L-Ornithine L-Aspartate for the Treatment of Sarcopenia in Chronic Liver Disease: The Taming of a Vicious Cycle

Figure 1

Classical view of interorgan trafficking of ammonia (derived principally from protein digestion in the gastrointestinal tract) between liver, muscle, and brain under normal physiological conditions compared to chronic liver disease. Note the decrease of ammonia removal as urea and glutamine by periportal and perivenous hepatocytes, respectively, in chronic liver disease accompanied by increased removal of ammonia by skeletal muscle and increased uptake of ammonia by brain, a key factor in the pathogenesis of HE.