Aims: Liver disease leads to hyperammonemia, a central component in the pathogenesis of hepatic encephalopathy (HE). There is increasing evidence that systemic oxidative stress may exacerbate the neuropsychological effects of hyperammonemia in patients with liver disease. With new, highly sensitive imaging techniques, brain edema is commonly being observed in patients with cirrhosis and HE. Bile duct ligated rats, six-week after intervention, present with brain edema, hyperammonemia and also an increase in plasma reactive oxygen species (ROS) along with an increase in xanthine oxidase activity. In order to better understand the relationship between oxidative stress and ammonia and their role in the pathogenesis of brain edema, we evaluated the effect of xanthine oxidase inhibition in rats with cirrhosis. Methods: Cirrhosis was induced in rats by bile duct ligation (BDL) for 6 weeks. BDL and SHAM-operated rats received 100 mg/kg/day of allopurinol (xanthine oxidase inhibitor) during the last 10 days before sacrifice. As control groups, separate BDL and SHAM-operated rats received equivalent volume of saline. AST and ALT were measured at the end of the treatment period to assess liver function. Ammonia and ROS were assessed in arterial plasma using a commercially available kit and a DCFDA-fluorescent technique respectively. Brain water content was measured in the frontal cortex using the specific gravimetric technique. Results: Arterial ROS and ammonia levels were significantly increased in BDL vs SHAM-operated rats (p<0.001). BDL rats treated with allopurinol demonstrated a significant decrease in systemic ROS as well as ammonia levels vs non-treated BDL rats (1.70 ± 0.53RFU vs 4.97 ± 1.38RFU, p<0.05, 37.9 ± 13.8µM vs 101.1 ± 10.1µM, p<0.001, respectively), reaching values similar to those seen in SHAM-operated rats. Brain water content increased in BDL vs SHAM-operated rats and normalised in allopurinol treated BDL rats (77.20 ± 0.08% vs BDL: 78.46 ± 0.28%, p<0.05). Liver function markers, AST and ALT, increased in BDL rats compared to their respective SHAM-operated controls (p<0.001) and were not attenuated following allopurinol treatment. Conclusions: Allopurinol treatment decreased systemic ROS and attenuated brain edema as well as arterial ammonia levels. The effect of allopurinol demonstrates oxidative stress plays a role in ammonia metabolism and in the pathogenesis of brain edema. Our results suggest antioxidant treatment directed towards inhibiting ROS production could be beneficial in lowering ammonia and treating HE. Additional studies are warranted to evaluate the implication of oxidative stress in ammonia metabolism.
