Metabolic Brain Disease

, Volume 13, Issue 4, pp 351–360 | Cite as

Does Ammonia Contribute to Increased GABA-ergic Neurotransmission in Liver Failure?

  • E. Anthony Jones
  • Anthony S. Basile


The ammonia and GABAergic neurotransmission hypotheses of the pathogenesis of hepatic encephalopathy (HE) have appeared to be unrelated and perhaps mutually exclusive. Observations in animal models of fulminant hepatic failure, that are consistent with increased GABAergic inhibitory neurotransmission contributing to the manifestations of HE, include: (i) abnormal visual evoked potential waveforms that resemble those induced by GABAA/benzodiazepine (BZ) receptor complex agonists; (ii) GABAA/BZ receptor complex antagonist-induced ameliorations of encephalopathy; (iii) increased resistance to drugs which decrease GABAergic tone; and (iv) hypersensitivity of CNS neurons to depression by GABAA/BZ receptor complex agonists. Mechanisms of increased GABAergic tone in HE may include the following: (i) increased brain concentrations of natural BZs; and (ii) increased GABA concentrations in synaptic clefts, possibly due to increased blood-brain-barrier permeability to GABA and a decrease in GABAB receptor density. Both neuroelectrophysiological and behavioral data indicate that ammonia concentrations in the range 0.75-2 mM induce increased excitatory neurotransmission. In contrast, recently, ammonia concentrations in the range 0.15-0.75 mM, i.e. concentrations that commonly occur in plasma in precoma HE, have been shown: (i) to increase GABA-induced chloride current in cultured neurons; and (ii) to enhance synergistically the binding of GABAA/BZ receptor agonists. In addition, increased ammonia concentrations enhance synthesis of neurosteroids in astrocytes, and some neurosteroids potently augment GABAergic neurotransmission. Thus, the modestly elevated concentrations of ammonia, that commonly occur in liver failure, may contribute to the manifestations of HE by enhancing GABAergic inhibitory neurotransmission. This concept appears to unify the ammonia and GABAergic neurotransmission hypotheses.


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Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • E. Anthony Jones
    • 1
  • Anthony S. Basile
    • 2
  1. 1.Department of Gastrointestinal and Liver DiseasesAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Laboratory of NeuroscienceNIDDK, National Institutes of HealthBethesda

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