Moreover, increased Alcaligenaceae and Porphyromonadaceae, Veillonellaceae, Enterococcus, Megasphaera, and Burkholderia were related to the high ammonia levels and systemic inflammation and thus worsen the hepatic encephalopathy (HE) symptoms by means of ammoniagenesis and generation of endotoxin-driven inflammatory response (higher IL-6, TNF-α, IL-2, and IL-13) [29]. Here, IL6 is linked to hereditary elliptocytosis.