Liver pathology in a new congenital disorder of urea synthesis: N-acetylglutamate synthetase deficiency

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Abstract
Detoxification through the urea cycle is the means by which mammalian organisms dispose of their excess ammonia. Within this cycle, N-acetylglutamate (NAG) is the most important cofactor for optimal enzyme activity. It is formed from acetyl CoA and glutamate through the action of N-acetylglutamate synthetase (NAGS). Recently, a congenital deficiency of NAGS has been reported. In this communication, we present results of structural investigations on liver tissue of the index patient with NAGS defect. Light microscopy revealed small, eosinophilic inclusions in some of the hepatocytes. Electron microscopy showed vesicular SER and fibrillar material in expanded cisterns of the RER, presumably corresponding to the inclusions seen in light microscopy. Immunofluorescence of liver tissue uncovered a discrete distribution of intracellular albumin in the form of small deposits. We suggest that in NAGS deficiency, some secretory proteins might be incompletely processed due to the lack of a protease activator, NAG.

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