Ho are able to give written informed consent. Patients were diagnosed with cirrhosis if they had biopsy evidence, radiological MedChemExpress 548-04-9 evidence or endoscopic evidence of varices). We excluded patients with prior overt HE, who had a recent minimental status exam result of ,25, those who scored better than the inclusion criteria on the cognitive tests and those with prior TIPS or overt HE. For the first visit, we gave the patients the tests again to confirm the MHE status and to account for any learning effect. The patients were prescribed open-label rifaximin 550 mg PO BID for 8 weeks and the tests were repeated at the end of the study. Subjects were advised to inform the study staff of any adverse events and adherence was assessed at week 8 by the percentage of pills returned. This report is the microbiome, metabolome and cognitive analysis of this open-label trial that also involved MR imaging of the brain before and after rifaximin. It is registered at www.Metabiome and Rifaximin in CirrhosisFigure 1. Consort Flowchart of the Open-label trial. doi:10.1371/journal.pone.0060042.gscore scatter plots were generated for at least the first three dimensionless principal components or PLS vectors, and 3D plots were generated to better distinguish metabolic phenotypes if needed. Third, loading plots were generated for each vector in PCA or PLS, showing the impact of variables on the formation of vectors. The abundances of the bacterial identifications were normalized and taxa present at 25837696 .1 of the community were tabulated. Unifrac analysis was performed using Version 1.3.0 of Quantitative Insights into Microbial Ecology (QIIME) and weighted Pvalues were calculated using a Bonferroni correction. Correlation networks were performed separately for groups before and after rifaximin. The microbiome features along with endotoxin, ammonia, and metabolomics were correlated using a Spearman’s correlation function and then filtered for correlations .0.60 and p,0.05. These correlates were calculated using a custom R module, and the correlations and corresponding attributes were imported into Cytoscape for visualization of the network models [21]. The Intersection of the networks was done using the advanced network merge function in Cytoscape. A Correlation Difference (CorrDiff) network was calculated using a R module which extracts edges whose correlations are statistically differentbetween the before and after treatment with a P value ,0.05 and where at least one of the 1485-00-3 site original correlations was greater than 0.06 [22,23]. We then compared the network topology of the network before and after rifaximin to identify which sub-networks were present in one and not the other, giving us clues on system functionality [24]. It is assumed that correlations present in one treatment group that are missing in another not only differentiate the groups but indicate potential clues to the functionality of the system, leading the way to hypothesis-driven experimental research.Results Rifaximin TrialAll patients were able to complete the trial with rifaximin 550 mg BID for 8 weeks. The overall compliance with the medication was 92 . We included 20 patients, 14 men and 6 women with a mean age of 59.763.5 years and education of 1461.7 years. The majority was Caucasian (14, 70 ) with the remainder being African American (6, 30 ). The predominant etiology was hepatitis C (7, 35 ), followed by alcohol+hepatitis C (4, 20 ), non-alcoholic fatty liver disease (4, 20 ), alcohol aloneMetab.Ho are able to give written informed consent. Patients were diagnosed with cirrhosis if they had biopsy evidence, radiological evidence or endoscopic evidence of varices). We excluded patients with prior overt HE, who had a recent minimental status exam result of ,25, those who scored better than the inclusion criteria on the cognitive tests and those with prior TIPS or overt HE. For the first visit, we gave the patients the tests again to confirm the MHE status and to account for any learning effect. The patients were prescribed open-label rifaximin 550 mg PO BID for 8 weeks and the tests were repeated at the end of the study. Subjects were advised to inform the study staff of any adverse events and adherence was assessed at week 8 by the percentage of pills returned. This report is the microbiome, metabolome and cognitive analysis of this open-label trial that also involved MR imaging of the brain before and after rifaximin. It is registered at www.Metabiome and Rifaximin in CirrhosisFigure 1. Consort Flowchart of the Open-label trial. doi:10.1371/journal.pone.0060042.gscore scatter plots were generated for at least the first three dimensionless principal components or PLS vectors, and 3D plots were generated to better distinguish metabolic phenotypes if needed. Third, loading plots were generated for each vector in PCA or PLS, showing the impact of variables on the formation of vectors. The abundances of the bacterial identifications were normalized and taxa present at 25837696 .1 of the community were tabulated. Unifrac analysis was performed using Version 1.3.0 of Quantitative Insights into Microbial Ecology (QIIME) and weighted Pvalues were calculated using a Bonferroni correction. Correlation networks were performed separately for groups before and after rifaximin. The microbiome features along with endotoxin, ammonia, and metabolomics were correlated using a Spearman’s correlation function and then filtered for correlations .0.60 and p,0.05. These correlates were calculated using a custom R module, and the correlations and corresponding attributes were imported into Cytoscape for visualization of the network models [21]. The Intersection of the networks was done using the advanced network merge function in Cytoscape. A Correlation Difference (CorrDiff) network was calculated using a R module which extracts edges whose correlations are statistically differentbetween the before and after treatment with a P value ,0.05 and where at least one of the original correlations was greater than 0.06 [22,23]. We then compared the network topology of the network before and after rifaximin to identify which sub-networks were present in one and not the other, giving us clues on system functionality [24]. It is assumed that correlations present in one treatment group that are missing in another not only differentiate the groups but indicate potential clues to the functionality of the system, leading the way to hypothesis-driven experimental research.Results Rifaximin TrialAll patients were able to complete the trial with rifaximin 550 mg BID for 8 weeks. The overall compliance with the medication was 92 . We included 20 patients, 14 men and 6 women with a mean age of 59.763.5 years and education of 1461.7 years. The majority was Caucasian (14, 70 ) with the remainder being African American (6, 30 ). The predominant etiology was hepatitis C (7, 35 ), followed by alcohol+hepatitis C (4, 20 ), non-alcoholic fatty liver disease (4, 20 ), alcohol aloneMetab.