Background: Hepatic encephalopathy (HE) is a debilitating neurological complication of chronic liver disease with alcohol being a common etiological factor. However, excessive alcohol consumption has been shown to impact neurological integrity. To date, the influence of alcohol in the development of HE remains unclear. Therefore, we examined the effect of constant alcohol consumption on neurological decline in rats with chronic liver disease induced via bile-duct ligation (BDL). Method: 5-week BDL rats and Sham-operated controls were used. Day 7 after surgery, rats were administered alcohol twice a day (dose of 3g/kg, via gavage) for 4 weeks. Motor coordination (rotarod) and anxiety-like behavior (open field (OF) and elevated plus maze (EPM)) were assessed. Upon sacrifice, brains were collected, and western blot and immunohistochemical (IHC) analyses were used to investigate neuronal integrity in frontal cortex and cerebellum. Results: Alcohol (BDL-alcohol rats) further impaired motor coordination at weeks 2, 3, 4, and 5 compared to SHAM-alcohol (p<0.01). Furthermore, BDL-alcohol rats demonstrated an increase in anxiety-like behavior; increase in time spent in the closed arms of EPM and decrease in time spent in the center of the OF (p<0.05 vs SHAM-alcohol). BDL-alcohol rats demonstrated a decrease in neuronal markers of NeuN and SMI311 (p<0.01 and p<0.05, respectively), an increase in apoptotic markers of cleaved/pro-caspase3 (p<0.001), an increase in necroptosis markers of pRIP3 and pMLKL (p<0.01 and p<0.001, respectively), a decrease in total antioxidant capacity (p<0.001) and an increase in oxidative stress marker of 4-HNE (p<0.05) in the cerebellum (not found in frontal cortex) compared to all groups. IHC results confirmed the colocalization of apoptotic marker (cleaved Caspase3) and necroptosis marker (pMLKL) in the granular and Purkinje layer neurons of the cerebellum of BDL-alcohol rats. Conclusion: Constant alcohol consumption exacerbates HE and leads to neuronal loss via apoptosis and necroptosis in the cerebellum. Additionally, higher levels of oxidative stress marker of 4-HNE and decreased total antioxidant capacity in the cerebellum of BDL-alcohol rats suggest that oxidative stress is a triggering factor leading to neuronal loss/injury. These results demonstrate an adverse effect of constant alcohol consumption on the development of HE and neuronal integrity in chronic liver disease.
