Amino acids carbamyl phosphate synthetase

Citrulline is an endogenous amino acid involved in the urea cycle. Clinically, it can be used as an arginine substitute in the treatment of inborn errors of urea synthesis, including carbamyl phosphate synthetase and ornithine transcarbamylase. It is also a diuretic. 

None of these cases can be considered as established examples of an isolated carbamyl phosphate synthetase deficiency. Although in the first the clinical history and the presence of severe hyperammonemia support the diagnosis of a defect of urea synthesis, the normal finding of levels of plasma amino acids, apart from glycine, is against it. No actual numerical data on the level of activity of the urea cycle enzymes are given. 

In preceding sections of this chapter, the important metabolic reactions which yield ammonia have been discussed. Certain of these systems are capable of fixing ammonia (glutamic dehydrogenase, alanine dehydrogenase, L-amino acid oxidase, etc.). The fixation of ammonia in the glutamine synthetase system will be discussed in Chapter 17. The present section will deal with (a) enzymes which fix ammonia to form carbamyl phosphate and (b) enzymes which utilize carbamyl phosphate for the synthesis of arginine (and urea) and pyrimidines. 

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