Frontiers in Neuroscience (Nov 2014)

Oxidative metabolism of astrocytes is not reduced in hepatic encephalopathy: A PET study with [11C]acetate in humans

  • Peter eIversen,
  • Kim eMouridsen,
  • Mikkel Bo Hansen,
  • Svend Borup Jensen,
  • Michael eSørensen,
  • Michael eSørensen,
  • Lasse Kristoffer eBak,
  • Helle S Waagepetersen,
  • Arne eSchousboe,
  • Peter eOtt,
  • Hendrik eVilstrup,
  • Susanne eKeiding,
  • Susanne eKeiding,
  • Susanne eKeiding,
  • Albert eGjedde,
  • Albert eGjedde,
  • Albert eGjedde,
  • Albert eGjedde

DOI
https://doi.org/10.3389/fnins.2014.00353
Journal volume & issue
Vol. 8

Abstract

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In patients with impaired liver function and hepatic encephalopathy (HE), consistent elevations of blood ammonia concentration suggest a crucial role in the pathogenesis of HE. Ammonia and acetate are metabolized in brain both primarily in astrocytes. Here, we used dynamic [11C]acetate PET of the brain to measure the contribution of astrocytes to the previously observed reduction of brain oxidative metabolism in patients with liver cirrhosis and HE, compared to patients with cirrhosis without HE, and to healthy subjects. We used a new kinetic model to estimate uptake from blood to astrocytes and astrocyte metabolism of [11C]acetate. No significant differences of the rate constant of oxidation of [11C]acetate (k3) were found among the three groups of subjects. The net metabolic clearance of [11C]acetate from blood was lower in the group of patients with cirrhosis and HE than in the group of healthy subjects (P<0.05), which we interpret to be an effect of reduced cerebral blood flow rather than a reflection of low [11C]acetate metabolism. We conclude that the characteristic decline of whole-brain oxidative metabolism in patients with cirrhosis with HE is not due to malfunction of oxidative metabolism in astrocytes. Thus, the observed decline of brain oxidative metabolism implicates changes of neurons and their energy turnover in patients with HE.

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