1) Ammonia is produced in tissues and transported to the liver where it is detoxified to urea in the urea cycle. The three main transport forms are glutamate, glutamine, and alanine.
2) The urea cycle converts ammonia and carbon dioxide to urea using enzymes in the liver mitochondria and cytoplasm. This prevents ammonia toxicity.
3) Genetic defects in urea cycle enzymes can cause hyperammonemia, leading to complications like cerebral edema, seizures, coma and death if not treated. Treatment aims to reduce ammonia levels and promote its excretion through alternate pathways.
1. Dr. N. Sivaranjani
Asst. Prof.
1
BY
VANA JAGAN MOHAN RAO M.S.Pharm, MED.CHEM
NIPER,KOLKATA
Asst. Professor, MIPER- KURNOOL
Email: jaganvana6@gmail.com
2. * Ammonia is produced in most tissues – less than 1% is TOXIC
especially to CNS
Readily ionizes to ammonium ion NH4
+
*It is immediately removed from the circulation and detoxified to
Urea in the LIVER.
* Three transport forms of NH3 from peripheral tissues to LIVER:
1. Glutamate – ALL tissues
2. Glutamine – Brain
3. Alanine - Muscle
4NH +
pKa = 9.3
NH3 + H+
2
4. Glucose-Alanine cycle
4
• Glucose Alanine
Cycle / Cahill Cycle
Plays a dual role :
• Transports ammonia from
muscle to liver in a non-toxic
form (Alanine)
• Transports carbon skeleton to
liver for gluconeogenesis
Alanine is safe way to transport ammonia from muscle to liver via blood.
5. Amino acids
G
L
U
T
A
M
A
T
E NH3
α Keto glutarate
Glutamate dehydrogenase
Transamination
Glutamine
Glutamate
Glutamate
NH3
Urea
Glutamine synthetase
Glutaminase
Alanine
Brain
Liver
Aspargine
Muscle
All cells
Pyruvate
NH3
Aspartate
Aspartate
Liver
Liver
5
6. Sources of Ammonia
6
Intestine
GLUTAMINE Glutamate
Bacterial
degradation
of Urea
GDH
GLUTAMATE
Serine Threonine Histidine
Pyruvate α KB Urocanate
NH4
+
Purine
Pyrimidine
Catabolism
ASPARGINE Aspartate
Oxidation of Monoamine
by MAO
Amino Sugars
Non Oxidative Deamination
Oxidative
Deamination
7. Biochemical basis of Ammonia toxicity
7
• In Brain cell Mitochondria – excess NH3 reacts with αKG to
form GLUTAMATE by GDH – dec. αKG – dec. TCA cycle- dec.
Glucose utilization & ATP generation. not universally
accepted.
Glutamate depletion – NH3 Inhibits glutaminase – depletes
glutamate which is a excitatory NT.
Glutamine is accumulated in neurons – osmotic shift of H2O
into the cell- Edema & swelling of Astrocytes.
8. Neuronal dysfunction – inc.
permeability of K+ & Cl- ions
Accumulation of Excito-
toxins – inc. transport of
Tryptophan across BBB – its
Metabolites are accumulated
– which are Excito-toxins.
8
9. Excretory forms of Nitrogen
9
Mammals including
human beings
The basic features of
nitrogen metabolism
were elucidated
initially in pigeons
10. Urea cycle
10
Krebs–Henseleit urea cycle / Ornithine cycle
Site – LIVER
Subcellular organelle – Mitochondria , cytoplasm – 2 steps occur in
mitochondria, remaining in the cytosol.
Converts NH3 into harmless Urea
11. • Disposable form of NH3
• Accounts for 90% of NPN in Urine
UREA
• 1 N – Ammonia
• 2 N – Aspartate
• C & O – CO2
11
12. H3N-CO-O-PO3
NH3 + CO2 + H2O
2 ATP
2 ADP + Pi
Carbamoyl Phosphate
Citrulline
Argininosuccinate
Ornithine
Aspartate
UREA
H2O
Argininosuccinate lyase
Arginase
H2N-CO-NH2
Transporter
Carbamoyl PO4 synthetase I
Ornithine Trans Carbamoylase
Argininosuccinate synthetase
12
Cytosol
13. Significance Of Urea Cycle
13
2 N of urea ( H2N-CO-NH2) – NH3 , amino N of Aspartate
Disposes 2 waste products – NH3, HCO3
-
Arginase E – only in LIVER
Forms SEAA – Arginine
Ornithine is regenerated – Polyamine syn. , NEAA syn. - proline
Fumarate is the link b/w UREA & TCA cycle – Kreb’s bi cycle
21. Disorders of UREA cycle
21
• Genetic defect have been described in all enzymes of urea
cycle - results in ammonia intoxication
• These are extremely rare – 1 in 30,000 live births
• Autosomal Recessive , except OTC defect – X linked
• Defect in reaction 1 and 2 – accumulation of Ammonia directly
• Defect of later enzymes - accumulation of intermediates
22. Common features seen are – severity varies
Feeding difficulties , Lethargy , irritability ,
protein induced vomiting and poor intellectual
development – MR ,cerebral edema, seizures
leads to COMA and death
22
23. Disorders Defective
Enzyme
Products
Accumulated
Clinical features
23
Hyperammonaemia CPS – I Ammonia Severe hyperammonemia
type – I Mental retardation ,
developmental delay
Variant of N acetyl Ammonia Neonatal Hyperammonemia –
hyperammonemia glutamate Fatal.
type I synthase Rx -N-carbamoyl-L-glutamate
– activates CPS-I
Hyperammonaemia OTC , X- Ammonia Orotic aciduria -channeling of
type – II linked CP to Pyrimidine syn.
24. Hepatic Coma (Acquired Hyperammonemia)
Portal systemic Encephalopathy
• / Hepatic encephalopathy
Hepatic failure –finally lead to hepatic
coma and death
Hyperammonemia – characteristic
feature of liver failure
C/F - Altered sensorium, convulsions,
ascites, jaundice, hepatomegaly,
cerebral edema, hemorrhage.
24
Urea
26. 26
• Dietary restriction of protein – Mainstay of management
Replacement of EAA by their corresponding α-Keto acids –
dec. N disposal – without causing EAA deficiencies.
• Maximal calories should be provided in the form of I.V glucose
& lipids to reduce catabolism.
•Promote N excretion in forms other than Urea Block
due to Argininosuccinate lyase defect – supplement
Arginine diet – Argininosuccinate is excreted.
First 2 blocks – supplement diet with Benzoate & Phenylacetate
Treatment
27. Treatment for first 2 defects
Benzyl CoA + Glycine = Hippuric acid
Phenylacetyl CoA + Glutamine = Phenylaceylglutamine
Arginine
Urea
Citrulline
Argininosuccinate
Aspartate
Ornithine
Arginine supplements
Excreted in URINE
27
28. Treatment
28
• Gene therapy is in experimental stage
• Neonatal Hyperammonaemia – Medical emergency
- requires rapid lowering of NH3
- Hemodilaysis ,
- Exchange Transfusion ,
- Peritoneal dialysis
• Hepatic Encepahalopathy
- sterilization of Gut – Lactulose laxative
- liver transplantation
- Treat the underlying cause.