Argininosuccinate, arginine synthesis

Patients who survive the neonatal period can be maintained with a low-protein diet and sodium benzoate. A useful therapeutic adjunct for citrullinemia and argininosuccinic aciduria is dietary arginine supplementation, which enhances the ability to eliminate nitrogen as either citrulline or argininosuccinate. Maintaining normal arginine levels also facilitates protein synthesis. 

What about the other enzymes in the urea cycle Ornithine transcarbamoylase is homologous to aspartate transcarbamoylase and the structures of their catalytic subunits are quite similar (Figure 23.18). Thus, two consecutive steps in the pyrimidine biosynthetic pathway were adapted for urea synthesis. The next step in the urea cycle is the addition of aspartate to citrulline to form argininosuccinate, and the subsequent step is the removal of fumarate. These two steps together accomplish the net addition of an amino group to citrulline to form arginine. Remarkably, these steps are analogous to two consecutive steps in the purine biosynthetic pathway (Section 25.2 3). 

Arginine and fumarate are produced from argininosuccinate by the cytosolic enzyme argininosuccinate lyase. In the final step of the cycle arginase cleaves urea from aspartate, regenerating cytosolic ornithine, which can be transported to the mitochondrial matrix for another round of urea synthesis. 

Arginine or citrulline in concentration in excess of the optimal can inhibit both argininosuccinate synthetase or argininosuccinate lyase in tissue cultures (S6). Whether this is applicable to the conditions of synthesis of the urea in liver is uncertain. a-Methylaspartic acid also specifically inhibits argininosuccinate synthetase (B7, C4, SIO). 

Protein Intake and Urea Excretion. Levin et al. (L7) were the first to show that urea excretion and therefore presumably urea synthesis was increased with increased protein intake in argininosuccinic aciduria. They showed in their patient that an increase of 2.5 times in the protein intake resulted in a 4- or 5-fold increase in urea output. From the results of a feeding trial, in which the infant was given a casein hydrolyzate from which most of the arginine had been removed, they concluded from the small amount of arginine present and the relatively high amount of urea excreted daily, that most of the urea was derived from a urea cycle, presumably in the liver. Conversely, reduction of protein intake resulted in a marked decrease in the output of both urea and argininosuccinic acid. 

The synthesis of arginine from citrulline involves the condensation of citrulline with aspartate to form argininosuccinate (S88, 437-441), in accordance with the following formulation ... 

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