Alcohol, Amino Acids, and Encephalopathy

  • Spencer Shaw
  • Charles S. Lieber


Encephalopathy is a severe and common complication of cirrhosis, including alcoholic cirrhosis, but its pathogenesis is not fully understood. Several new theories have been proposed, and many have emphasized the importance of plasma amino acids. Recent studies have called into question the hypothesis that the ratio of aromatic to branched-chain amino acids in plasma is the key abonormality in this disorder.


Hepatic Encephalopathy Plasma Amino Acid Hepatic Coma Idiopathic Portal Hypertension Chronic Alcohol Consumption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Aguirre, A. L., Yoshimura, N., Westman, T., and Fischer, J. E., 1974, Plasma α-amino acids in dogs with two experimental forms of liver damage, J. Surg. Res. 16:339–345.PubMedCrossRefGoogle Scholar
  2. Branchey, L., Shaw, S., and Lieber, C. S., 1981, Ethanol impairs tryptophan transport into the brain and depresses serotonins Life Sci. 29:2751–2755.PubMedCrossRefGoogle Scholar
  3. Faraj, B. A., Bowen, P. A., Isaacs, J. W., and Rudman, D., 1976, Hypertyraminemia in cirrhotic patients, N. Engl. J. Med. 294:1360–1364.PubMedCrossRefGoogle Scholar
  4. Faraj, B. A., Fulwider, J. T., Rypins, E. B., Nordlinger, B., Ivey, G. L., Jansen, R. D., Ali, F. M., Camp, V. M., Kutner, M., Schmidt, F., and Rudman, D., 1979, Tyramine kinetics and metabolism in cirrhosis, J. Clin. Invest. 64:413–420.PubMedCrossRefGoogle Scholar
  5. Fernstrom, J. D., and Wurtman, R. J., 1972, Brain serotonin content: Physiological regulation by plasma neutral amino acids, Science 178:414–416.PubMedCrossRefGoogle Scholar
  6. Finkelstein, J. D., and Kyle, W. E., 1968, Ethanol effects on methionine metabolism in rat liver, Proc. Soc. Exp. Biol. Med. 129:497–501.PubMedGoogle Scholar
  7. Finkelstein, J. D., Cello, J. P., and Kyle, W. E., 1974, Ethanol induced changes in methionine metabolism in rat liver, Biochem. Biophys. Res. Commun. 61:525–531.PubMedCrossRefGoogle Scholar
  8. Fischer, J. E., Yoshimura, N., Aguirre, A., James, J. H., Cummings, M. G., Abel, R. M., and Deindorfer, F., 1974, Plasma amino acids in patients with hepatic encephalopathy: Effects of amino acid infusions, Am. J. Surg. 127:40–47.PubMedCrossRefGoogle Scholar
  9. Fischer, J. E., Funovics, J.M., Aguirre, A., James, J. H., Keane, J. M., Wesdorp, R. I. C., Yoshimura, N., Westman, T., 1975, The role of plasma amino acids in hepatic encephalopathy, Surgery 78:276–290.PubMedGoogle Scholar
  10. Fischer, J. E., Rosen, H. M., Ebeid, A. M., James, J. H., Keane, J. M., and Soeters, P. B., 1976, The effect of normalization of plasma amino acids on hepatic encephalopathy in man, Surgery 80:77–91.PubMedGoogle Scholar
  11. Holt, L. E., Snyderman, S. E., Norton, P. M., and Roitman, E., 1968, The plasma aminogram as affected by protein intake, in: Protein Nutrition and Free Amino Acid Patterns (J. H. Leathern, ed.), pp. 32–39, Rutgers University Press, New Brunswick, New Jersey.Google Scholar
  12. Hsu, J. M., 1979, Ethanol comsumption and free amino acids of rat plasma and liver, in: NIAAA Research Monograph 2: Alcohol and Nutrition (T.-K. Li, S. Schenker, and L. Lumeng, eds.), pp. 289–293, DHEW Publication (ADM) 79–780, U.S. Government Printing Office, Washington.Google Scholar
  13. Iber, F. L., Rosen, H., Levenson, S. M., and Chalmers, T. C., 1957, Plasma amino acids in patients with liver failure, J. Lab. Clin. Med. 50:417–425.PubMedGoogle Scholar
  14. Ishii, H., Kanno, T., Shigeta, Y., Takagi, S., Yasurakka, S., Kano, S., Takeshita, E., and Tsuchiya, M., 1976, Hepatic gamma glutamyl transpeptidase (GGTP) activity: Its activation by chronic ethanol administration, Gastroenterology 71:913.Google Scholar
  15. Iwasaki, Y., Sato, H., Ohkubo, A., Sanjo, T., Futagawa, S., Sugiura, M., and Tsuji, S., 1980, Effect of spontaneous portal-systemic shunting on plasma insulin and amino acid concentrations, Gastroenterology 78:677–683.PubMedGoogle Scholar
  16. James. H. J., Hodgman, J. M., Funovics, J. M., Yoshimura, N., and Fischer, J. E., 1976, Brain tryptophan, plasma free tryptophan and distribution of plasma neutral amino acids, Metabolism 25:471–476.PubMedCrossRefGoogle Scholar
  17. Levine, R. J., and Conn, H. O., 1967, Tyrosine metabolism in patients with liver disease, J. Clin. Invest. 46:2012–2020.PubMedCrossRefGoogle Scholar
  18. Morgan, M. Y., Milson, J. P., and Sherlock, S., 1978, Plasma ratio of valine, leucine and isoleucine to phenylalanine and tyrosine in liver disease, Gut 19:1068–1073.PubMedCrossRefGoogle Scholar
  19. Ning, M., Lowenstein, L. M., and Davidson, C. S., 1967, Serum amino acid concentrations in alcoholic hepatitis, J. Lab. Clin. Med. 70:554–562.PubMedGoogle Scholar
  20. Ono, J., Hutson, D. G., Dombro, R. S., Levi, J. U., Livingstone, A., and Zeppa, R., 1978, Tryptophan and hepatic coma, Gastroenterology 74:196–200.PubMedGoogle Scholar
  21. Rosen, H. M., Yoshimura, N., Hodgman, J. M., and Fischer, J. E., 1977, Plasma amino acid patterns in hepatic encephalopathy of differing etiology, Gastroenterology 72:438–488.Google Scholar
  22. Shaw, S., and Lieber, C. S., 1975, Plasma amino acids in alcoholic liver injury: Contrast with protein malnutrition, Clin. Res. 23:459.Google Scholar
  23. Shaw, S., and Lieber, C. S., 1978, Plasma amino acid abnormalities in the alcoholic; respective role of alcohol, nutrition and liver injury, Gastroenterology 74:677–682.PubMedGoogle Scholar
  24. Shaw, S., and Lieber, C. S., 1980, Increased hepatic production of alpha amino-n-butyric acid after chronic alcohol consumption in rats and baboons, Gastroenterology 78:108–113.PubMedGoogle Scholar
  25. Shaw, S., and Lieber, C. S., 1980, Mechanism of increased gamma glutamyl transpeptidase after chronic alcohol consumption: Hepatic microsomal induction rather than dietary imbalance, Substance Alc. Actions Misuse 1:423–428.Google Scholar
  26. Shaw, S., Stimmel, B., and Lieber, C. S., 1976, Plasma alpha amino-n-butyric acid to leucine ratio: An empirical biochemical marker of alcoholism, Science 194:105710–58.CrossRefGoogle Scholar
  27. Shaw, S., Worner, T. M., Borysow, M. F., Schmitz, R. E., and Lieber C. S., 1979, Detection of alcoholic relapse: Comparative diagnostic value of MCV, GGTP and AANB, Alcoholism: Clin. Exp. Res. 3:297–301.CrossRefGoogle Scholar
  28. Sherwin, R., Joshi, P., Hendler, R., Felig, P., and Conn, H., 1974, Hyperglucagonemia in Laennec’s cirrhosis, N. Engl. J. Med. 290:239–242.PubMedCrossRefGoogle Scholar
  29. Sies, H., Koch, O. R., Martino, E., and Boveris, A., 1979, Increased biliary glutathione disulfide release in chronically ethanol-treated rats, FEBS Lett. 103:287–290.PubMedCrossRefGoogle Scholar
  30. Soeters, P. B., and Fischer, J. E., 1976, Insulin, glucagon, aminoacid imbalance and hepatic encephalopathy, Lancet 2:880–882.PubMedCrossRefGoogle Scholar
  31. Stanko. R. T., Morse, E. L., and Adibi, S. A., 1979, Prevention of effects of ethanol on amino acid concentrations in plasma and tissues by hepatic lipotropic factors in rats, Gastroenterology 76:132–138.PubMedGoogle Scholar
  32. Swendseid, M. E., Tuttle, S. G., Figueroa, W. S., Mulcare, D., Clark, A. J., and Massey, F. J., 1966, Plasma amino acid levels of men fed diets differing in protein content. Some observations with valine-deficient diets, J. Nutr. 88:239–248.PubMedGoogle Scholar
  33. Swendseid, M. E., Yamada, C., Vinyard, E., and Figueroa, W. G., 1968, Plasma amino acid levels in young subjects receiving diets containing 14 or 3.5 grams nitrogen per day, Am. J. Clin. Nutr. 21:1381–1383.PubMedGoogle Scholar
  34. Teschke, R., Brand, A., and Strohmeyer, G., 1977, Induction of hepatic microsomal gamma-glutamyltransferase activity following chronic alcohol consumption, Biochem. Biophys. Res. Commun. 75:718–724.PubMedCrossRefGoogle Scholar
  35. Zinneman, H. H., Seal, U. S., and Doe, R. P., 1969, Plasma and urinary amino acids in Laennec’s cirrhosis, Am. J. Dig. Dis. 14:118–126.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1982

Authors and Affiliations

  • Spencer Shaw
    • 1
    • 2
  • Charles S. Lieber
    • 1
    • 2
  1. 1.Mount Sinai School of Medicine of the CityUniversity of New YorkNew YorkUSA
  2. 2.Alcohol Research and Treatment Center, Bronx Veterans Administration Medical CenterNew YorkUSA

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