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may activate microglia. Additional factors would Additional studies to identify and test new targets to
act synergistically with hyperammonemia to induce reduce neuroinflammation in MHE without inducing
pro-inflammatory factors and neuroinflammation in secondary effects would be very useful to develop
chronic liver failure. new therapeutic tools to reverse the cognitive and
motor alterations in patients with MHE and clinical
THERAPEUTIC IMPLICATIONS HE associated with chronic liver diseases.

The in vivo studies reported above in animal models ACKNOWLEDGMENTS
show that neuroinflammation would be a key
therapeutic target to improve the cognitive and motor Supported by grants from Ministerio de Ciencia e
alterations in MHE and overt HE. However, different Innovación (SAF2011-23051, CSD2008-00005),
approaches can be used to reduce neuroinflammation Consellería Educación Generalitat Valenciana
in chronic liver disease, but it is important to take (PROMETEO-2009-027, PROMETEOII/2014/033,
into account the possible secondary effects of each ACOMP/2012/066, and ACOMP/2013/101).
treatment, which may depend on the type and grade
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