ABSTRAm. Children with inborn errors of urea synthesis who survive neonatal hyperammonemic coma commonly exhibit cognitive deficits and neurologic abnormalities. Yet, there is evidence that ammonia is not the only neurotoxin. Hyperammonemia appears to induce a number of neurochemical alterations. In rodent models of hyperammonemia, uptake of L-tryptophan into brain is increased. It has been reported that in an experimental rat model of hepatic encephalopathy, in the ammonium acetate-injected rat, and in patients with hepatic failure and inborn errors of ammonia metabolism, quinolinate, a tryptophan metabolite, is increased. Elevations in quinolinate are of particular concern, as quinolinate could excessively activate the Nmethyl-maspartate subclass of excitatory amino acid receptors, thereby causing selective neuronal necrosis. We sought to identify an animal model that would replicate the increases in quinolinate that have been associated with hyperammonemia in humans. Levels of quinolinate were measured in hyperammonemic urease-infused rats and ammonium acetate-injected rats. In the urease-infused rat, brain tryptophan was doubled, and serotonin and its metabolite 5-hydroxyindoleacetic acid were significantly increased. Yet, despite the increase in tryptophan and evidence for increased metabolism of tryptophan to serotonin, there were no obsewed increases of quinolinate in brain, cerebrospinal fluid, or plasma. In the ammonium acetateinjected rat, significant increases of 5-hydroxyindoleacetic acid in cerebral cortex were also observed, but quinolinate did not change in cerebrospinal fluid or cerebral cortex. In summary, we were unable to demonstrate an increase of quinolinate in brain or cerebrospinal fluid in these rat models of hyperammonemia. (Pediatr Res 32: 483-488, 1992)
AbbreviationsThe most common causes of symptomatic hyperammonemia in children are congenital urea cycle disorders and organic acidemias. Affected children present with episodes of vomiting, lethargy, and coma either in the newborn period or in early childhood, depending on the severity of the enzyme deficiency (I). Despite treatment, the majority of children have cognitive deficits and other neurologic impairments (2). Although the mechanism of brain damage induced by hyperammonemia is not clear, it is known that the degree of brain damage correlates with the duration of hyperammonemic coma rather than peak plasma ammonia level (2), suggesting that ammonia may be acting through a secondary neurotoxin in a time-influenced fashion.In certain animal models and humans with hyperammonemia induced by portal systemic encephalopathy, the level of the Trp metabolite, QUIN, has been found to be elevated in brain and CSF (3,4). This observation is noteworthy because QUIN is an agonist at the NMDA subclass of excitatory amino acid receptors. It is well documented that excessive activation of NMDA recep tors results in specific degeneration of the neurons that express these receptors (5,6).It has been reported previously that children with urea cycl...