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Review
. 2021 Jan 5;22(1):463.
doi: 10.3390/ijms22010463.

The Association between Hepatic Encephalopathy and Diabetic Encephalopathy: The Brain-Liver Axis

So Yeong Cheon  1 , Juhyun Song  2
Affiliations
Review

The Association between Hepatic Encephalopathy and Diabetic Encephalopathy: The Brain-Liver Axis

So Yeong Cheon et al. Int J Mol Sci. .

Abstract

Hepatic encephalopathy (HE) is one of the main consequences of liver disease and is observed in severe liver failure and cirrhosis. Recent studies have provided significant evidence that HE shows several neurological symptoms including depressive mood, cognitive dysfunction, impaired circadian rhythm, and attention deficits as well as motor disturbance. Liver disease is also a risk factor for the development of diabetes mellitus. Diabetic encephalopathy (DE) is characterized by cognitive dysfunction and motor impairment. Recent research investigated the relationship between metabolic changes and the pathogenesis of neurological disease, indicating the importance between metabolic organs and the brain. Given that a diverse number of metabolites and changes in the brain contribute to neurologic dysfunction, HE and DE are emerging types of neurologic disease. Here, we review significant evidence of the association between HE and DE, and summarise the common risk factors. This review may provide promising therapeutic information and help to design a future metabolic organ-related study in relation to HE and DE.

Keywords: blood–brain barrier (BBB); brain-liver axis; diabetic encephalopathy; hepatic encephalopathy; neurotransmitter.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
BBB breakdown and brain edema may aggravate brain dysfunction in HE and DE. Circulating factors can cause BBB breakdown, accompanied by astrocyte swelling and dysfunction, and glial activation. These can induce neuroinflammation, which is responsible for neuronal cell damage in HE and DE.
Figure 2
Figure 2
The neurotransmitter imbalance in HE and DE. The changes in neurotransmitters, such as glutamate, GABA, serotonin, dopamine, and noradrenaline, may lead to motor dysfunction, learning and memory dysfunction, and emotional disturbance. The levels of dopamine and choline are decreased and the levels of glutamate, GABA, and norepinephrine are increased in HE and DE. However, Dopamine and serotonin levels are elevated in HE. Conversely, serotonin level is reduced in HE.
Figure 3
Figure 3
Insulin resistance and impaired glucose metabolism may aggravate brain dysfunction in HE and DE. Peripheral insulin and glucose metabolism can influence brain homeostasis, and impaired glucose tolerance and insulin resistance can cause brain dysfunction in HE and DE.
See this image and copyright information in PMC

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