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Liver disease leads to hepatic encephalopathy with alteration of 73 cerebrospinal fluid metabolites including amino acids, acylcarnitines, bile acids, nucleosides and acetylated compounds possibly due to defects of the Krebs cycle and alterations of ammonia, amino-acid and energy metabolism 73

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It is also an important thiol buffer, maintaining sulfhydryl groups in their reduced form, an additional mechanism for cellular signaling