Abstract
Cyclic GMP (cGMP) modulates important cerebral processes including some forms of learning and memory. cGMP pathways are strongly altered in hyperammonemia and hepatic encephalopathy (HE). Patients with liver cirrhosis show reduced intracellular cGMP in lymphocytes, increased cGMP in plasma and increased activation of soluble guanylate cyclase by nitric oxide (NO) in lymphocytes, which correlates with minimal HE assessed by psychometric tests. Activation of soluble guanylate cyclase by NO is also increased in cerebral cortex, but reduced in cerebellum, from patients who died with HE. This opposite alteration is reproduced in vivo in rats with chronic hyperammonemia or HE. A main pathway modulating cGMP levels in brain is the glutamate-NO-cGMP pathway. The function of this pathway is impaired both in cerebellum and cortex of rats with hyperammonemia or HE. Impairment of this pathway is responsible for reduced ability to learn some types of tasks. Restoring the pathway and cGMP levels in brain restores learning ability. This may be achieved by administering phosphodiesterase inhibitors (zaprinast, sildenafil), cGMP, anti-inflammatories (ibuprofen) or antagonists of GABAA receptors (bicuculline). These data support that increasing cGMP by safe pharmacological means may be a new therapeutic approach to improve cognitive function in patients with minimal or clinical HE.
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Aguilar MA, Miñarro J, Felipo V (2000) Chronic moderate hyperammonemia impairs active, passive avoidance behavior, conditional discrimination learning in rats. Exp Neurol 161:704–713
Amodio P, Del Piccolo F, Marchetti P, Angeli P, Iemmolo R, Caregaro L, Merkel C, Gerunda G, Gatta A (1999) Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests. Hepatology 29:1662–1667
Amodio P, Montagnese S, Gatta A, Morgan MY (2004) Characteristics of minimal hepatic encephalopathy. Metab Brain Dis 19:253–267
Andrew CR, Green EL, Lawson DM, Eady RR (2001) Resonance raman studies of cytochrome c’ support the binding of NO and CO to opposite sides of the heme: implications for ligand discrimination in heme-based sensors. Biochemistry 40:4115–4122
Barnstable CJ, Wei JY, Han MH (2004) Modulation of synaptic function by cGMP and cGMP-gated cation channels. Neurochem Int 45:875–884
Bernabeu R, Scmitz P, Faillace MP, Izquierdo I, Medina JM (1996) Hippocampal cGMP, cAMP are differentially involved in memory processing of inhibitory avoidance learning. NeuroReport 7:585–588
Bernabeu R, Schroder N, Quevedo J, Cammarota M, Izquierdo I, Medina JM (1997) Further evidence for the involvement of a hippocampal cGMP/cGMP-dependent protein kinase cascade in memory consolidation. NeuroReport 8:2221–2224
Bliss TVP, Collingridge GL (1993) A synaptic model of memory: long-term potentiation in the hippocampus. Nature 361:31–39
Boulton CL, Southam E, Garthwaite J (1995) Nitric oxide-dependent long-term potentiation is blocked by a specific inhibitor of soluble guanylyl cyclase. Neuroscience 69:699–703
Brune B, Schmidt KU, Ullrich V (1990) Activation of soluble guanylate cyclase by carbon monoxide and inhibition by superoxide anion. Eur J Biochem 192:683–688
Cauli O, Rodrigo R, Piedrafita B, Boix J, Felipo V (2007) Inflammation, hepatic encephalopathy: ibuprofen restores learning ability in rats with porto-caval shunts. Hepatology 46:514–519
Cauli O, Rodrigo R, Boix J, Piedrafita B, Agusti A, Felipo V (2008) Acute liver failure-induced death of rats is delayed or prevented by blocking NMDA receptors in brain. Am J Physiol Gastr Liv Physiol 295:G503–G511
Cauli O, Mansouri MT, Agusti A, Felipo V (2009) Hyperammonemia increases GABAergic tone in cerebellum but decreases it in cortex of rats. Role in cognitive impairment. Gastroenterology 136:1359–1367
Corbalán R, Miñana MD, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V (2002a) Altered modulation of soluble guanylate cyclase in lymphocytes from patients with liver disease. J Mol Med 80:117–123
Corbalán R, Chatauret N, Behrends S, Butterworth RF, Felipo V (2002b) Region selective alterations of soluble guanylate cyclase content and modulation in brain of cirrhotic patients. Hepatology 36:1155–1162
Davis S, Butcher SP, Morris RG (1992) The NMDA receptor antagonist D-2-amino-5-phosphonopentanoate (D-AP5) impairs spatial learning and LTP in vivo at intracerebral concentrations comparable to those that block LTP in vitro. J Neurosci 12:21–34
Dawson VL, Dawson TM, London ED, Bredt DS, Snyder SH (1991) Nitric oxide mediates glutamate neurotoxicity in primary cortical cultures. Proc Natl Acad Sci USA 88:6368–6371
Dawson VL, Dawson T, Bartley DA, Uhl GR, Snyder SH (1993) Mechanisms of nitric oxide-mediated neurotoxicity in primary brain cultures. J Neurosci 13:2651–2661
Degerman E, Belfrage P, Manganiello VC (1996) cGMP-inhibited phosphodiesterases (PDE3 gene family). Biochem Soc Trans 24:1010–1014
Elithorn A, Lunzer M, Weinman J (1975) Cognitive deficit associated with chronic hepatic encephalopathy and their response to levodopa. J Neurol Neurosurg Psych 38:794–798
El-Mlili N, Rodrigo R, Naghizadeh B, Cauli O, Felipo V (2008) Chronic hyperammonemia reduces the activity of neuronal nitric oxide synthase in cerebellum by altering its localization and increasing its phosphorylation by calcium-calmodulin kinase II. J Neurochem 106:440–1449
Erceg S, Monfort P, Hernández-Viadel M, Llansola M, Montoliu C, Felipo V (2005a) Restoration of learning ability in hyperammonemic rats by increasing extracellular cGMP in brain. Brain Res 1036:115–121
Erceg S, Monfort P, Hernández-Viadel M, Rodrigo R, Montoliu C, Felipo V (2005b) Oral administration of sildenafil restores learning ability in rats with hyperammonemia, with portacaval shunt. Hepatology 45:2–10
Fedele E, Jin Y, Varnier G, Raiteri M (1996) In vivo microdialysis study of a specific inhibitor of soluble guanylyl cyclase on the glutamate receptor/nitric oxide/cyclic GMP pathway. Br J Pharmacol 119:590–594
Felipo V (2008) Hyperammonemia. In Handbook of neurochemistry and molecular neurobiology, vol 24, 3rd edn. Kluwer Academic/Plenum, USA, pp 1–27
Felipo V, Butterworth RF (2002) Neurobiology of ammonia. Prog Neurobiol 67:259–279
Felipo V, Hermenegildo C, Montoliu C, Llansola M, Miñana MD (1998) Neurotoxicity of ammonia and glutamate: molecular mechanisms and prevention. NeuroToxicology 19:675–682
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721
García-Moreno LM, Conejo NM, González-Pardo H, Aller MA, Nava MP, Arias J, Arias JL (2005) Evaluation of two experimental models of hepatic encephalopathy in rats. Braz J Med Biol Res 38:127–132
Gilberstadt SJ, Gilberstadt H, Zieve L, Buegel B, Collier RO Jr, McClain CJ (1980) Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch Intern Med 140:519–521
Gordon N (2007) The cerebellum and cognition. Eur J Paediatr Neurol 11:232–234
Hawkins RD (1996) NO honey, I don’t remember. Neuron 16:465–467
Hermenegildo C, Marcaida G, Montoliu C, Grisolia S, Minana MD, Felipo V (1996) NMDA receptor antagonists prevent acute ammonia toxicity in mice. Neurochem Res 21:1237–1244
Hermenegildo C, Montoliu C, Llansola M, Muñoz MD, Gaztelu JM, Miñana MD, Felipo V (1998) Chronic hyperammonemia impairs glutamate-nitric oxide-cyclic GMP pathway in cerebellar neurons in culture and in the rat in vivo. Eur J NeuroSci 10:3201–3209
Hermenegildo C, Monfort P, Felipo V (2000) Activation of NMDA receptors in rat brain in vivo following acute ammonia intoxication. Characterization by in vivo brain microdialysis. Hepatology 31:709–715
Hilgier W, Oja SS, Saransaari P, Albrecht J (2004) A novel glycine site-specific N-methyl-D-aspartate receptor antagonist prevents activation of the NMDA/NO/cGMP pathway by ammonia. Brain Res 1015:186–188
Hofmann F, Bernhard D, Lukowski R, Weinmeister P (2009) cGMP regulated protein kinases (cGK). Handb Exp Pharmacol 191:137–162
Humbert P, Niroomand F, Fischer G, Mayer B, Koesling D, Hinsch KD, Gausepohl H, Frank R, Schultz G, Bohme E (1990) Purification of soluble guanylate cyclase from bovine lung by a new immunoaffinity chromatographic method. Eur J Biochem 190:273–278
Jin XH, Siragy HM, Carey RM (2001) Renal interstitial cGMP mediates natriuresis by direct tubule mechanism. Hypertension 38:309–316
Kleppisch T (2009) Phosphodiesterases in the central nervous system. Handb Exp Pharmacol 191:71–92
Konopacka A, Zielińska M, Albrecht J (2008) Ammonia inhibits the C-type natriuretic peptide-dependent cyclic GMP synthesis and calcium accumulation in a rat brain endothelial cell line. Neurochem Int 52:1160–1166
Konopacka A, Konopacki FA, Albrecht J (2009) Protein kinase G is involved in ammonia-induced swelling of astrocytes. J Neurochem 109(Suppl 1):246–251
Kosenko E, Kaminsky YG, Felipo V, Miñana MD, Grisolía S (1993) Chronic hyperammonemia prevents changes in brain energy and ammonia metabolites induced by acute ammonium intoxication. Biochim Biophys Acta 1180:321–326
Kuhn M (2009) Function and dysfunction of mammalian membrane guanylyl cyclase receptors: lessons from genetic mouse models and implications for human diseases. Handb Exp Pharmacol 191:47–69
Lin CS, Lin G, Xin ZC, Lue TF (2006) Expression, distribution and regulation of phosphodiesterase 5. Curr Pharm Des 12:3439–3457
Llansola M, Hernandez-Viadel M, Erceg S, Montoliu C, Felipo V (2009) Increasing the function of the glutamate-nitric oxide-cGMP pathway increases the ability to learn a Y maze task. J Neurosci Res 87:2351–2355
Lucas KA, Pitari GM, Kazerounian S, Ruiz-Stewart I, Park J, Schulz S, Chepenik KP, Waldman SA (2000) Guanylyl cyclases and signaling by cyclic GMP. Pharmacol Rev 52:375–414
Marcaida G, Felipo V, Hermenegildo C, Miñana MD, Grisolía S (1992) Acute ammonia toxicity is mediated by the NMDA type of glutamate receptors. FEBS Lett 296:67–68
Marcaida G, Miñana MD, Grisolía S, Felipo V (1995) Lack of correlation between glutamate-induced depletion of ATP and neuronal death in primary cultures of cerebellum. Brain Res 695:146–150
McCrea M, Cordoba J, Vessey G, Blei AT, Randolph C (1996) Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol 53:758–763
Méndez M, Méndez-López M, López L, Aller MA, Arias J, Cimadevilla JM, Arias JL (2008a) Spatial memory alterations in three models of hepatic encephalopathy. Behav Brain Res 188:32–40
Méndez M, Méndez-López M, López L, Aller MA, Arias J, Arias JL (2008b) Working memory impairment and reduced hippocampal and prefrontal cortex c-Fos expression in a rat model of cirrhosis. Physiol Behav 95:302–307
Méndez M, Méndez-López M, López L, Aller MA, Arias J, Arias JL (2009) Associative learning deficit in two experimental models of hepatic encephalopathy. Behav Brain Res 98:346–351
Miñana MD, Felipo V, Grisolía S (1988) Protective effect of long term ammonium ingestion against acute ammonium intoxication. Biochem Biophys Res Commun 153(979):983
Miñana MD, Hermenegildo C, Llansola M, Montoliu C, Grisolía S, Felipo V (1996) Carnitine and choline derivatives containing a trimethylamine group prevent ammonia toxicity in mice and glutamate toxicity in primary cultures of neurons. J Pharmacol Exp Ther 279:194–199
Monfort P, Montoliu C, Hermenegildo C, Muñoz MD, Felipo V (2000) Differential effects of acute and chronic hyperammonemia on signal transduction pathways associated to NMDA receptors. Neurochem Int 37:249–253
Monfort P, Corbalán R, Martinez L, López-Talavera JC, Córdoba J, Felipo V (2001) Altered content and modulation of soluble guanylate cyclase in the cerebellum of rats with portacaval anastomosis. Neuroscience 104:1119–1125
Monfort P, Muñoz MD, Kosenko E, Felipo V (2002a) Long-term potentiation in hippocampus involves sequential activation of soluble guanylate cyclase, cGMP-dependent protein kinase and cGMP-degrading phosphodiesterase. J Neurosci 22:10116–10122
Monfort P, Muñoz MD, ElAyadi A, Kosenko E, Felipo V (2002b) Effects of hyperammonemia and liver disease on glutamatergic neurotransmission. Metab Brain Dis 17:237–250
Monfort P, Muñoz MD, Felipo V (2004a) Hyperammonemia impairs long-term potentiation in hippocampus by altering the modulation of cGMP-degrading phosphodiesterase by protein kinase G. Neurobiol Dis 15:1–10
Monfort P, Muñoz MD, Kosenko E, Llansola M, Sánchez-Pérez A, Cauli O, Felipo V (2004b) Sequential activation of soluble guanylate cyclase, protein kinase G and cGMP-degrading phosphodiesterase is necessary for proper induction of long-term potentiatio in CA1 of hippocampus. Alterations in hyperammonemia. Neurochem Int 45:895–902
Monfort P, Muñoz MD, Felipo V (2005) Chronic hyperammonemia in vivo impairs long-term potentiation in hippocampus by altering activation of cGMP dependent-protein kinase and of phosphodiesterase 5. J Neurochem 94:934–942
Monfort P, Erceg S, Piedrafita B, Llansola M, Felipo V (2007) Chronic liver failure in rats impairs glutamatergic synaptic transmission and long-term potentiation in hippocampus and learning ability. Eur J NeuroSci 25:2103–2111
Monfort P, Cauli O, Montoliu C, Rodrigo R, Llansola M, Piedrafita B, El Mlili N, Boix J, Agustí A, Felipo V (2009) Mechanisms of cognitive alterations in hyperammonemia and hepatic encephalopathy. Therapeutical implications. Neurochem Int 55:106–112
Montoliu C, Llansola M, Kosenko E, Corbalán R, Felipo V (1999) Role of cyclic GMP in glutamate neurotoxicity in primary cultures of cerebellar neurons. Neuropharmacology 38:1883–1891
Montoliu C, Kosenko E, Calvete JJ, Nies A, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V (2004) Increased protein kinase A regulatory subunit and cGMP binding in erythrocyte membranes in liver cirrhosis. J Hepatol 40:766–773
Montoliu C, Kosenko E, Del Olmo JA, Serra MA, Rodrigo JM, Felipo V (2005) Correlation of nitric oxide and atrial natriuretic peptide changes with altered cGMP homeostasis in liver cirrhosis. Liver Int 25:787–795
Montoliu C, Piedrafita B, Serra MA, del Olmo JA, Ferrandez A, Rodrigo JM, Felipo V (2007) Activation of soluble guanylate cyclase by nitric oxide in lymphocytes correlates with minimal hepatic encephalopathy in cirrhotic patients. J Mol Med 85:233–241
Muñoz MD, Monfort P, Gaztelu JM, Felipo V (2000) Hyperammonemia impairs NMDA receptor-dependent long-term potentiation in the CA1 of rat hippocampus in vitro. Neurochem Res 25:437–441
Oliveri M, Torriero S, Koch G, Salerno S, Petrosini L, Caltagirone C (2007) The role of transcranial magnetic stimulation in the study of cerebellar cognitive function. Cerebellum 6:95–101
Piedrafita B, Cauli O, Montoliu C, Felipo V (2007) The function of the glutamate-nitric oxide-cGMP pathway in brain in vivo, learning ability decrease in parallel in mature compared to young rats. Learn Mem 14:254–258
Piedrafita B, Erceg S, Cauli O, Felipo V (2008) Developmental exposure to polychlorinated biphenyls or methylmercury, but not to its combination, impairs the glutamate-nitric oxide-cyclic GMP pathway, learning in 3 months-old rats. Neuroscience 1544:1408–1416
Prickaerts J, Sik A, van Staveren WC, Koopmans G, Steinbusch HW, van der Staay FJ, de Vente J, Blokland A (2004) Phosphodiesterase type 5 inhibition improves early memory consolidation of object information. Neurochem Int 45:915–928
Rehnström S, Simert G, Hansson JA, Johnson G, Vang J (1977) Chronic hepatic encephalopathy. A psychometrical study. Scand J Gastroenterol 12:305–311
Rikkers L, Jenko P, Rudman D, Freides D (1978) Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462–469
Rodrigo R, Montoliu C, Chatauret N, Butterworth R, Behrends S, Del Olmo JA, Serra MA, Rodrigo JM, Erceg S, Felipo V (2004) Alterations in soluble guanylate cyclase content and modulation by nitric oxide in liver disease. Neurochem Int 45:947–954
Rodrigo R, Jover R, Candela A, Compañ A, Sáez-Valero J, Erceg S, Felipo V (2005a) Bile duct ligation plus hyperammonemia in rats reproduces the alterations in the modulation of soluble guanylate cyclase by nitric oxide in brain of cirrhotic patients. Neuroscience 130:435–443
Rodrigo R, Erceg S, Felipo V (2005b) Neurons exposed to ammonia reproduce the differential alteration in nitric oxide modulation of guanylate cyclase in cerebellum and cortex of patients with liver cirrhosis. Neurobiol Dis 19:150–161
Rodrigo R, Erceg S, Rodriguez-Diaz J, Saez-Valero J, Piedrafita B, Suarez I, Felipo V (2007) Glutamate-induced activation of nitric oxide synthase is impaired in cerebral cortex in vivo in rats with chronic liver failure. J Neurochem 102:51–64
Rutten K, Vente JD, Sik A, Ittersum MM, Prickaerts J, Blokland A (2005) The selective PDE5 inhibitor, sildenafil, improves object memory in Swiss mice and increases cGMP levels in hippocampal slices. Behav Brain Res 164:11–16
Sager G (2004) Cyclic GMP transporters. Neurochem Int 45:865–873
Schomerus H, Hamster W (1998) Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 13:361–377
Smith S, Dringenberg HC, Bennett BM, Thatcher GRJ, Reynolds JN (2000) A novel nitrate ester reverses the cognitive impairment caused by scopolamine in the Morris water maze. NeuroReport 11:3883–3886
Stone JR, Marletta MA (1996) Spectral and kinetic studies on the activation of soluble guanylate cyclase by nitric oxide. Biochem 35:1093–1099
Tarter RE, Hegedus AM, Van Thiel DH, Schade RR, Gavaler JS, Starzl TE (1984) Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterology 86:1421–1427
Tarter RE, Arria AM, Carra J, Van Thiel DH (1987) Memory impairments concomitant with nonalcoholic cirrhosis. Int J Neurosci 32:853–859
Thiesson HC, Jensen BL, Jespersen B, de Muckadell OBS, Bistrup C, Walter S, Ottosen PD, Veje A, Skott O (2005) Inhibition of cGMP-specific phosphodiesterase type 5 reduces sodium excretion and arterial blood pressure in patients with NaCl retention and ascites. Am J Physiol 288:F1044–F1052
Tzathas C, Christidou A, Ladas SD (2002) Sildenafil (viagra) is a risk factor for acute variceal bleeding. Am J Gastroenterol 97:1856
Weissenborn K, Heidenreich S, Giewekemeyer K, Rückert N, Hecker H (2003) Memory function in early hepatic encephalopathy. J Hepatol 39:320–325
Yamada K, Hiramatsu M, Noda Y, Mamiya T, Murai M, Kameyama T, Komori Y, Nikai T, Sugihara H, Nabeshima T (1996) Role of nitric oxide, cyclic GMP in the dizocilpine-induced impairment of spontaneous alternation behaviour in mice. Neuroscience 74:365–374
Zaccolo M, Movsesian MA (2007) cAMP and cGMP signaling cross-talk: role of phosphodiesterases and implications for cardiac pathophysiology. Circ Res 100:1569–78
Zielińska M, Fresko I, Konopacka A, Felipo V, Albrecht J (2007) Hyperammonemia inhibits the natriuretic peptide receptor 2 (NPR-2)-mediated cyclic GMP synthesis in the astrocytic compartment of rat cerebral cortex slices. Neurotoxicology 28:1260–1263
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Supported by grants from Ministerio de Ciencia e Innovacion (SAF2005-06089, SAF2008-00062, CSD2008-00005) and from Ministerio de Sanidad (FIS 06/0065) of Spain and from Conselleria de Educacion de la Generalitat Valenciana (ACOMP/2009/191; ACOMP06/005, ACOMP-2009-025; PROMETEO/2009/027) and AP005/06, EVES 034/2007, AP-024/08 and A-01/08 from Conselleria de Sanitat of Generalitat Valenciana.
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Montoliu, C., Rodrigo, R., Monfort, P. et al. Cyclic GMP pathways in hepatic encephalopathy. Neurological and therapeutic implications. Metab Brain Dis 25, 39–48 (2010). https://doi.org/10.1007/s11011-010-9184-z
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DOI: https://doi.org/10.1007/s11011-010-9184-z