The Current Hepatic Encephalopathy Pipeline.
CHESS, clinical hepatic encephalopathy staging scale
FMT, fecal microbiota transplant
HE, hepatic encephalopathy
HESA, hepatic encephalopathy scoring algorithm
MAD, multiple-ascending dose
MES, modified encephalopathy scale
ORT, object recognition test
PEG, polyethylene glycol-3350
SAD, single-ascending dose
SEV, saccadic eye velocity
ammonia
antibiotics
fecal microbiota transplant
hepatic encephalopathy
lactulose
therapy
trials
Journal
Journal of clinical and experimental hepatology
ISSN: 0973-6883
Titre abrégé: J Clin Exp Hepatol
Pays: India
ID NLM: 101574137
Informations de publication
Date de publication:
Historique:
received:
13
09
2019
accepted:
06
01
2020
entrez:
14
7
2020
pubmed:
14
7
2020
medline:
14
7
2020
Statut:
ppublish
Résumé
Hepatic encephalopathy (HE) is a complication of acute or chronic liver failure; its mechanism is complex, involving multiple organ systems, and is still being elucidated. The standard of care, lactulose, has remained generally unchanged for decades. However, in recent years, better understanding of the pathophysiology has yielded new therapeutic targets for this reversible condition. These novel treatments act both on traditional pathways established in the ammonia hypothesis and through more recently discovered mechanisms. Here, we review contemporary investigational therapies for HE. We used narrative reviews and searched ClinicalTrials.gov database for the condition "hepatic encephalopathy" through August 29, 2019. Our review yielded six key areas of therapeutic focus: (1) antibiotics against urease-producing gut bacteria, (2) intravenous ammonia scavengers, (3) modified synthetic probiotics, (4) fecal microbiota transplant, (5) brain steroid-modulating agents, and 6) nonlactulose laxatives. Active trials are ongoing in each of these therapeutic areas.
Identifiants
pubmed: 32655239
doi: 10.1016/j.jceh.2020.01.001
pii: S0973-6883(20)30003-7
pmc: PMC7335727
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
377-385Informations de copyright
© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
R.S.R. served on advisory boards for Mallinckrodt and has received research support from Valeant and Mallinckrodt (formerly Ocera Therapeutics). M.L.D. and A.J.R. have nothing to disclose.
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