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The horizontal axis represents the directional intensity of the metabolite peak abundance fold change (FC) and the vertical axis represents statistical significance

Those cell changes inhibit glutamine synthesis and glutamate receptor expression, reducing its neuronal uptake and triggering an imbalance in the glutamate-glutamine cycle with the consequent increase in brain blood flow, edema, and intracranial pressure, leading to the neuropsychiatric and neurologic clinical manifestations seen in HE.16 6 Systemic inflammation, oxidative stress, alterations in intestinal permeability and the gut microbiota, sarcopenia, zinc deficiency, and neurogliovascular unit dysfunction are other factors that contribute to the presence and severity of HE