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Matrix metalloproteinases (MMPs) are up-regulated by pro-inflammatory cytokines, as well as by acute phase proteins like serum amyloid A (SAA), with counter-regulatory inhibition by IL-4 and IL-13, and released into the circulation from damaged vascular endothelium

These observations are very important as lactate does not only act as an osmolyte but is also an essential energy metabolite, reflecting potential cerebral energy impairment in patients with HE

Particles larger than 20 nm evade hepatic filtration but show brain uptake of less than 1%

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