John W. Schoggins, Ph.D. “
“Encephalopathy and brain edema are serious central nervous system complications of liver failure. Recent studies using molecular probes and antibodies to cell-specific marker proteins have demonstrated Nutlin-3 the activation of microglial cells in the brain during liver failure and confirmed a central neuroinflammatory response. In animal models of ischemic or toxic liver injury, microglial activation and concomitantly increased expression of genes coding for proinflammatory cytokines in the brain occur early in the progression of encephalopathy and brain edema. Moreover, the prevention of these complications with mild hypothermia or N-acetylcysteine
(two treatments known to manifest both peripheral and central cytoprotective properties) averts central neuroinflammation due to liver failure. Recent studies using anti-inflammatory agents such as ibuprofen and indomethacin have shown promise for the treatment of mild encephalopathy in patients with cirrhosis, whereas treatment with minocycline, a potent inhibitor of microglial activation, attenuates the encephalopathy grade and prevents brain edema in
experimental acute liver failure. The precise nature of the signaling mechanisms between the failing liver and central neuroinflammation has yet to be fully elucidated; mechanisms involving blood-brain cytokine transfer PCI-32765 research buy and receptor-mediated cytokine signal transduction as well as a role for liver-related toxic metabolites such as ammonia have been proposed. The prevention of central proinflammatory processes will undoubtedly herald a new chapter in the development of agents for the prevention and
treatment MCE公司 of the central nervous system complications of liver failure. (HEPATOLOGY 2011;) Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of both acute liver failure (ALF) and chronic liver failure with the potential to affect heath-related quality of life, clinical management strategies, liver transplant priority, and patient survival. The neuropathological features of HE primarily include changes in the morphology and function of cells of the glial (rather than neuronal) lineage and have led to the suggestion that HE is a primary gliopathy. In particular, morphological changes in astroglial cells are characteristic of HE. Such changes include cell swelling, a characteristic cell phenotype known as Alzheimer type II astrocytosis, and concomitant alterations in the expression of genes coding for a wide range of astrocytic proteins with key roles in the control of cellular energy status, cell volume regulation, and neurotransmission.1 The causes of these alterations of astroglial integrity have generally been attributed to the toxic effects of ammonia. However, in recent years, attention has increasingly been focused on the role of proinflammatory mechanisms.