Portosystemic shunt placement reveals blood signatures for the development of hepatic encephalopathy through mass spectrometry.
Ana Carolina Dantas MachadoStephany Flores RamosJulia M GauglitzAnne-Marie FasslerDaniel PetrasAlexander A AksenovUn Bi KimMichael LazarowiczAbbey Barnard GiustiniHamed AryafarIrine VodkinCurtis WarrenPieter C DorresteinAli ZarrinparAmir ZarrinparPublished in: Nature communications (2023)
Elective transjugular intrahepatic portosystemic shunt (TIPS) placement can worsen cognitive dysfunction in hepatic encephalopathy (HE) patients due to toxins, including possible microbial metabolites, entering the systemic circulation. We conducted untargeted metabolomics on a prospective cohort of 22 patients with cirrhosis undergoing elective TIPS placement and followed them up to one year post TIPS for HE development. Here we suggest that pre-existing intrahepatic shunting predicts HE severity post-TIPS. Bile acid levels decrease in the peripheral vein post-TIPS, and the abundances of three specific conjugated di- and tri-hydroxylated bile acids are inversely correlated with HE grade. Bilirubins and glycerophosphocholines undergo chemical modifications pre- to post-TIPS and based on HE grade. Our results suggest that TIPS-induced metabolome changes can impact HE development, and that pre-existing intrahepatic shunting could be used to predict HE severity post-TIPS.
Keyphrases
- mass spectrometry
- early onset
- end stage renal disease
- patients undergoing
- liquid chromatography
- ultrasound guided
- chronic kidney disease
- pulmonary artery
- dna methylation
- photodynamic therapy
- gene expression
- high resolution
- oxidative stress
- staphylococcus aureus
- pulmonary hypertension
- endothelial cells
- high glucose
- high resolution mass spectrometry
- prognostic factors
- candida albicans
- gas chromatography