Figure 1.

Major pathogenesis mechanisms of hepatic encephalopathy. Under liver dysfunction conditions, ammonia, manganese, and other heterogeneous precipitation factors cause astrocyte swelling and enhanced oxidative/nitrosative stress, which mutually reinforce each other. This self-amplifying loop then leads to a variety of harmful alterations in intracellular processes, including protein modification, RNA oxidation, multiple signaling pathway alterations, inflammation, autophagy inhibition, mitochondrial damage, and senescence. These unfavorable changes accumulatively impair astrocyte and neuron function/communication and stimulate the development of more severe HE symptoms. (Modified from [7,19]. The figure was partially generated using images from Servier Medical Art, licensed under a Creative Commons Attribution 3.0 Unported License).