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Published in: Metabolic Brain Disease 1/2010

01-03-2010 | Original Paper

No oxygen delivery limitation in hepatic encephalopathy

Authors: Albert Gjedde, Susanne Keiding, Hendrik Vilstrup, Peter Iversen

Published in: Metabolic Brain Disease | Issue 1/2010

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Abstract

Hepatic encephalopathy is a condition of reduced brain functioning in which both blood flow and brain energy metabolism declined. It is not known whether blood flow or metabolism is the primary limiting factor of brain function in this condition. We used calculations of mitochondrial oxygen tension to choose between cause and effect in three groups of volunteers, including healthy control subjects (HC), patients with cirrhosis of the liver without hepatic encephalopathy (CL), and patients with cirrhosis with acute hepatic encephalopathy. Compared to HC subjects, blood flow and energy metabolism had declined in all gray matter regions of the brain in patients with HE but not significantly in patients with CL. Analysis of flow-metabolism coupling indicated that blood flow declined in HE as a consequence of reduced brain energy metabolism implied by the calculation of increased mitochondrial oxygen tensions that patients with HE were unable to utilize. We ascribe the inability to use the delivered oxygen of patients with HE to a specific inhibition associated with oxidative metabolism in mitochondria.
Literature
go back to reference Bohr C (1909) Über die spezifische Tätigkeit der Lungen bei der respiratorischen Gasaufnahme und ihr Verhalten zu der durch die Alveolarwand statt findenden Gasdiffusion. Skandinavisches Archiv Physiologie 22:221–280 Bohr C (1909) Über die spezifische Tätigkeit der Lungen bei der respiratorischen Gasaufnahme und ihr Verhalten zu der durch die Alveolarwand statt findenden Gasdiffusion. Skandinavisches Archiv Physiologie 22:221–280
go back to reference Chen JL, Wei L, Bereczki D, Hans FJ, Otsuka T, Acuff V, Richardson G, Patlak C, Fenstermacher J (1994) Virtually unaltered permeability-surface area products imply little capillary recruitment in brain with hypoxia. Microcirculation 1(1):35–47CrossRefPubMed Chen JL, Wei L, Bereczki D, Hans FJ, Otsuka T, Acuff V, Richardson G, Patlak C, Fenstermacher J (1994) Virtually unaltered permeability-surface area products imply little capillary recruitment in brain with hypoxia. Microcirculation 1(1):35–47CrossRefPubMed
go back to reference Gjedde A, Marrett S, Vafaee M (2002) Oxidative and nonoxidative metabolism of excited neurons and astrocytes. J Cereb Blood Flow Metab 22(1):1–14CrossRefPubMed Gjedde A, Marrett S, Vafaee M (2002) Oxidative and nonoxidative metabolism of excited neurons and astrocytes. J Cereb Blood Flow Metab 22(1):1–14CrossRefPubMed
go back to reference Gjedde A, Johannsen P, Cold GE, Ostergaard L (2005) Cerebral metabolic response to low blood flow: possible role of cytochrome oxidase inhibition. J Cereb Blood Flow Metab 25(9):1183–1196CrossRefPubMed Gjedde A, Johannsen P, Cold GE, Ostergaard L (2005) Cerebral metabolic response to low blood flow: possible role of cytochrome oxidase inhibition. J Cereb Blood Flow Metab 25(9):1183–1196CrossRefPubMed
go back to reference Hudetz AG (1997) Regulation of oxygen supply in the cerebral circulation. Adv Exp Med Biol 428:513–520PubMed Hudetz AG (1997) Regulation of oxygen supply in the cerebral circulation. Adv Exp Med Biol 428:513–520PubMed
go back to reference Iversen P, Sørensen M, Bak LK, Waagepetersen HS, Vafaee MS, Borghammer P, Mouridsen K, Jensen SB, Vilstrup H, Schousboe A, Ott P, Gjedde A, Keiding S (2008) Low cerebral oxygen consumption and blood flow in patients with cirrhosis and an acute episode of hepatic encephalopathy. Gastroenterology 136(3):863–871CrossRefPubMed Iversen P, Sørensen M, Bak LK, Waagepetersen HS, Vafaee MS, Borghammer P, Mouridsen K, Jensen SB, Vilstrup H, Schousboe A, Ott P, Gjedde A, Keiding S (2008) Low cerebral oxygen consumption and blood flow in patients with cirrhosis and an acute episode of hepatic encephalopathy. Gastroenterology 136(3):863–871CrossRefPubMed
go back to reference Krogh A (1919a) The rate of diffusion of gases through animal tissues, with some remarks on the coefficient of invasion. J Physiol 52:392–408 Krogh A (1919a) The rate of diffusion of gases through animal tissues, with some remarks on the coefficient of invasion. J Physiol 52:392–408
go back to reference Krogh A (1919b) The number and distribution of capillaries in muscles with calculation of the oxygen pressure head necessary for supplying the tissue. J Physiol 52:409–415PubMed Krogh A (1919b) The number and distribution of capillaries in muscles with calculation of the oxygen pressure head necessary for supplying the tissue. J Physiol 52:409–415PubMed
go back to reference Krogh A (1919c) The supply of oxygen to the tissues and the regulation of the capillary circulation. J Physiol 52:458–474 Krogh A (1919c) The supply of oxygen to the tissues and the regulation of the capillary circulation. J Physiol 52:458–474
go back to reference Kuschinsky W, Paulson OB (1992) Capillary circulation in the brain. Cerebrovasc Brain Metab Rev 4(3):261–286PubMed Kuschinsky W, Paulson OB (1992) Capillary circulation in the brain. Cerebrovasc Brain Metab Rev 4(3):261–286PubMed
go back to reference Ohta S, Meyer E, Thompson CJ, Gjedde A (1992) Oxygen consumption of the living human brain measured after a single inhalation of positron emitting oxygen. J Cereb Blood Flow Metab 12(2):179–192PubMed Ohta S, Meyer E, Thompson CJ, Gjedde A (1992) Oxygen consumption of the living human brain measured after a single inhalation of positron emitting oxygen. J Cereb Blood Flow Metab 12(2):179–192PubMed
go back to reference Ohta S, Meyer E, Fujita H, Reutens DC, Evans A, Gjedde A (1996) Cerebral [15O]water clearance in humans determined by PET: I. Theory and normal values. J Cereb Blood Flow Metab 16(5):765–780CrossRefPubMed Ohta S, Meyer E, Fujita H, Reutens DC, Evans A, Gjedde A (1996) Cerebral [15O]water clearance in humans determined by PET: I. Theory and normal values. J Cereb Blood Flow Metab 16(5):765–780CrossRefPubMed
go back to reference Paulson OB, Hasselbalch SG, Rostrup E, Knudsen GM, Pelligrino D (2010) Cerebral blood flow response to functional activation. J Cereb Blood Flow Metab 30(1):2–14CrossRefPubMed Paulson OB, Hasselbalch SG, Rostrup E, Knudsen GM, Pelligrino D (2010) Cerebral blood flow response to functional activation. J Cereb Blood Flow Metab 30(1):2–14CrossRefPubMed
go back to reference Roy CS, Sherrington CS (1890) On the regulation of the blood supply to the brain. J Physiol (London) 11(1–2):85–158 Roy CS, Sherrington CS (1890) On the regulation of the blood supply to the brain. J Physiol (London) 11(1–2):85–158
Metadata
Title
No oxygen delivery limitation in hepatic encephalopathy
Authors
Albert Gjedde
Susanne Keiding
Hendrik Vilstrup
Peter Iversen
Publication date
01-03-2010
Publisher
Springer US
Published in
Metabolic Brain Disease / Issue 1/2010
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI
https://doi.org/10.1007/s11011-010-9179-9

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