Endothelial-astrocytic interactions in acute liver failure
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Brain edema and the subsequent increase in intracranial pressure are major neurological complications of acute liver failure (ALF), and swelling of astrocytes (cytotoxic brain edema) is the most prominent neuropathological abnormality in ALF. Recent studies, however, have suggested the co-existence of cytotoxic and vasogenic mechanisms in the brain edema associated with ALF. This review 1) summarizes the nature of the brain edema in humans and experimental animals with ALF; 2) reviews in vitro studies supporting the presence of cytotoxic brain edema (cell swelling in cultured astrocytes); and 3) documents the role of brain endothelial cells in the development of astrocyte swelling/brain edema in ALF.
KeywordsAcute liver failure Astrocytes Blood-brain barrier Brain edema Endothelial cells Hepatic encephalopathy
This work was supported by a Merit Review from the Department of Veterans Affairs and by National Institutes of Health grant DK063311. ARJ is supported by the Stanley J. Glaser Foundation grant.
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