Emerging evidence suggests that non-hepatic hyperammonemia enhances aquaporin-4 (AQP4) expression in astrocytes via the gut-microbiota-brain axis (MGBA), inducing astrocyte edema, decreasing cerebral blood flow, and causing neuronal damage, leading to worsening of SAE (Zhao et al., 2024). Here, AQP4 is linked to Hyperammonemia.