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• Fumarate that is generated is part of the TCA cycle and forms malate which gets
oxidized to form oxaloacetate
(b). Write an equation to represent the overall reaction in the urea cycle:
NH4+ + HCO3- + aspartate + 3ATp -> urea + fumarate + 2ADP + AMP + 4Pi
(c). The management of the rare urea cycle disorder, ornithine transcarbamoylase deficiency,
requires protein restriction as well as citrulline supplementation. With reference to (a),
explain how these two strategies work.
The entry point for NH3 in the urea cycle involves the formation of carbamoyl phosphate.
Ornithine transcarbamoylase then catalyses the conversion of carbamoyl phosphate to
citrulline. For patients with this enzyme deficiency, NH3’s entry into the urea cycle is
affected. Excess dietary protein is the source of NH3 as they are not stored but catabolized
this protein restriction is necessary to reduce NH3 load. Another entry point for NH3 into the
urea cycle is via aspartate. The provision of citrulline allows the entry of aspartate to form
urea, which helps in the excretion of NH3.