Portosystemic Shunt Placement Reveals Blood Signatures for the Development of Hepatic Encephalopathy Through Mass Spectrometry

Overview

Journal Nat Commun

Specialty Biology

Date 2023 Aug 31

PMID 37652904

Authors

Ana Carolina Dantas Machado

Stephany Flores Ramos

Julia M Gauglitz

Anne-Marie Fassler

Daniel Petras

Alexander A Aksenov

Un Bi Kim

Michael Lazarowicz

Abbey Barnard Giustini

Hamed Aryafar

Irine Vodkin

Curtis Warren

Pieter C Dorrestein

Ali Zarrinpar

Amir Zarrinpar

Affiliations

Soon will be listed here.

Abstract

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.

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