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.
Highlights
Encephalopathies are a group of diseases affecting the brain that are manifested through a wide gamut of etiologies and symptomatology
Studies have indicated that the gamma amino-butyric acid (GABA)-receptor complex may contribute to neuronal inhibition in Hepatic encephalopathy (HE) [24,26]
Vogels et al [94] demonstrated that the L-ornithine (ORN) and L-ornithine-L-aspartate (OA) therapeutic treatment had beneficial effects on the symptomatology of rats with hyperammonemia-induced encephalopathy by portacaval shunt (PCS)
Summary
Encephalopathies are a group of diseases affecting the brain that are manifested through a wide gamut of etiologies and symptomatology. Hepatic encephalopathy (portosystemic 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. In the presence of chronic liver disease, HE is a sign of decompensation, while in fulminant liver failure represents a worrying sign and usually indicates that transplantation is required [2] The mechanisms causing this brain dysfunction are still largely unclear [3,4]. The technique of microdialysis consists of sample recollection using semi-permeable membranes in order to evaluate chemical substances (endogenous neurotransmitters or exogenous such as drugs), in extracellular spaces from different tissues This is used to determine the neurochemical abnormalities induced by the encephalopathies, and to determine the therapeutic effect of various drugs in the treatment of this pathologic condition. In this review we will discuss the contributions of microdialysis in the understanding of the physiological alterations that underlie hepatic encephalopathy in the human and experimental models and studies to find alternative therapies for this disease
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