TNF and Hyperammonemia: Balzano et al. found that rats with chronic hyperammonemia and MHE experienced not only increased proinflammatory cytokines, such as IL-6, prostaglandin E2, IL-17 and TNF-α and reduced anti-inflammatory IL-10, but also microglial activation and increased messenger RiboNucleic Acid (mRNA) of IL-1β and TNF-α in the hippocampus of the rats, indicating the presence of both systemic and neuroinflammation in MHE [40].