Reduced Glymphatic System Activity Induces Elevated GABA Level in Hepatic Encephalopathy Patients: A Potential MRI-Based Mechanism

Motivation: Hepatic encephalopathy (HE) is a severe complication of decompensated cirrhosis. Understanding the pathogenesis is crucial for developing effective treatments and improving outcomes. Goal(s): This study delved into the HE pathogenesis by employing diffusion tensor imaging analysis focused on the perivascular space (DTI-ALPS), alongside the quantification of GABA levels in the thalamus of patients with cirrhosis. Approach: 48 patients with decompensated cirrhosis were enrolled, with all of them undergoing DTI and MRS assessments. Results: We found that patients with HE exhibited impaired glymphatic system function and increased levels of the inhibitory neurotransmitter GABA in the thalamus, with a noteworthy correlation found between them. Impact: The discovery of decreased glymphatic system activity and increased GABA levels may hold significant promise in understanding the potential mechanisms behind HE patients. These findings could contribute to the development of targeted therapies for HE and improve patient care and outcomes.