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Wei JD, Xu X. Oxidative stress in Wernicke's encephalopathy. Front Aging Neurosci 2023; 15:1150878. [PMID: 37261263 PMCID: PMC10229051 DOI: 10.3389/fnagi.2023.1150878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Wernicke's encephalopathy (WE) is a severe life-threatening disease that occurs due to vitamin B1 (thiamine) deficiency (TD). It is characterized by acute mental disorder, ataxia, and ophthalmoplegia. TD occurs because of the following reasons: insufficient intake, increased demand, and long-term drinking due to corresponding organ damage or failure. Recent studies showed that oxidative stress (OS) can damage organs and cause TD in the brain, which further leads to neurodegenerative diseases, such as WE. In this review, we discuss the effects of TD caused by OS on multiple organ systems, including the liver, intestines, and brain in WE. We believe that strengthening the human antioxidant system and reducing TD can effectively treat WE.
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Affiliation(s)
- Jun-Dong Wei
- Department of Basic Medical Science, Medical College, Taizhou University, Taizhou, China
| | - Xueming Xu
- Department of Psychiatry, Taizhou Second People's Hospital, Taizhou, China
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Hong S, Li S, Meng X, Li P, Wang X, Su M, Liu X, Liu L. Bile duct ligation differently regulates protein expressions of organic cation transporters in intestine, liver and kidney of rats through activation of farnesoid X receptor by cholate and bilirubin. Acta Pharm Sin B 2023; 13:227-245. [PMID: 36815051 PMCID: PMC9939304 DOI: 10.1016/j.apsb.2022.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Body is equipped with organic cation transporters (OCTs). These OCTs mediate drug transport and are also involved in some disease process. We aimed to investigate whether liver failure alters intestinal, hepatic and renal Oct expressions using bile duct ligation (BDL) rats. Pharmacokinetic analysis demonstrates that BDL decreases plasma metformin exposure, associated with decreased intestinal absorption and increased urinary excretion. Western blot shows that BDL significantly downregulates intestinal Oct2 and hepatic Oct1 but upregulates renal and hepatic Oct2. In vitro cell experiments show that chenodeoxycholic acid (CDCA), bilirubin and farnesoid X receptor (FXR) agonist GW4064 increase OCT2/Oct2 but decrease OCT1/Oct1, which are remarkably attenuated by glycine-β-muricholic acid and silencing FXR. Significantly lowered intestinal CDCA and increased plasma bilirubin levels contribute to different Octs regulation by BDL, which are confirmed using CDCA-treated and bilirubin-treated rats. A disease-based physiologically based pharmacokinetic model characterizing intestinal, hepatic and renal Octs was successfully developed to predict metformin pharmacokinetics in rats. In conclusion, BDL remarkably downregulates expressions of intestinal Oct2 and hepatic Oct1 protein while upregulates expressions of renal and hepatic Oct2 protein in rats, finally, decreasing plasma exposure and impairing hypoglycemic effects of metformin. BDL differently regulates Oct expressions via Fxr activation by CDCA and bilirubin.
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Affiliation(s)
- Shijin Hong
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China
| | - Shuai Li
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China
| | - Xiaoyan Meng
- Tianjin Institutes of Pharmaceutical Research, Tianjin 300301, China
| | - Ping Li
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China
| | - Xun Wang
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China
| | - Mengxiang Su
- Departments of Pharmaceutical Analysis, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China
| | - Xiaodong Liu
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China,Corresponding author. Tel./fax: +86 25 83271060.
| | - Li Liu
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, China Pharmaceutical University, Nanjing 210098, China,Corresponding author. Tel./fax: +86 25 83271060.
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Metabolic and Cellular Compartments of Acetyl-CoA in the Healthy and Diseased Brain. Int J Mol Sci 2022; 23:ijms231710073. [PMID: 36077475 PMCID: PMC9456256 DOI: 10.3390/ijms231710073] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
The human brain is characterised by the most diverse morphological, metabolic and functional structure among all body tissues. This is due to the existence of diverse neurons secreting various neurotransmitters and mutually modulating their own activity through thousands of pre- and postsynaptic interconnections in each neuron. Astroglial, microglial and oligodendroglial cells and neurons reciprocally regulate the metabolism of key energy substrates, thereby exerting several neuroprotective, neurotoxic and regulatory effects on neuronal viability and neurotransmitter functions. Maintenance of the pool of mitochondrial acetyl-CoA derived from glycolytic glucose metabolism is a key factor for neuronal survival. Thus, acetyl-CoA is regarded as a direct energy precursor through the TCA cycle and respiratory chain, thereby affecting brain cell viability. It is also used for hundreds of acetylation reactions, including N-acetyl aspartate synthesis in neuronal mitochondria, acetylcholine synthesis in cholinergic neurons, as well as divergent acetylations of several proteins, peptides, histones and low-molecular-weight species in all cellular compartments. Therefore, acetyl-CoA should be considered as the central point of metabolism maintaining equilibrium between anabolic and catabolic pathways in the brain. This review presents data supporting this thesis.
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Ding LM, Deng LS, Qian JJ, Liu G, Zhou L, Zheng SS. Clinical analysis of Wernicke encephalopathy after liver transplantation. Hepatobiliary Pancreat Dis Int 2022:S1499-3872(22)00181-3. [PMID: 35909062 DOI: 10.1016/j.hbpd.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Wernicke encephalopathy (WE) is an acute neurological disease resulting from vitamin B1 deficiency, and there are only very few case reports of WE after liver transplantation. The present study aimed to investigate the clinical characteristics, etiology, magnetic resonance imaging (MRI) features, treatment and prognosis of patients with WE after liver transplantation. METHODS Twenty-three patients with WE after liver transplantation from the First Affiliated Hospital, Zhejiang University School of Medicine and Jiangxi Provincial People's Hospital between January 2011 and December 2021 were retrospectively analyzed. RESULTS Among the 23 patients diagnosed with WE after liver transplantation, 6 (26%) had a classic triad of impaired consciousness, oculomotor palsy and ataxia, 17 (74%) had two features. The misdiagnosis rate was 65%. After treatment with high-dose vitamin B1, 19 (83%) patients showed improvement, whereas 4 showed no improvement, including 3 with residual short-term memory impairments and 1 with residual spatial and temporal disorientation and ataxia. CONCLUSIONS The misdiagnosis rate is high in the early stage of WE, and the prognosis is closely associated with whether WE is diagnosed early and treated timely. High-dose glucose or glucocorticoids can trigger WE and cannot be administered before vitamin B1 treatment. Vitamin B1 is suggested to be used as a prophylactic treatment for patients with WE after liver transplantation.
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Affiliation(s)
- Li-Min Ding
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, Chinese Academy of Medical Sciences, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, Hangzhou 310003, China
| | - Li-Shan Deng
- Culture and Sports Center for the Disabled of Jiangxi Province, Nanchang 330000, China
| | - Jun-Jie Qian
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, Chinese Academy of Medical Sciences, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, Hangzhou 310003, China
| | - Gang Liu
- Department of Transplantation, Jiangxi Provincial People's Hospital, Nanchang 330000, China
| | - Lin Zhou
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, Chinese Academy of Medical Sciences, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, Chinese Academy of Medical Sciences, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou 310003, China.
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Panchani NN, Colvin T, Aryan M, Shoreibah MG. Nutritional Deficiencies and Clinical Practices in Decompensated Cirrhotics With Hepatic Encephalopathy. Cureus 2022; 14:e25352. [PMID: 35761919 PMCID: PMC9233434 DOI: 10.7759/cureus.25352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hepatic encephalopathy (HE), a major complication of end-stage cirrhosis, is often associated with nutritional deficiencies. We aimed to assess the frequency in which vitamins and zinc were tested for and deficient in our cirrhotic population with HE. Methods We performed a retrospective chart review of 143 patients with decompensated cirrhosis that were seen in a hepatology clinic from January 2020 to May 2021. Patient demographics and decompensations were recorded. Vitamins and minerals that were evaluated included zinc, vitamin B12, folate, vitamin D, and thiamine. Continuous variables were reported as mean ± standard deviation and categorical variables were calculated as frequency percentages. Results Out of 143 patients, 73 were found to have HE. Out of 73, 33 were male, and the average MELD was 15.5 ± 6.3. 44% of patients had NASH cirrhosis, and 30% had alcoholic cirrhosis. Of the minority of patients that had their nutrient levels checked, 17/23 (74%) were deficient in zinc (<60 mcg/dL). 75% of patients were deficient in thiamine. 2/34 (6%) were deficient in folate (<5.9 ng/mL), 2/10 (20%) in vitamin D (<20 ng/mL), and 2/47 (4%) in B12 (<300 pg/mL). Conclusion Nutritional deficiencies are common in cirrhotics with HE. Further studies are needed to determine if routine testing and treatment for vitamin and Zinc deficiencies would have a positive impact on the clinical trajectory of HE.
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Lin S, Guo Z, Chen S, Lin X, Ye M, Qiu Y. Progressive Brain Structural Impairment Assessed via Network and Causal Analysis in Patients With Hepatitis B Virus-Related Cirrhosis. Front Neurol 2022; 13:849571. [PMID: 35599731 PMCID: PMC9120530 DOI: 10.3389/fneur.2022.849571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives This research amid to elucidate the disease stage-specific spatial patterns and the probable sequences of gray matter (GM) deterioration as well as the causal relationship among structural network components in hepatitis B virus-related cirrhosis (HBV-RC) patients. Methods Totally 30 HBV-RC patients and 38 healthy controls (HC) were recruited for this study. High-resolution T1-weighted magnetic resonance imaging and psychometric hepatic encephalopathy score (PHES) were evaluated in all participants. Voxel-based morphometry (VBM), structural covariance network (SCN), and causal SCN (CaSCN) were applied to identify the disease stage-specific GM abnormalities in morphology and network, as well as their causal relationship. Results Compared to HC (0.443 ± 0.073 cm3), the thalamus swelled significantly in the no minimal hepatic encephalopathy (NMHE) stage (0.607 ± 0.154 cm3, p <0.05, corrected) and further progressed and expanded to the bilateral basal ganglia, the cortices, and the cerebellum in the MHE stage (p < 0.05, corrected). Furthermore, the thalamus swelling had a causal effect on other parts of cortex-basal ganglia-thalamus circuits (p < 0.05, corrected), which was negatively correlated with cognitive performance (r = −0.422, p < 0.05). Moreover, the thalamus-related SCN also displayed progressive deterioration as the disease advanced in HBV-RC patients (p < 0.05, corrected). Conclusion Progressive deterioration of GM morphology and SCN exists in HBV-RC patients during advanced disease, displaying thalamus-related causal effects. These findings indicate that bilateral thalamus morphology as well as the thalamus-related network may serve as an in vivo biomarker for monitoring the progression of the disease in HBV-RC patients.
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Affiliation(s)
- Shiwei Lin
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zheng Guo
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shengli Chen
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xiaoshan Lin
- Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory of Precision Medicine for Hematological Malignancies, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Shenzhen, China
| | - Min Ye
- Department of Geriatrics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Geriatrics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Min Ye
| | - Yingwei Qiu
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Yingwei Qiu
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Novo-Veleiro I, Herrera-Flores J, Rosón-Hernández B, Medina-García JA, Muga R, Fernández-Solá J, Martín-González MC, Seco-Hernández E, Suárez-Cuervo C, Mateos-Díaz AM, Monte-Secades R, Machado-Prieto B, Puerta-Louro R, Prada-González C, Fernández-Rial Á, Sabio-Repiso P, Vázquez-Vigo R, Antolí-Royo AC, Gomila-Grange A, Felipe-Pérez NC, Sanvisens-Bergé A, Antúnez-Jorge E, Fernández-Rodríguez CM, Alvela-Suárez L, Fidalgo-Navarro A, Castro J, Polvorosa-Gómez MA, Del Valle-Sánchez M, López-Castro J, Chamorro AJ, Marcos M. Alcoholic Liver Disease Among Patients with Wernicke Encephalopathy: A Multicenter Observational Study. Drug Alcohol Depend 2022; 230:109186. [PMID: 34864357 DOI: 10.1016/j.drugalcdep.2021.109186] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND data regarding the association between Wernicke encephalopathy (WE) and alcoholic liver disease (ALD) are scarce in spite of alcohol consumption being the main risk factor for WE. AIMS to describe the frequency of ALD in a cohort of patients diagnosed with WE and alcohol use disorders (AUDs) and to compare the characteristics of WE patients with and without ALD. METHODS we conducted an observational study in 21 centers through a nationwide registry of the Spanish Society of Internal Medicine. WE Caine criteria were applied and demographic, clinical, and outcome variables were analyzed. RESULTS 434 patients were included in the study, of which 372 were men (85.7%), and the mean age was 55 ± 11.8 years. ALD was present in 162 (37.3%) patients and we found a higher percentage of cases with tremor, flapping and hallucinations in the ALD group. A total of 22 patients (5.0%) died during admission (7.4% with ALD vs 3.7% without ALD; P = 0.087). Among the ALD patients, a relationship between mortality and the presence of anemia (Odds ratio [OR]=4.6 Confidence interval [CI]95% 1.1-18.8; P = 0.034), low level of consciousness (OR=4.9 CI95% 1.1-21.2; P = 0.031) and previous diagnosis of cancer (OR=10.3 CI95% 1.8-59.5; P = 0.009) was detected. Complete recovery was achieved by 27 patients with ALD (17.8%) and 71 (27.8%) without ALD (P = 0.030). CONCLUSION the association of WE and ALD in patients with AUDs is frequent and potentially linked to differences in clinical presentation and to poorer prognosis, as compared to alcoholic patients with WE without ALD.
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Affiliation(s)
- Ignacio Novo-Veleiro
- Department of Internal Medicine, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Herrera-Flores
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | | | | | - Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Elena Seco-Hernández
- Department of Internal Medicine, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Ana-M Mateos-Díaz
- Department of Internal Medicine, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
| | - Rafael Monte-Secades
- Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Begoña Machado-Prieto
- Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Álvaro Fernández-Rial
- Department of Internal Medicine, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | | | - Rocío Vázquez-Vigo
- Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Ana-C Antolí-Royo
- Department of Internal Medicine, Complejo Asistencial de Ávila, Ávila, Spain
| | - Aina Gomila-Grange
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Arantza Sanvisens-Bergé
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Lucía Alvela-Suárez
- Department of Internal Medicine, HM Rosaleda Hospital, Santiago de Compostela, A Coruña, Spain
| | | | - Joaquín Castro
- Hospital Santa Bárbara, Puerto Llano, Ciudad-Real, Spain
| | | | | | | | - Antonio-J Chamorro
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain
| | - Miguel Marcos
- Department of Internal Medicine, Hospital Universitario de Salamanca-IBSAL, University of Salamanca, Salamanca, Spain.
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Kim SE, Park JW, Kim HS, Jang MK, Suk KT, Kim DJ. The Role of Gut Dysbiosis in Acute-on-Chronic Liver Failure. Int J Mol Sci 2021; 22:ijms222111680. [PMID: 34769109 PMCID: PMC8584227 DOI: 10.3390/ijms222111680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
Acute-on-chronic liver failure (ACLF) is an important syndrome of liver failure that has a high risk of short-term mortality in patients with chronic liver disease. The development of ACLF is associated with proinflammatory precipitating events, such as infection, alcoholic hepatitis, and intense systemic inflammation. Recently, the role of the gut microbiome has increasingly emerged in human health and disease. Additionally, the gut microbiome might have a major role in the development of liver disease. In this review, we examine evidence to support the role of gut dysbiosis in cirrhosis and ACLF. Additionally, we explore the mechanism by which the gut microbiome contributes to the development of ACLF, with a focus on alcohol-induced liver disease.
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Affiliation(s)
- Sung-Eun Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Ji Won Park
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Hyung Su Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Myoung-Kuk Jang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (S.-E.K.); (J.W.P.); (H.S.K.); (M.-K.J.); (K.T.S.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
- Correspondence: ; Tel.: +82–33–240–5646
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Watanabe Y, Mawatari A, Aita K, Sato Y, Wada Y, Nakaoka T, Onoe K, Yamano E, Akamatsu G, Ohnishi A, Shimizu K, Sasaki M, Doi H, Senda M. PET imaging of 11C-labeled thiamine tetrahydrofurfuryl disulfide, vitamin B 1 derivative: First-in-human study. Biochem Biophys Res Commun 2021; 555:7-12. [PMID: 33812058 DOI: 10.1016/j.bbrc.2021.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Abstract
Vitamine B1 thiamine is an essential component for glucose metabolism and energy production. The disulfide derivative, thiamine tetrahydrofurfuryl disulfide (TTFD), is more absorbent compared to readily-available water-soluble thiamine salts since it does not require the rate-limiting transport system required for thiamine absorption. However, the detailed pharmacokinetics of thiamine and TTFD under normal and pathological conditions were not clarified yet. Recently, 11C-labeled thiamine and TTFD were synthesized by our group, and their pharmacokinetics were investigated by PET imaging in normal rats. In this study, to clarify the whole body pharmacokinetics of [11C]TTFD in human healthy volunteers, we performed first-in-human PET imaging study with [11C]TTFD, along with radiation dosimetry of [11C]TTFD in humans. METHODS Synthesis of [11C]TTFD was improved for clinical study. Dynamic whole-body PET images were acquired on three young male normal subjects after intravenous injection of [11C]TTFD. VOIs were defined for source organs on the PET images to measure time-course of [11C]TTFD uptake as percentage injected dose and the number of disintegrations for each organ. Radiation dosimetry was calculated with OLINDA/EXM. RESULTS We succeeded in developing the improved synthetic method of [11C]TTFD for the first-in-human PET study. In the whole body imaging, uptake of [11C]TTFD by various tissues was almost plateaued at 10 min after intravenous injection, afterward gradually increased for the brain and urinary bladder (urine). %Injected dose was high in the liver, kidney, urinary bladder, heart, spine, brain, spleen, pancreas, stomach, and salivary glands, in this order. %Injected dose per gram of tissue was high also in the pituitary. By dosimetry, the effective radiation dose of [11C]TTFD calculated was 5.5 μSv/MBq (range 5.2-5.7). CONCLUSION Novel synthetic method enabled clinical PET study with [11C]TTFD, which is a safe PET tracer with a dosimetry profile comparable to other common 11C-PET tracers. Pharmacokinetics of TTFD in the pharmacological dose and at different nutritional states could be further investigated by future quantitative PET studies. Noninvasive in vivo PET imaging for pathophysiology of thiamine-related function may provide diagnostic evidence of novel information about vitamin B1 deficiency in human tissues.
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Affiliation(s)
- Yasuyoshi Watanabe
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan; RIKEN Compass to Healthy Life Research Complex Program, Kobe, Hyogo, Japan.
| | - Aya Mawatari
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Kazuki Aita
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yuzuru Sato
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Yasuhiro Wada
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | | | - Kayo Onoe
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Emi Yamano
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan; RIKEN Compass to Healthy Life Research Complex Program, Kobe, Hyogo, Japan
| | - Go Akamatsu
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Akihito Ohnishi
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Keiji Shimizu
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Masahiro Sasaki
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Hisashi Doi
- RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Michio Senda
- Division of Molecular Imaging, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Gut Microbiota at the Intersection of Alcohol, Brain, and the Liver. J Clin Med 2021; 10:jcm10030541. [PMID: 33540624 PMCID: PMC7867253 DOI: 10.3390/jcm10030541] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
Over the last decade, increased research into the cognizance of the gut-liver-brain axis in medicine has yielded powerful evidence suggesting a strong association between alcoholic liver diseases (ALD) and the brain, including hepatic encephalopathy or other similar brain disorders. In the gut-brain axis, chronic, alcohol-drinking-induced, low-grade systemic inflammation is suggested to be the main pathophysiology of cognitive dysfunctions in patients with ALD. However, the role of gut microbiota and its metabolites have remained unclear. Eubiosis of the gut microbiome is crucial as dysbiosis between autochthonous bacteria and pathobionts leads to intestinal insult, liver injury, and neuroinflammation. Restoring dysbiosis using modulating factors such as alcohol abstinence, promoting commensal bacterial abundance, maintaining short-chain fatty acids in the gut, or vagus nerve stimulation could be beneficial in alleviating disease progression. In this review, we summarize the pathogenic mechanisms linked with the gut-liver-brain axis in the development and progression of brain disorders associated with ALD in both experimental models and humans. Further, we discuss the therapeutic potential and future research directions as they relate to the gut-liver-brain axis.
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Bordia T, Zahr NM. The Inferior Colliculus in Alcoholism and Beyond. Front Syst Neurosci 2020; 14:606345. [PMID: 33362482 PMCID: PMC7759542 DOI: 10.3389/fnsys.2020.606345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 12/28/2022] Open
Abstract
Post-mortem neuropathological and in vivo neuroimaging methods have demonstrated the vulnerability of the inferior colliculus to the sequelae of thiamine deficiency as occurs in Wernicke-Korsakoff Syndrome (WKS). A rich literature in animal models ranging from mice to monkeys-including our neuroimaging studies in rats-has shown involvement of the inferior colliculi in the neural response to thiamine depletion, frequently accomplished with pyrithiamine, an inhibitor of thiamine metabolism. In uncomplicated alcoholism (i.e., absent diagnosable neurological concomitants), the literature citing involvement of the inferior colliculus is scarce, has nearly all been accomplished in preclinical models, and is predominately discussed in the context of ethanol withdrawal. Our recent work using novel, voxel-based analysis of structural Magnetic Resonance Imaging (MRI) has demonstrated significant, persistent shrinkage of the inferior colliculus using acute and chronic ethanol exposure paradigms in two strains of rats. We speculate that these consistent findings should be considered from the perspective of the inferior colliculi having a relatively high CNS metabolic rate. As such, they are especially vulnerable to hypoxic injury and may be provide a common anatomical link among a variety of disparate insults. An argument will be made that the inferior colliculi have functions, possibly related to auditory gating, necessary for awareness of the external environment. Multimodal imaging including diffusion methods to provide more accurate in vivo visualization and quantification of the inferior colliculi may clarify the roles of brain stem nuclei such as the inferior colliculi in alcoholism and other neuropathologies marked by altered metabolism.
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Affiliation(s)
- Tanuja Bordia
- Neuroscience Program, SRI International, Menlo Park, CA, United States
| | - Natalie M. Zahr
- Neuroscience Program, SRI International, Menlo Park, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Abstract
Wernicke’s encephalopathy is caused by thiamine deficiency and has a
range of presenting features, including gait disturbance, altered
cognitive state, nystagmus and other eye movement disorders. In the
past, Wernicke’s encephalopathy was described almost exclusively in
the alcohol-dependent population. However, in current times,
Wernicke’s encephalopathy is also well recognized in many other
patient groups, including patients following bariatric surgery,
gastrointestinal surgery, cancer and pancreatitis. Early recognition
of Wernicke’s encephalopathy is vital, as prompt treatment can restore
cognitive or ocular function and can prevent permanent disability.
Unfortunately, Wernicke’s encephalopathy is often undiagnosed –
presumably because it is relatively uncommon and has a variable
clinical presentation. Clinical biochemists have a unique role in
advising clinicians about potential nutritional or metabolic causes of
unexplained neurological symptoms and to prompt consideration of
thiamine deficiency as a potential cause in high-risk patient groups.
The aim of this review is to summarize the clinical features,
diagnosis and treatment of Wernicke’s encephalopathy and to highlight
some non-traditional causes, such as after bariatric surgery.
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Affiliation(s)
- Sara Kohnke
- Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Claire L Meek
- Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.,Department of Clinical Biochemistry, North West Anglia NHS Foundation Trust, Peterborough City Hospital, Peterborough, UK.,Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
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13
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Liotta EM, Kimberly WT. Cerebral edema and liver disease: Classic perspectives and contemporary hypotheses on mechanism. Neurosci Lett 2020; 721:134818. [PMID: 32035166 DOI: 10.1016/j.neulet.2020.134818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/01/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Liver disease is a growing public health concern. Hepatic encephalopathy, the syndrome of brain dysfunction secondary to liver disease, is a frequent complication of both acute and chronic liver disease and cerebral edema (CE) is a key feature. While altered ammonia metabolism is a key contributor to hepatic encephalopathy and CE in liver disease, there is a growing appreciation that additional mechanisms contribute to CE. In this review we will begin by presenting three classic perspectives that form a foundation for a discussion of CE in liver disease: 1) CE is unique to acute liver failure, 2) CE in liver disease is only cytotoxic, and 3) CE in liver disease is primarily an osmotically mediated consequence of ammonia and glutamine metabolism. We will present each classic perspective along with more recent observations that call in to question that classic perspective. After highlighting these areas of debate, we will explore the leading contemporary mechanisms hypothesized to contribute to CE during liver disease.
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Affiliation(s)
- Eric M Liotta
- Northwestern University-Feinberg School of Medicine, Department of Neurology, United States; Northwestern University-Feinberg School of Medicine, Department of Surgery, Division of Organ Transplantation, United States; Northwestern University Transplant Outcomes Research Collaboration, United States.
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14
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Medeiros RDCN, Moraes JO, Rodrigues SDC, Pereira LM, Aguiar HQDS, de Cordova CAS, Yim Júnior A, de Cordova FM. Thiamine Deficiency Modulates p38 MAPK and Heme Oxygenase-1 in Mouse Brain: Association with Early Tissue and Behavioral Changes. Neurochem Res 2020; 45:940-955. [PMID: 31989470 DOI: 10.1007/s11064-020-02975-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/11/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
Thiamine deficiency (TD) produces severe neurodegenerative lesions. Studies have suggested that primary neurodegenerative events are associated with both oxidative stress and inflammation. Very little is known about the downstream effects on intracellular signaling pathways involved in neuronal death. The primary aim of this work was to evaluate the modulation of p38MAPK and the expression of heme oxygenase 1 (HO-1) in the central nervous system (CNS). Behavioral, metabolic, and morphological parameters were assessed. Mice were separated into six groups: control (Cont), TD with pyrithiamine (Ptd), TD with pyrithiamine and Trolox (Ptd + Tr), TD with pyrithiamine and dimethyl sulfoxide (Ptd + Dmso), Trolox (Tr) and DMSO (Dmso) control groups and treated for 9 days. Control groups received standard feed (AIN-93M), while TD groups received thiamine deficient feed (AIN-93DT). All the groups were subjected to behavioral tests, and CNS samples were collected for cell viability, histopathology and western blot analyses. The Ptd group showed a reduction in weight gain and feed intake, as well as a reduction in locomotor, grooming, and motor coordination activities. Also, Ptd group showed a robust increase in p38MAPK phosphorylation and mild HO-1 expression in the cerebral cortex and thalamus. The Ptd group showed a decreased cell viability, hemorrhage, spongiosis, and astrocytic swelling in the thalamus. Groups treated with Trolox and DMSO displayed diminished p38MAPK phosphorylation in both the structures, as well as attenuated thalamic lesions and behavioral activities. These data suggest that p38MAPK and HO-1 are involved in the TD-induced neurodegeneration in vivo, possibly modulated by oxidative stress and neuroinflammation.
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Affiliation(s)
- Rita de Cássia Noronha Medeiros
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Juliana Oliveira Moraes
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | | | - Leidiano Martins Pereira
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Helen Quézia da Silva Aguiar
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | | | - Alberto Yim Júnior
- Curso de Medicina Veterinária, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil
| | - Fabiano Mendes de Cordova
- Programa de Pós-Graduação em Sanidade Animal e Saúde Pública nos Trópicos, Universidade Federal do Tocantins, BR-153, km 112, Araguaína, TO, 77804-970, Brazil.
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15
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Kujur A, D′souza N, Rajeswari D. Understanding the role of serum lactate as an end point in burn resuscitation. INDIAN JOURNAL OF BURNS 2020. [DOI: 10.4103/ijb.ijb_1_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Harder AM, Willoughby JR, Ardren WR, Christie MR. Among-family variation in survival and gene expression uncovers adaptive genetic variation in a threatened fish. Mol Ecol 2019; 29:1035-1049. [PMID: 31837181 DOI: 10.1111/mec.15334] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/29/2022]
Abstract
Variation in among-family transcriptional responses to different environmental conditions can help to identify adaptive genetic variation, even prior to a selective event. Coupling differential gene expression with formal survival analyses allows for the disentanglement of treatment effects, required for understanding how individuals plastically respond to environmental stressors, from the adaptive genetic variation responsible for differential survival. We combined these two approaches to investigate responses to an emerging conservation issue, thiamine (vitamin B1 ) deficiency, in a threatened population of Atlantic salmon (Salmo salar). Thiamine is an essential vitamin that is increasingly limited in many ecosystems. In Lake Champlain, Atlantic salmon cannot acquire thiamine in sufficient quantities to support natural reproduction; fertilized eggs must be reared in hatcheries and treated with supplemental thiamine. We evaluated transcriptional responses (via RNA sequencing) to thiamine treatment across families and found 3,616 genes differentially expressed between control (no supplemental thiamine) and treatment individuals. Fewer genes changed expression equally across families (i.e., additively) than exhibited genotype × environment interactions in response to thiamine. Differentially expressed genes were related to known physiological effects of thiamine deficiency, including oxidative stress, cardiovascular irregularities and neurological abnormalities. We also identified 1,446 putatively adaptive genes that were strongly associated with among-family survival in the absence of thiamine treatment, many of which related to neurogenesis and visual perception. Our results highlight the utility of coupling RNA sequencing with formal survival analyses to identify candidate genes that underlie the among-family variation in survival required for an adaptive response to natural selection.
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Affiliation(s)
- Avril M Harder
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Janna R Willoughby
- Department of Forestry and Natural Resources, Purdue University, West Lafayette, IN, USA.,School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL, USA
| | | | - Mark R Christie
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.,Department of Forestry and Natural Resources, Purdue University, West Lafayette, IN, USA
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17
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Coulbault L, Ritz L, Vabret F, Lannuzel C, Boudehent C, Nowoczyn M, Beaunieux H, Pitel AL. Thiamine and phosphate esters concentrations in whole blood and serum of patients with alcohol use disorder: a relation with cognitive deficits. Nutr Neurosci 2019; 24:530-541. [PMID: 31419185 DOI: 10.1080/1028415x.2019.1652438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In this study, we investigated (1) the effect of chronic and excessive alcohol consumption on whole blood (WB) and serum concentrations of thiamine and its metabolites after supplementation, and (2) the relationship between the perturbations of thiamine metabolism and neuropsychological abilities.Methods: WB and serum samples were collected in patients with Alcohol Use Disorder (AUD) and in healthy control subjects (after oral thiamine supplementation, or without supplementation). Thiamine (Th), thiamine monophosphate (TMP) and thiamine diphosphate (TDP) were quantified. The Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI) and the Montreal Cognitive Assessment (MoCA) were performed by each AUD participant. Based on the BEARNI score, two groups of AUD patients were studied: AUD patients with no or mild cognitive impairment (AUD COG+), and AUD patients with moderate-to-severe cognitive impairment (AUD COG-).Results: In WB, Th concentrations were significantly higher, and percentages of phosphate esters of thiamine were significantly lower in AUD COG- patients compared to controls. In serum, Th concentrations were significantly higher in AUD COG- patients compared to controls. The percentage of Th in serum was significantly higher in AUD COG- patients compared to AUD COG+ patients, and to the groups of controls. When adjusted on education level, the percentage of Th in serum in AUD patients negatively correlated with the scores at BEARNI and MoCA, and Th concentration in serum negatively correlated with MoCA.Conclusions: These data support an impairment of metabolism and/or distribution of thiamine in AUD patients, and a relationship with the development of alcohol-related cognitive deficits.
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Affiliation(s)
- Laurent Coulbault
- Service de Biochimie, Centre Hospitalier Universitaire de Caen, Caen, France.,Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Ludivine Ritz
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - François Vabret
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Coralie Lannuzel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Céline Boudehent
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Marie Nowoczyn
- Service de Biochimie, Centre Hospitalier Universitaire de Caen, Caen, France.,Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Caen, France
| | - Hélène Beaunieux
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Anne Lise Pitel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
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Abstract
Alcoholic liver disease, which ranges from mild disease to alcoholic hepatitis and cirrhosis, is a leading cause of morbidity and mortality worldwide. Alcohol intake can lead to changes in gut microbiota composition, even before liver disease development. These alterations worsen with advancing disease and could be complicit in disease progression. Microbial function, especially related to bile acid metabolism, can modulate alcohol-associated injury even in the presence of cirrhosis and alcoholic hepatitis. Microbiota changes might also alter brain function, and the gut-brain axis might be a potential target to reduce alcoholic relapse risk. Gut microbiota manipulation including probiotics, faecal microbial transplant and antibiotics has been studied in alcoholic liver disease with varying success. Further investigation of the modulation of the gut-liver axis is relevant, as most of these patients are not candidates for liver transplantation. This Review focuses on clinical studies involving the gut microbiota in patients with alcoholic liver disease across the spectrum from alcoholic fatty liver to cirrhosis and alcoholic hepatitis. Specific alterations in the gut-liver-brain axis that are complicit in the interactions between the gut microbiota and alcohol addiction are also reviewed.
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20
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Weissenborn K. Minimal/Covert Hepatic Encephalopathy - Impact of Comorbid Conditions. J Clin Exp Hepatol 2019; 9:109-111. [PMID: 30765943 PMCID: PMC6363959 DOI: 10.1016/j.jceh.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022] Open
Abstract
Mild cognitive dysfunction as in minimal or covert hepatic encephalopathy (HE) can be found in a variety of metabolic disturbances, several neurological diseases, and even older age. Because liver cirrhosis usually is accompanied by one or the other of these, a differentiation between HE and cognitive decline because of comorbidities is difficult. Somehow discriminating is the impairment of motor speed and accuracy, which is more prominent in HE than in any of the comorbidities. The observation that, for example, diabetes mellitus, renal dysfunction, infections, or hyponatremia as well as older age increase the risk of developing HE indicates the interaction between these factors and liver dysfunction in the development of HE and the necessity to adjust the therapy accordingly.
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Affiliation(s)
- Karin Weissenborn
- Address for correspondence: Karin Weissenborn, Clinic for Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Tel.: +49 511 532 2339; fax: +49 511 532 3115.
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Moraes JO, Rodrigues SDC, Pereira LM, Medeiros RDCN, de Cordova CAS, de Cordova FM. Amprolium exposure alters mice behavior and metabolism in vivo. Animal Model Exp Med 2018; 1:272-281. [PMID: 30891577 PMCID: PMC6388078 DOI: 10.1002/ame2.12040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Thiamine deficiency (TD) models have been developed, mainly using the thiamine analog pyrithiamine. Other analogs have not been used in rodents. We aimed to evaluate the effects and mechanisms of intraperitoneal (ip) amprolium-induced TD in mice. We also evaluated the associated pathogenesis using antioxidant and anti-inflammatory compounds (Trolox, dimethyl sulfoxide). METHODS Male mice were separated into two groups, one receiving a standard diet (control animals), and the other a TD diet (deficient groups) for 20 days. Control mice were further subdivided into three groups receiving daily ip injections of saline (NaCl 0.9%; Cont group), Tolox (Tr group) or dimethyl sulfoxide (DMSO; Dmso group). The three TD groups received amprolium (Amp group), amprolium and Trolox (Amp+Tr group), or amprolium and DMSO (Amp+Dmso group). The animals were subjected to behavioral tests and then euthanized. The brain and viscera were analyzed. RESULTS Amprolium exposure induced weight loss with hyporexia, reduced the behavioral parameters (locomotion, exploratory activity, and motor coordination), and induced changes in the brain (lower cortical cell viability) and liver (steatosis). Trolox co-treatment partially improved these conditions, but to a lesser extent than DMSO. CONCLUSIONS Amprolium-induced TD may be an interesting model, allowing the deficiency to develop more slowly and to a lesser extent. Amprolium exposure also seems to involve oxidative stress and inflammation, suggested as the main mechanisms of cell dysfunction in TD.
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Affiliation(s)
- Juliana Oliveira Moraes
- Programa de Pós‐Graduação em Sanidade Animal e Saúde Pública nos TrópicosUniversidade Federal do TocantinsAraguaínaTOBrazil
| | | | | | | | | | - Fabiano Mendes de Cordova
- Programa de Pós‐Graduação em Sanidade Animal e Saúde Pública nos TrópicosUniversidade Federal do TocantinsAraguaínaTOBrazil
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22
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Ronowska A, Szutowicz A, Bielarczyk H, Gul-Hinc S, Klimaszewska-Łata J, Dyś A, Zyśk M, Jankowska-Kulawy A. The Regulatory Effects of Acetyl-CoA Distribution in the Healthy and Diseased Brain. Front Cell Neurosci 2018; 12:169. [PMID: 30050410 PMCID: PMC6052899 DOI: 10.3389/fncel.2018.00169] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/31/2018] [Indexed: 12/25/2022] Open
Abstract
Brain neurons, to support their neurotransmitter functions, require a several times higher supply of glucose than non-excitable cells. Pyruvate, the end product of glycolysis, through pyruvate dehydrogenase complex reaction, is a principal source of acetyl-CoA, which is a direct energy substrate in all brain cells. Several neurodegenerative conditions result in the inhibition of pyruvate dehydrogenase and decrease of acetyl-CoA synthesis in mitochondria. This attenuates metabolic flux through TCA in the mitochondria, yielding energy deficits and inhibition of diverse synthetic acetylation reactions in all neuronal sub-compartments. The acetyl-CoA concentrations in neuronal mitochondrial and cytoplasmic compartments are in the range of 10 and 7 μmol/L, respectively. They appear to be from 2 to 20 times lower than acetyl-CoA Km values for carnitine acetyltransferase, acetyl-CoA carboxylase, aspartate acetyltransferase, choline acetyltransferase, sphingosine kinase 1 acetyltransferase, acetyl-CoA hydrolase, and acetyl-CoA acetyltransferase, respectively. Therefore, alterations in acetyl-CoA levels alone may significantly change the rates of metabolic fluxes through multiple acetylation reactions in brain cells in different physiologic and pathologic conditions. Such substrate-dependent alterations in cytoplasmic, endoplasmic reticulum or nuclear acetylations may directly affect ACh synthesis, protein acetylations, and gene expression. Thereby, acetyl-CoA may regulate the functional and adaptative properties of neuronal and non-neuronal brain cells. The excitotoxicity-evoked intracellular zinc excess hits several intracellular targets, yielding the collapse of energy balance and impairment of the functional and structural integrity of postsynaptic cholinergic neurons. Acute disruption of brain energy homeostasis activates slow accumulation of amyloid-β1-42 (Aβ). Extra and intracellular oligomeric deposits of Aβ affect diverse transporting and signaling pathways in neuronal cells. It may combine with multiple neurotoxic signals, aggravating their detrimental effects on neuronal cells. This review presents evidences that changes of intraneuronal levels and compartmentation of acetyl-CoA may contribute significantly to neurotoxic pathomechanisms of different neurodegenerative brain disorders.
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Affiliation(s)
- Anna Ronowska
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Szutowicz
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Hanna Bielarczyk
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Sylwia Gul-Hinc
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Joanna Klimaszewska-Łata
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksandra Dyś
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marlena Zyśk
- Department of Laboratory Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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PET Imaging Analysis of Vitamin B1 Kinetics with [11C]Thiamine and its Derivative [11C]Thiamine Tetrahydrofurfuryl Disulfide in Rats. Mol Imaging Biol 2018; 20:1001-1007. [DOI: 10.1007/s11307-018-1186-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Microglial activation and vascular responses that are associated with early thalamic neurodegeneration resulting from thiamine deficiency. Neurotoxicology 2018; 65:98-110. [DOI: 10.1016/j.neuro.2018.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/05/2018] [Accepted: 02/05/2018] [Indexed: 12/15/2022]
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Hammad A, Kaido T, Aliyev V, Mandato C, Uemoto S. Nutritional Therapy in Liver Transplantation. Nutrients 2017; 9:E1126. [PMID: 29035319 PMCID: PMC5691742 DOI: 10.3390/nu9101126] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/10/2017] [Accepted: 10/12/2017] [Indexed: 12/11/2022] Open
Abstract
Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.
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Affiliation(s)
- Ahmed Hammad
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan.
- Department of General Surgery, Mansoura University, Mansoura 35516, Egypt.
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan.
| | - Vusal Aliyev
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan.
| | - Claudia Mandato
- L'AORN Children's Hospital Santobono and Pausilipon, Napoli 80122, Italy.
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan.
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Abstract
Gastrointestinal (GI) complications of cirrhosis are frequent in patients who require intensive care support and are often the primary indication for intensive care unit (ICU) admission. Perhaps the most worrisome GI complication for the intensivist is variceal hemorrhage. Bleeding from esophageal or gastric varices represents a life-threatening event for cirrhotic patients and provides management challenges for the ICU team. Nonvariceal GI bleeding, impaired GI motility, and malnutrition also provide significant challenges for the intensivist. This article reviews GI issues that present in critically ill cirrhotic patients and their management in the acute setting.
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Affiliation(s)
- Jody C Olson
- The University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Kia Saeian
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Zahr NM. Structural and microstructral imaging of the brain in alcohol use disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 125:275-90. [PMID: 25307581 DOI: 10.1016/b978-0-444-62619-6.00017-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Magnetic resonance imaging (MRI), by enabling rigorous in vivo study of the longitudinal, dynamic course of alcoholism through periods of drinking, sobriety, and relapse, has enabled characterization of the effects of chronic alcoholism on the brain in the human condition. Importantly, MRI has distinguished alcohol-related brain effects that are permanent versus those that are reversible with abstinence. In support of postmortem neuropathologic studies showing degeneration of white matter, MRI has shown a specific vulnerability of brain white matter to chronic alcohol exposure by demonstrating white-matter volume deficits, yet not leaving selective gray-matter structures unscathed. Diffusion tensor imaging (DTI), by permitting microstructural characterization of white matter, has extended MRI findings in alcoholics. This review focuses on MRI and DTI findings in common concomitants of alcoholism, including Wernicke's encephalopathy, Korsakoff's syndrome, hepatic encephalopathy, central pontine myelinolysis, alcoholic cerebellar degeneration, alcoholic dementia, and Marchiafava-Bignami disease as a framework for findings in so-called "uncomplicated alcoholism," and also covers findings in abstinence and relapse.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Neuroscience Program, SRI International, Menlo Park, CA, USA.
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28
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Ganapathy D, Bajaj JS. Neurological examination. Clin Liver Dis (Hoboken) 2016; 7:151-153. [PMID: 31041051 PMCID: PMC6490279 DOI: 10.1002/cld.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/27/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
- Dinesh Ganapathy
- Division of Gastroenterology, Hepatology and NutritionVirginia Commonwealth University and McGuire VA Medical CenterRichmondVA
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology and NutritionVirginia Commonwealth University and McGuire VA Medical CenterRichmondVA
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Duca J, Lum CJ, Lo AM. Elevated Lactate Secondary to Gastrointestinal Beriberi. J Gen Intern Med 2016; 31:133-6. [PMID: 25876741 PMCID: PMC4699997 DOI: 10.1007/s11606-015-3326-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/14/2014] [Accepted: 03/26/2015] [Indexed: 11/25/2022]
Abstract
Thiamine deficiency usually occurs with prolonged nutritional deficiency and is almost universally identified with Wernicke's encephalopathy or beriberi. It is also, however, a rare cause of elevated lactate and gastroenterological symptoms. This case report describes a 30-year-old man with 2 weeks of gastroenterological symptoms and intermittent oral intake, who was found to have an elevated lactate level. Neurological exam was normal and an extensive workup was negative, but after being treated with thiamine, his lactate level improved overnight and all of his symptoms resolved. Thiamine levels returned low at 44 nmol/L (normal 78-185 nmol/L). Lack of recognition of this phenomenon, while rare, can lead to unnecessary tests and procedures and increased morbidity and mortality.
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Affiliation(s)
- James Duca
- John A. Burns School of Medicine, 651 Ilalo St., Honolulu, 96813, HI, USA
| | - Corey J Lum
- University of Hawaii Internal Medicine Program, 1356 Lusitana St. # 510, Honolulu, 96813, HI, USA
| | - Angela M Lo
- The Queen's Medical Center, 1301 Punchbowl St., Honolulu, 96813, HI, USA.
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30
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Bémeur C, Butterworth RF. Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications. J Clin Exp Hepatol 2015; 5:S131-40. [PMID: 26041952 PMCID: PMC4442848 DOI: 10.1016/j.jceh.2015.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/19/2013] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is a common feature of chronic liver diseases that is often associated with a poor prognosis including worsening of clinical outcome, neuropsychiatric complications as well as outcome following liver transplantation. Nutritional assessment in patients with cirrhosis is challenging owing to confounding factors related to liver failure. The objectives of nutritional intervention in cirrhotic patients are the support of liver regeneration, the prevention or correction of specific nutritional deficiencies and the prevention and/or treatment of the complications of liver disease per se and of liver transplantation. Nutritional recommendations target the optimal supply of adequate substrates related to requirements linked to energy, protein, carbohydrates, lipids, vitamins and minerals. Some issues relating to malnutrition in chronic liver disease remain to be addressed including the development of an appropriate well-validated nutritional assessment tool, the identification of mechanistic targets or therapy for sarcopenia, the development of nutritional recommendations for obese cirrhotic patients and liver-transplant recipients and the elucidation of the roles of vitamin A hepatotoxicity, as well as the impact of deficiencies in riboflavin and zinc on clinical outcomes. Early identification and treatment of malnutrition in chronic liver disease has the potential to lead to better disease outcome as well as prevention of the complications of chronic liver disease and improved transplant outcomes.
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Key Words
- AAAs, aromatic amino acids
- BCAAs, branched-chain amino acids
- BMI, body mass index
- CNS, central nervous system
- CONUT, controlling nutritional status
- HE, hepatic encephalopathy
- ISHEN, International Society for Hepatic Encephalopathy and Nitrogen metabolism
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steato-hepatitis
- PNI, prognostic nutritional index
- complications
- hepatic encephalopathy
- liver disease
- liver transplantation
- nutritional status
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Affiliation(s)
- Chantal Bémeur
- Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, Canada
- Unité de recherche en sciences neurologiques, Hôpital Saint-Luc (CHUM), Université de Montréal, Montréal, Canada
| | - Roger F. Butterworth
- Unité de recherche en sciences neurologiques, Hôpital Saint-Luc (CHUM), Université de Montréal, Montréal, Canada
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31
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Szutowicz A, Bielarczyk H, Jankowska-Kulawy A, Ronowska A, Pawełczyk T. Retinoic acid as a therapeutic option in Alzheimer's disease: a focus on cholinergic restoration. Expert Rev Neurother 2015; 15:239-49. [PMID: 25683350 DOI: 10.1586/14737175.2015.1008456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Retinoic acid is a potent cell differentiating factor, which through its nuclear receptors affects a vast range of promoter sites in brain neuronal and glial cells in every step of embryonic and postnatal life. Its capacities, facilitating maturation of neurotransmitter phenotype in different groups of neurons, pave the way for its application as a potential therapeutic agent in neurodegenerative diseases including Alzheimer's disease. Retinoic acid was found to exert particularly strong enhancing effects on acetylcholine transmitter functions in brain cholinergic neurons, loss of which is tightly linked to the development of cognitive and memory deficits in course of different cholinergic encephalopathies. Here, we review cholinotrophic properties of retinoic acid and its derivatives, which may justify their application in the management of Alzheimer's disease and the related neurodegenerative conditions.
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Affiliation(s)
- Andrzej Szutowicz
- Department of Laboratory Medicine, Medical University of Gdańsk, Gdańsk, Poland
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32
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Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol 2014; 61:642-59. [PMID: 25015420 DOI: 10.1016/j.jhep.2014.05.042] [Citation(s) in RCA: 287] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 02/07/2023]
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33
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Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014; 60:715-35. [PMID: 25042402 DOI: 10.1002/hep.27210] [Citation(s) in RCA: 1241] [Impact Index Per Article: 124.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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34
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Bémeur C, Butterworth RF. Nutrition in the management of cirrhosis and its neurological complications. J Clin Exp Hepatol 2014; 4:141-50. [PMID: 25755550 PMCID: PMC4116712 DOI: 10.1016/j.jceh.2013.05.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/19/2013] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is a common feature of chronic liver diseases that is often associated with a poor prognosis including worsening of clinical outcome, neuropsychiatric complications as well as outcome following liver transplantation. Nutritional assessment in patients with cirrhosis is challenging owing to confounding factors related to liver failure. The objectives of nutritional intervention in cirrhotic patients are the support of liver regeneration, the prevention or correction of specific nutritional deficiencies and the prevention and/or treatment of the complications of liver disease per se and of liver transplantation. Nutritional recommendations target the optimal supply of adequate substrates related to requirements linked to energy, protein, carbohydrates, lipids, vitamins and minerals. Some issues relating to malnutrition in chronic liver disease remain to be addressed including the development of an appropriate well-validated nutritional assessment tool, the identification of mechanistic targets or therapy for sarcopenia, the development of nutritional recommendations for obese cirrhotic patients and liver-transplant recipients and the elucidation of the roles of vitamin A hepatotoxicity, as well as the impact of deficiencies in riboflavin and zinc on clinical outcomes. Early identification and treatment of malnutrition in chronic liver disease has the potential to lead to better disease outcome as well as prevention of the complications of chronic liver disease and improved transplant outcomes.
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Key Words
- AAAs, aromatic amino acids
- BCAAs, branched-chain amino acids
- BMI, body mass index
- CNS, central nervous system
- CONUT, controlling nutritional status
- HE, hepatic encephalopathy
- ISHEN, International Society for Hepatic Encephalopathy and Nitrogen metabolism
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steato-hepatitis
- PNI, prognostic nutritional index
- complications
- hepatic encephalopathy
- liver disease
- liver transplantation
- nutritional status
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Affiliation(s)
- Chantal Bémeur
- Département de nutrition, Faculté de médecine, Université de Montréal, Montréal, Canada ; Unité de recherche en sciences neurologiques, Hôpital Saint-Luc (CHUM), Université de Montréal, Montréal, Canada
| | - Roger F Butterworth
- Unité de recherche en sciences neurologiques, Hôpital Saint-Luc (CHUM), Université de Montréal, Montréal, Canada
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35
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Perioperative nutritional therapy in liver transplantation. Surg Today 2014; 45:271-83. [PMID: 24473669 DOI: 10.1007/s00595-014-0842-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/16/2013] [Indexed: 12/21/2022]
Abstract
Protein-energy malnutrition is frequently seen in patients with end-stage liver disease who undergo liver transplantation. This causes a deterioration of the patients' clinical condition and affects their post-transplantation survival. Accurate assessment of the nutritional status and adequate intervention are prerequisites for perioperative nutritional treatment. However, the metabolic abnormalities induced by liver failure make the traditional assessment of the nutritional status difficult. The methods that were recently developed for accurately assessing the nutritional status by body bioelectrical impedance may be implemented in pre-transplant management. Because preoperative malnutrition and the loss of skeletal muscle mass, called sarcopenia, have a significant negative impact on the post-transplantation outcome, it is essential to provide adequate nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the necessary caloric intake. We herein discuss both bioelectrical impedance and the latest findings in the current perioperative nutritional interventions in liver transplant patients regarding synbiotics, micronutrients, branched-chain amino acid supplementation, the use of immune system modulating formulas, the fluid balance and the offering of nocturnal meals.
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36
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Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc 2013; 88:1127-40. [PMID: 24079682 PMCID: PMC3975915 DOI: 10.1016/j.mayocp.2013.06.012] [Citation(s) in RCA: 399] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/31/2013] [Accepted: 06/26/2013] [Indexed: 02/07/2023]
Abstract
Lactate levels are commonly evaluated in acutely ill patients. Although most often used in the context of evaluating shock, lactate levels can be elevated for many reasons. While tissue hypoperfusion may be the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate level elevation as the clinical and prognostic importance of an elevated lactate level varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to April 30, 2013, using the search term lactate or lactic acidosis combined with known associations, such as shock, sepsis, cardiac arrest, trauma, seizure, ischemia, diabetic ketoacidosis, thiamine, malignancy, liver, toxins, overdose, and medication. We provide an overview of the pathogenesis of lactate level elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical end point of resuscitation are discussed. The review ends with some general recommendations on the management of patients with elevated lactate levels.
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Affiliation(s)
- Lars W. Andersen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Julie Mackenhauer
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | - Jonathan C. Roberts
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Katherine M. Berg
- Department of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michael N. Cocchi
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michael W. Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Division of Pulmonary Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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37
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Al-Daghri NM, Al-Attas OS, Alkharfy KM, Alokail MS, Abd-Alrahman SH, Sabico S. Thiamine and its phosphate esters in relation to cardiometabolic risk factors in Saudi Arabs. Eur J Med Res 2013; 18:32. [PMID: 24059534 PMCID: PMC3848859 DOI: 10.1186/2047-783x-18-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/02/2013] [Indexed: 11/24/2022] Open
Abstract
Background Thiamine deficiency has suggested to be linked to several insulin-resistance complications. In this study, we aim to associate circulating thiamine levels among cardiometabolic parameters in an Arab cohort using a simple, sensitive, rapid and selective high-performance liquid chromatography (HPLC) method that has recently been developed. Methods A total of 236 randomly selected, consenting Saudi adult participants (166 males and 70 females) were recruited and screened for the presence of the metabolic syndrome (MetS) using the modified National Cholesterol Education Program–Adult Treatment Panel III definition. Blood thiamine and its derivatives were quantified using HPLC. Results A total of 140 participants (53.9%) had MetS. The levels of thiamine and its derivatives of those with MetS were not significantly different from those without. However, hypertensive subjects had significantly higher urinary thiamine (P = 0.03) as well as significantly lower levels of thiamine diphosphate (TDP) (P = 0.01) and total thiamine (P = 0.02) than the normotensive subjects, even after adjusting for age and body mass index (BMI). Furthermore, age- and BMI-matched participants with elevated blood glucose levels had significantly lower levels of thiamine monophosphate (P = 0.020), TDP (P < 0.001) and total thiamine (P < 0.001) and significantly elevated levels of urinary thiamine (P = 0.005) compared to normoglycemic participants. Conclusions Low thiamine levels are associated with elevated blood glucose and hypertension in Saudi adults. Determination of thiamine status may be considered and corrected among patients with, or at high risk for, MetS, but the question whether thiamine deficiency correction translates to improved cardiometabolic status needs further longitudinal investigation.
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Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, College of Science, King Saud University, Riyadh 11451, Kingdom of Saudi Arabia.
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38
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Bemeur C. Neurological complications post-liver transplantation: impact of nutritional status. Metab Brain Dis 2013; 28:293-300. [PMID: 23129292 DOI: 10.1007/s11011-012-9352-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/22/2012] [Indexed: 12/11/2022]
Abstract
Nutritional status is significantly altered in patients with end-stage liver disease (cirrhosis). Malnutrition is a common complication of cirrhosis and is known to be associated with a greater risk of post-operative complications and mortality, especially following liver transplantation. Neurological complications occur frequently after transplant and the nature and extent of these complications may relate to nutritional deficits such as protein-calorie malnutrition as well as vitamin and micronutrient deficiencies. A consensus document from the International Society on Hepatic Encephalopathy and Nitrogen metabolism (ISHEN) has been established in order to address these concerns. Careful assessment of nutritional status followed by prompt treatment of nutritional deficits has the potential to impact on transplant outcome and, in particular, on post-transplant neurological disorders in patients with cirrhosis.
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Affiliation(s)
- Chantal Bemeur
- Department of Nutrition, University of Montreal, Montreal, Québec, Canada.
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39
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de Andrade Belo MA, Soares VE, de Souza LM, da Rosa Sobreira MF, Cassol DMS, Toma SB. Hepatoprotective treatment attenuates oxidative damages induced by carbon tetrachloride in rats. ACTA ACUST UNITED AC 2012; 64:155-65. [DOI: 10.1016/j.etp.2010.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 07/08/2010] [Accepted: 08/11/2010] [Indexed: 11/16/2022]
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40
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Attias J, Raveh E, Aizer-Dannon A, Bloch-Mimouni A, Fattal-Valevski A. Auditory System Dysfunction due to Infantile Thiamine Deficiency: Long-Term Auditory Sequelae. ACTA ACUST UNITED AC 2012; 17:309-20. [DOI: 10.1159/000339356] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 04/19/2012] [Indexed: 01/19/2023]
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41
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Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, Kamath PS. Intensive care of the patient with cirrhosis. Hepatology 2011; 54:1864-72. [PMID: 21898477 DOI: 10.1002/hep.24622] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute deterioration of patients with cirrhosis manifests as multiple organ failure requiring admission to an intensive care unit. Precipitating events may be viral hepatitis, typically in Asia, and drug or alcoholic hepatitis and variceal hemorrhage in the West. Patients with cirrhosis in the intensive care unit have a high mortality, and each admission is associated with a mean charge of US $116,200. Prognosis is determined by the number of organs failing (sequential organ failure assessment [SOFA] score), the presence of infection, and the degree of liver dysfunction (Child-Turcotte-Pugh or Model for End-Stage Liver Disease scores). The most common organ failing is the kidney; sepsis is associated with further deterioration in liver function by compromise of the microcirculation. Care of these critically ill patients with impending multiple organ failure requires a team approach with expertise in both hepatology and critical care. Treatment is aimed at preventing further deterioration in liver function, reversing precipitating factors, and supporting failing organs. Liver transplantation is required in selected patients to improve survival and quality of life. Treatment is futile in some patients, but it is difficult to identify these patients a priori. Artificial and bioartificial liver support systems have thus far not demonstrated significant survival benefit in these patients.
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Affiliation(s)
- Jody C Olson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
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42
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Chamorro Fernández A, Marcos Martín M, Laso Guzmán F. Encefalopatía de Wernicke en el paciente alcohólico. Rev Clin Esp 2011; 211:458-63. [DOI: 10.1016/j.rce.2011.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/06/2011] [Accepted: 04/11/2011] [Indexed: 10/17/2022]
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43
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Bizon-Zygmańska D, Jankowska-Kulawy A, Bielarczyk H, Pawełczyk T, Ronowska A, Marszałł M, Szutowicz A. Acetyl-CoA metabolism in amprolium-evoked thiamine pyrophosphate deficits in cholinergic SN56 neuroblastoma cells. Neurochem Int 2011; 59:208-16. [PMID: 21672592 DOI: 10.1016/j.neuint.2011.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
Inhibition of pyruvate (PDHC) and ketoglutarate (KDHC) dehydrogenase complexes induced by thiamine pyrophosphate deficits is known cause of disturbances of cholinergic transmission in the brain, yielding clinical symptoms of cognitive, vegetative and motor deficits. However, particular alterations in distribution of key acetylcholine precursor, acetyl-CoA, in the cholinergic neuron compartment of thiamine pyrophosphate-deficient brain remain unknown. Therefore, the aim of our work was to find out how amprolium-induced thiamine pyrophosphate deficits (TD) affect distribution of acetyl-CoA in the compartment of pure cholinergic neuroblastoma SN56 cells originating from murine septum. Amprolium caused similar concentration-dependent decreases in thiamine pyrophosphate levels in nondifferentiated (NC) and differentiated (DC) cells cultured in low thiamine medium. In such conditions DC displayed significantly greater loss of viability than the NC ones, despite of lesser suppressions of PDHC activities and tetrazolium salt reduction rates in the former. On the other hand, intramitochondrial acetyl-CoA levels in DC were 73% lower than in NC, which explains their greater susceptibility to TD. Choline acetyltransferase activity and acetylcholine content in DC were two times higher than in NC. TD caused 50% decrease of cytoplasmic acetyl-CoA levels that correlated with losses of acetylcholine pool in DC but not in NC. These data indicate that particular sensitivity of DC to TD may result from relative shortage of acetyl-CoA due to its higher utilization in acetylcholine synthesis.
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Affiliation(s)
- D Bizon-Zygmańska
- Department of Laboratory Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland
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44
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Enneking D. The nutritive value of grasspea (Lathyrus sativus) and allied species, their toxicity to animals and the role of malnutrition in neurolathyrism. Food Chem Toxicol 2011; 49:694-709. [DOI: 10.1016/j.fct.2010.11.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 11/14/2010] [Accepted: 11/22/2010] [Indexed: 12/12/2022]
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45
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Role of nutrition in the management of hepatic encephalopathy in end-stage liver failure. J Nutr Metab 2010; 2010:489823. [PMID: 21234351 PMCID: PMC3017957 DOI: 10.1155/2010/489823] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/11/2010] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is common in patients with end-stage liver failure and hepatic encephalopathy, and is considered a significant prognostic factor affecting quality of life, outcome, and survival. The liver plays a crucial role in the regulation of nutrition by trafficking the metabolism of nutrients, their distribution and appropriate use by the body. Nutritional consequences with the potential to cause nervous system dysfunction occur in liver failure, and many factors contribute to malnutrition in hepatic failure. Among them are inadequate dietary intake, malabsorption, increased protein losses, hypermetabolism, insulin resistance, gastrointestinal bleeding, ascites, inflammation/infection, and hyponatremia. Patients at risk of malnutrition are relatively difficult to identify since liver disease may interfere with biomarkers of malnutrition. The supplementation of the diet with amino acids, antioxidants, vitamins as well as probiotics in addition to meeting energy and protein requirements may improve nutritional status, liver function, and hepatic encephalopathy in patients with end-stage liver failure.
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46
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Yang G, Meng Y, Li W, Yong Y, Fan Z, Ding H, Wei Y, Luo J, Ke ZJ. Neuronal MCP-1 mediates microglia recruitment and neurodegeneration induced by the mild impairment of oxidative metabolism. Brain Pathol 2010; 21:279-97. [PMID: 21029241 DOI: 10.1111/j.1750-3639.2010.00445.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Chemokines are implicated in the neuroinflammation of several chronic neurodegenerative disorders. However, the precise role of chemokines in neurodegeneration is unknown. Thiamine deficiency (TD) causes abnormal oxidative metabolism in the brain as well as a well-defined microglia activation and neurodegeneration in the submedial thalamus nucleus (SmTN), which are common features of neurodegenerative diseases. We evaluated the role of chemokines in neurodegeneration and the underlying mechanism in a TD model. Among the chemokines examined, TD selectively induced neuronal expression of monocyte chemoattractant protein-1 (MCP-1) in the SmTN prior to microglia activation and neurodegeneration. The conditioned medium collected from TD-induced neurons caused microglia activation. With a neuron/microglia co-culture system, we showed that MCP-1-induced neurotoxicity required the presence of microglia, and exogenous MCP-1 was able to activate microglia and stimulated microglia to produce cytokines. A MCP-1 neutralizing antibody inhibited MCP-1-induced microglia activation and neuronal death in culture and in the thalamus. MCP-1 knockout mice were resistant to TD-induced neuronal death in SmTN. TD selectively induced the accumulation of reactive oxygen species in neurons, and antioxidants blocked TD-induced MCP-1 expression. Together, our results indicated an induction of neuronal MCP-1 during mild impairment of oxidative metabolism caused by microglia recruitment/activation, which exacerbated neurodegeneration.
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Affiliation(s)
- Guang Yang
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Graduate School of the Chinese Academy of Sciences, Shanghai, China
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Thiamine status in humans and content of phosphorylated thiamine derivatives in biopsies and cultured cells. PLoS One 2010; 5:e13616. [PMID: 21049048 PMCID: PMC2963613 DOI: 10.1371/journal.pone.0013616] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/30/2010] [Indexed: 12/19/2022] Open
Abstract
Background Thiamine (vitamin B1) is an essential molecule for all life forms because thiamine diphosphate (ThDP) is an indispensable cofactor for oxidative energy metabolism. The less abundant thiamine monophosphate (ThMP), thiamine triphosphate (ThTP) and adenosine thiamine triphosphate (AThTP), present in many organisms, may have still unidentified physiological functions. Diseases linked to thiamine deficiency (polyneuritis, Wernicke-Korsakoff syndrome) remain frequent among alcohol abusers and other risk populations. This is the first comprehensive study on the distribution of thiamine derivatives in human biopsies, body fluids and cell lines. Methodology and Principal Findings Thiamine derivatives were determined by HPLC. In human tissues, the total thiamine content is lower than in other animal species. ThDP is the major thiamine compound and tissue levels decrease at high age. In semen, ThDP content correlates with the concentration of spermatozoa but not with their motility. The proportion of ThTP is higher in humans than in rodents, probably because of a lower 25-kDa ThTPase activity. The expression and activity of this enzyme seems to correlate with the degree of cell differentiation. ThTP was present in nearly all brain and muscle samples and in ∼60% of other tissue samples, in particular fetal tissue and cultured cells. A low ([ThTP]+[ThMP])/([Thiamine]+[ThMP]) ratio was found in cardiovascular tissues of patients with cardiac insufficiency. AThTP was detected only sporadically in adult tissues but was found more consistently in fetal tissues and cell lines. Conclusions and Significance The high sensitivity of humans to thiamine deficiency is probably linked to low circulating thiamine concentrations and low ThDP tissue contents. ThTP levels are relatively high in many human tissues, as a result of low expression of the 25-kDa ThTPase. Another novel finding is the presence of ThTP and AThTP in poorly differentiated fast-growing cells, suggesting a hitherto unsuspected link between these compounds and cell division or differentiation.
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Jankowska-Kulawy A, Bielarczyk H, Pawełczyk T, Wróblewska M, Szutowicz A. Acetyl-CoA deficit in brain mitochondria in experimental thiamine deficiency encephalopathy. Neurochem Int 2010; 57:851-6. [PMID: 20850489 DOI: 10.1016/j.neuint.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/01/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
Several pathologic conditions are known to cause thiamine deficiency, which induce energy shortages in all tissues, due to impairment of pyruvate decarboxylation. Brain is particularly susceptible to these conditions due to its high rate of glucose to pyruvate-driven energy metabolism. However, cellular compartmentalization of a key energy metabolite, acetyl-CoA, in this pathology remains unknown. Pyrithiamine-evoked thiamine deficiency caused no significant alteration in pyruvate dehydrogenase and 30% inhibition of α-ketoglutarate dehydrogenase activities in rat whole forebrain mitochondria. It also caused 50% reduction of the metabolic flux of pyruvate through pyruvate dehydrogenase, 78% inhibition of its flux through α-ketoglutarate dehydrogenase steps, and nearly 60% decrease of intramitochondrial acetyl-CoA content, irrespective of the metabolic state. State 3 caused a decrease in citrate and an increase in α-ketoglutarate accumulation. These alterations were more evident in thiamine-deficient mitochondria. Simultaneously thiamine deficiency caused no alteration of relative, state 3-induced increases in metabolic fluxes through pyruvate and α-ketoglutarate dehydrogenase steps. These data indicate that a shortage of acetyl-CoA in the mitochondrial compartment may be a primary signal inducing impairment of neuronal and glial cell functions and viability in the thiamine-deficient brain.
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Ferreira LG, Anastácio LR, Correia MI. The impact of nutrition on cirrhotic patients awaiting liver transplantation. Curr Opin Clin Nutr Metab Care 2010; 13:554-61. [PMID: 20531175 DOI: 10.1097/mco.0b013e32833b64d2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To review the most recent aspects of nutrition therapy of cirrhotic patients on the waiting list for liver transplantation. RECENT FINDINGS Undernutrition has been widely reported among these patients, despite the lack of consensus on the best nutritional assessment tools in this population. Nutrition therapy has been marked by controversy. Nonetheless, recent findings have pointed out to the important role of the nutrition status and of some specific nutrients on the outcome of these patients. SUMMARY We report the latest findings on nutrition care of patients with end-stage liver disease on the waiting list for liver transplantation such as the impact of the nutritional status on outcome, probiotic and branched-chain amino acid supplementation, as well as the use of immunomodulating formula. Another important strategy that has been shown to improve these patients' nutritional care is the offering of nocturnal meals and micronutrient supplementation.
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Affiliation(s)
- Lívia G Ferreira
- Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Jankowska-Kulawy A, Bielarczyk H, Pawełczyk T, Wróblewska M, Szutowicz A. Acetyl-CoA and acetylcholine metabolism in nerve terminal compartment of thiamine deficient rat brain. J Neurochem 2010; 115:333-42. [PMID: 20649840 DOI: 10.1111/j.1471-4159.2010.06919.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The decrease of pyruvate and ketoglutarate dehydrogenase complex activities is the main cause of energy and acetyl-CoA deficits in thiamine deficiency-evoked cholinergic encephalopathies. However, disturbances in pathways of acetyl-CoA metabolism leading to appearance of cholinergic deficits remain unknown. Therefore, the aim of this work was to investigate alterations in concentration and distribution of acetyl-CoA and in acetylcholine metabolism in brain nerve terminals, caused by thiamine deficits. They were induced by the pyrithiamine, a potent inhibitor of thiamine pyrophosphokinase. The thiamine deficit reduced metabolic fluxes through pyruvate and ketoglutarate dehydrogenase steps, yielding deficits of acetyl-CoA in mitochondrial and cytoplasmic compartments of K-depolarized nerve terminals. It also inhibited indirect transport of acetyl-CoA though ATP-citrate lyase pathway being without effect on its direct Ca-dependent transport to synaptoplasm. Resulting suppression of synaptoplasmic acetyl-CoA correlated with inhibition of quantal acetylcholine release (r = 0.91, p = 0.012). On the other hand, thiamine deficiency activated non-quantal acetylcholine release that was independent of shifts in intraterminal distribution of acetyl-CoA. Choline acetyltransferase activity was not changed by these conditions. These data indicate that divergent alterations in the release of non-quantal and quantal acetylcholine pools from thiamine deficient nerve terminals could be caused by the inhibition of acetyl-CoA and citrate synthesis in their mitochondria. They in turn, caused inhibition of acetyl-CoA transport to the synaptoplasmic compartment through ATP-citrate lyase pathway yielding deficits of cholinergic functions.
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