Cytokines and Inflammatory Factors

The release of toxic substances by necrotic liver cells is axiomatic and is strongly suspected to play some role in edema formation. This is supported by the clinical observation that patients with acute liver failure may respond to total hepatectomy with an immediate and significant lowering of ICP with improved overall hemodynamics.12 Candidate substances include the inflammatory cytokines, such as IL-1, IL-6 or TNF-a.2 The latter has, in fact, been shown to alter the permeability of the blood-brain barrier.13 It has also been suggested that various elements of the arachidonic acid cascade may also be important contributing factors. Unfortunately, in experimental anhepatic models, animals may still proceed to develop cerebral edema, suggesting a more complex etiology for edema formation.

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