Non-invasive identification of brain signatures of acute liver injury

Background: In many disorders, metabolic and inflammatory derangements that originate in peripheral organs have a deleterious impact on the brain.Brain functional impairment, defined as hepatic encephalopathy, is one of the main diagnostic criteria for acute liver failure (ALF), a severe complication of acute liver injury (ALI).While brain inflammation (neuroinflammation) and metabolic alterations significantly contribute to hepatic encephalopathy, their non-invasive evaluation remains challenging.Methods: To address this limitation, we utilized dual radiotracer [ 18 F]-fluoro-2-deoxy-2-D-glucose ([ 18 F]FDG) and [ 11 C]-peripheral benzodiazepine receptor ([ 11 C]PBR28) microPET imaging followed by conjunction analysis and metabolic connectivity mapping.We applied this advanced methodology in mice with high dose acetaminophen (N-acetyl-p-aminophenol, APAP)-induced ALI, which can progress into ALF.Results: We observed hepatocellular damage, liver and systemic inflammation, and increased density of hippocampal microglia in mice with ALI.MicroPET imaging analysis characterized the presence of brain region-specific neuroinflammation and altered brain energy metabolism in mice with ALI.We also identified both gains and losses in connectivity, as well as a dual role of neuroinflammation.These results revealed brain "neuroinflammetabolic" signatures of ALI.Conclusion: These findings provide a platform for non-invasively diagnosing early signs of hepatic encephalopathy with the goal of informing timely diagnoses and targeted therapies.Our approach can be further utilized in non-invasive brain assessments in liver diseases and other disorders classically characterized by peripheral immune and metabolic dysregulation.