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2014 ; 29
(4
): 991-1006
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?-Ketoglutaramate: an overlooked metabolite of glutamine and a biomarker for
hepatic encephalopathy and inborn errors of the urea cycle
#MMPMID24234505
Cooper AJ
; Kuhara T
Metab Brain Dis
2014[Dec]; 29
(4
): 991-1006
PMID24234505
show ga
Glutamine metabolism is generally regarded as proceeding via
glutaminase-catalyzed hydrolysis to glutamate and ammonia, followed by conversion
of glutamate to ?-ketoglutarate catalyzed by glutamate dehydrogenase or by a
glutamate-linked aminotransferase (transaminase). However, another pathway exists
for the conversion of glutamine to ?-ketoglutarate that is often overlooked, but
is widely distributed in nature. This pathway, referred to as the glutaminase II
pathway, consists of a glutamine transaminase coupled to ?-amidase.
Transamination of glutamine results in formation of the corresponding ?-keto
acid, namely, ?-ketoglutaramate (KGM). KGM is hydrolyzed by ?-amidase to
?-ketoglutarate and ammonia. The net glutaminase II reaction is:
L?-?Glutamine?+???-?keto acid?+?H2O ?
??-?ketoglutarate?+?L?-?amino acid?+?ammonia. In this mini-review the biochemical
importance of the glutaminase II pathway is summarized, with emphasis on the key
component KGM. Forty years ago it was noted that the concentration of KGM is
increased in the cerebrospinal fluid (CSF) of patients with hepatic
encephalopathy (HE) and that the level of KGM in the CSF correlates well with the
degree of encephalopathy. In more recent work, we have shown that KGM is markedly
elevated in the urine of patients with inborn errors of the urea cycle. It is
suggested that KGM may be a useful biomarker for many hyperammonemic diseases
including hepatic encephalopathy, inborn errors of the urea cycle, citrin
deficiency and lysinuric protein intolerance.