression of the ␣-1, ␣-2, and -1 subunits of sGC was measured by immunoblotting in autopsied frontal cortex and cerebellum from cirrhotic patients and controls. The contents of ␣-1 and ␣-2 subunits of guanylate cyclase was increased both in cortex and cerebellum, whereas the -1 subunit was not affected. Addition of the NO-generating agent S-nitroso-N-acetyl-penicillamine (SNAP) to homogenates of frontal cortex from controls increased the activity of sGC 87-fold, whereas, in homogenates from cirrhotic patients, the increase was significantly higher (183-fold). In contrast, in cerebellum, activation of guanylate cyclase by NO was significantly lower in patients (156-fold) than in controls (248-fold). A similar regional difference was found in rats with portacaval anastomosis. In conclusion, these findings show that the NO-guanylate cyclase signal transduction pathway is strongly altered in brain in patients with chronic liver failure and that the effects are different in different brain areas. Given that activation of sGC by NO in brain is involved in the modulation of important cerebral processes such as intercellular communication, learning and memory, and the sleep-wake cycle, these changes could be implicated in the pathogenesis of hepatic encephalopathy in these patients. (HEPATOLOGY 2002;36:1155-1162 T he pathophysiologic mechanisms responsible for hepatic encephalopathy (HE) in chronic liver failure are incompletely understood. However, disruption of neurotransmitter systems has increasingly been implicated. In particular, selective alterations of glutamatergic and monoaminergic receptor sites have been reported in both experimental animal models of HE 1,2 and the brains of human cirrhotic patients. 3,4 Many of these receptors are functionally coupled to the nitric oxide (NO) cyclic guanosine monophosphate (cGMP) signal transduction pathway, which serves to amplify the postsynaptic response to receptor activation.Previous studies provide evidence for a role for this signal transduction pathway in the mediation of important cerebral functions, including regulation of the sleepwake cycle and some components of learning and memory, abnormalities of which form part of the spectrum of neuropsychiatric symptoms, which characterize HE in chronic liver failure. Furthermore, recent studies in experimental chronic liver failure reveal significant alterations in expression of key components of this signal transduction pathway. Such evidence includes increased expression and activities of neuronal nitric oxide synthase (nNOS) 5 and of the ␣ subunit of soluble guanylate cyclase (sGC). 6 The purpose of the present study was, therefore, to evaluate the NO-cGMP signal transduction pathway in relation to human HE. To accomplish this, the content o...