Characterization of Oxidative Stress and Ammonia According to the Different Grades of Hepatic Encephalopathy

Daniel Hector Montes-Cortes, Ivonne M. Olivares-Corichi, José Vicente Rosas-Barrientos, Leticia Manuel-Apolinar, María De Los Angeles Martìnez-Godinez, Juan Carlos Hernández-López, Maria Del Pilar Cruz-Dominguez

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    2 Scopus citations

    Abstract

    Background: Hepatic encephalopathy (HE) in patients with chronic liver disease (CLD) is one of the main causes of reentry to the emergency department. Oxidative stress (OxS) regulated by ammonia leads to cerebral edema and astrocytes senescence in animal models, but seems to be different in humans. Objective: To analyze if OxS and ammonia in plasma are related to each other in the different grades of HE-CLD and to compare them with healthy volunteers (HV). Methods: In a cross-sectional study, we included 60 subjects in 2 groups: (a) 30 HV and (b) 30 HE patients. Plasma levels of oxidation lipids/proteins, ammonia, and West-Haven score were evaluated. Student t test, Spearman's correlation, and ANOVA with Dunn's post hoc test were performed. Results: Ammonia in HV and HE patients was 39-49 vs. 95-345 μmol/L, respectively (p < 0.0001). Malondialdehyde (MDA) in HV was 6.58 ± 3.11 compared to 16.69 ± 6.19 μmol/L in HE (p < 0.0001). Protein oxidation by osazone (carbonyls), formazan, and dityrosines was higher in HE than in HV (p < 0.0001). Ammonia level was directly associated to HE severity, but without correlation with lipid MDA or protein OxS formazan, carbonyls, and dityrosines. Lipid peroxidation showed higher levels at degree 2 and protein oxidation at degree 3 of HE. Conclusions: We confirm that OxS accompanies hyperammonemia in HE; however they contribute in different proportions to their natural progression. Early reduction of OxS in HE could contribute to minimize the neurotoxicity into CLD.

    Original languageEnglish
    Pages (from-to)240-250
    Number of pages11
    JournalDigestive Diseases
    Volume38
    Issue number3
    DOIs
    StateAccepted/In press - 1 Jan 2019

    Keywords

    • Ammonia
    • Chronic liver disease
    • Hepatic encephalopathy
    • Lipid peroxidation
    • Protein oxidation

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