2015
DOI: 10.1007/s11011-015-9740-7
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What we know: the inflammatory basis of hepatic encephalopathy

Abstract: Central Nervous System (CNS) degeneration appearing in patients with cirrhosis is responsible for cognitive and persistent motor impairments that lead to an important impact on life quality. Brain injury affects certain areas of the CNS that might affect two types of cells: neurons and astrocytes. The process leading to brain injury could be induced by portosystemic shunting accompanied by hyperammonemia and by the activation of peripheral inflammation, manifested as episodic encephalopathy. Hyperammonemia com… Show more

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Cited by 11 publications
(9 citation statements)
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“…About two-thirds of the gut microbiota is unique to each individual, being composed of more than a thousand species of bacteria, although less than 170 commensals predominate, such as Bacteroides and Firmicutes [14]. Some studies have shown that the composition of the intestinal microbiota affects the severity of hepatic encephalopathy by modulating its toxicological profile [15].…”
Section: The Role Of Intestinal Microbiota and Enterocytesmentioning
confidence: 99%
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“…About two-thirds of the gut microbiota is unique to each individual, being composed of more than a thousand species of bacteria, although less than 170 commensals predominate, such as Bacteroides and Firmicutes [14]. Some studies have shown that the composition of the intestinal microbiota affects the severity of hepatic encephalopathy by modulating its toxicological profile [15].…”
Section: The Role Of Intestinal Microbiota and Enterocytesmentioning
confidence: 99%
“…Given its location and abundant vascular supply, with immense exposure to antigens absorbed by the intestine, the liver regulates important immune functions [9]. In cirrhosis, intestinal bacterial overgrowth associated with hepatocellular failure triggers a systemic immune reaction, bypassing endotoxins such as membrane lipopolysaccharides, flagellins, and peptidoglycans for arterial circulation [15,22]. Circulating cytokines, such as tumor necrosis factor alpha (TNFα), interleukin 1b (IL-1b) and interleukin 6, induce the synthesis of nitric oxide and prostanoids in endothelial cells, triggering a state of inflammatory hyperemia that facilitates the uptake of ammonia by the central nervous system [9].…”
Section: The Role Of Hepatocytes and Endothelial Cellsmentioning
confidence: 99%
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“…This may in turn lead to microglia activation and local production of pro-inflammatory cytokines (i.e., TNF-a, IL-1B and IL-6), a phenomenon referred to as 'neuroinflammation' [78]. This has especially been shown in advanced stages of HE in ALF, while the degree of neuroinflammation in CLD seems less pronounced and relies on the characteristic of the precipitating factor [82]. Multiple studies have shown that neuroinflammation can lead to neuronal cell death [83,84].…”
Section: The Systemic Inflammation Hypothesismentioning
confidence: 99%