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Reuters Health Information (2007-08-15): Anti-inflammatory therapy may improve cognitive function in hepatic encephalopathy


Anti-inflammatory therapy may improve cognitive function in hepatic encephalopathy

Last Updated: 2007-08-15 11:03:27 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Animal studies suggest that reducing inflammation may lessen the cognitive impairment that often accompanies hepatic encephalopathy.

"A main contributor to the neurological alterations in hepatic encephalopathy is hyperammonemia in blood and brain due to impaired elimination by the liver," study investigator Dr. Vicente Felipo noted in comments to Reuters Health. "Recent advances in the field suggest that inflammation and hyperammonemia would act synergistically to alter the cerebral function."

In their study, Dr. Felipo of the Centro de Investigacion Principe Felipe in Valencia, Spain, and colleagues showed that rats with hepatic encephalopathy induced by portacaval shunt have hyperammonemia and neuroinflammation and display a decreased ability to learn the Y maze cognitive task.

However, after chronic administration of ibuprofen, the ability of the rats to learn the maze was completely restored, the researchers report in the August issue of Hepatology.

"The results also showed that restoration of learning ability is due to ibuprofen's ability to restore the function of a pathway in the brain known as the glutamate-NO-cGMP pathway," Dr. Felipo noted.

In addition, ibuprofen normalized the activity of inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX) -- two enzymes that play a role in inflammation in the cerebral cortex.

These observations support "the idea that reducing inflammation would improve cognitive function in patients with hepatic encephalopathy," Dr. Felipo and colleagues suggest in their report.

It would be worthwhile, they say, to "look for procedures to decrease inflammation without having the possible secondary effects of NSAIDS, and perhaps new specific inhibitors of COX with no or less secondary effects could have beneficial effects."

Hepatology 2007;46:514-519.

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