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Tamil Journal of Science, Engineering and Technology
Volume 1, Number 1, Pages 67-81 (November 2016)
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Endothelial dysfunction in advanced liver disease

Tamil Journal of Science, Engineering and Technology, Vol. 1, No. 1, Pages 67-81, November 2016

Balasubramaniyan Vairappan

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ABSTRACT

This review describes the recent developments in the pathobiology of endothelial dysfunction (ED) in the context
of cirrhosis with portal hypertension and defines novel strategies and potential targets for therapy. ED has
prognostic implications by predicting unfavourable early hepatic events and mortality in patients with portal
hypertension and advanced liver diseases. ED characterised by an impaired bioactivity of nitric oxide (NO) within
the hepatic circulation and is mainly due to decreased bioavailability of NO and accelerated degradation of NO
with reactive oxygen species (ROS). Furthermore, elevated inflammatory markers also inhibit NO synthesis and
causes ED in cirrhotic liver. Therefore, improvement of NO availability in the hepatic circulation can be beneficial
for the improvement of endothelial dysfunction and associated portal hypertension in patients with cirrhosis.
Furthermore, therapeutic agents that are identified in increasing NO bioavailability through improvement of
hepatic endothelial nitric oxide synthase (eNOS) activity and reduction in hepatic asymmetric dimethylarginine
(ADMA), an endogenous modulator of eNOS and a key mediator of elevated intrahepatic vascular tone in cirrhosis
would be interesting therapeutic approaches in patients with endothelial dysfunction and portal hypertension
(PHT) in advanced liver diseases.
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