Ammonium and chronic liver diseases — the inseparable tandem | Ukrainian Medical Journal

Chronic liver diseases occupy one of the leading places among digestive diseases, the course of which in most cases in the initial stages is subclinical, which leads to late coming patients to hospitals and, as a result, the disease progression and the development of liver cirrhosis. The key cells of the liver responsible for the extracellular matrix deposition in response to hepatocellular damage are hepatic stellate cells. According to in vivo and in vitro studies the action of them is activated under the ammonium influence. According to the literature data, in chronic liver diseases, ammonium excretion decreases due to the implementation of the ornithine cycle of urea synthesis (the main path of ammonium detoxification), and the removal of ammonium by muscles increases. Some authors provide data that removing excess ammonium concentration can restore the function of hepatic stellate cells, which indicates the reversibility of the process. A well-known drug that effectively reduces the level of toxic ammonium is original L-ornithine L-aspartate, which prevents hyperammonemia by increasing the synthesis of urea, which indicates the possibility of using the drug in the treatment of chronic liver diseases. Although this drug has already proven himself well in the treatment of liver cirrhosis, hepatic encephalopathy, and liver failure, today its effect on the course of non-alcoholic fatty liver disease is being actively studied.

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