Potential of hypoammonemic therapy in patients with non-alcoholic fatty liver disease and metabolic dysfunction

A duet of non-alcoholic fatty liver disease (NAFLD) / metabolically associated fatty liver disease (MAFLD) and hyperammonemia in patients with metabolic dysfunction is still insufficiently studied, and elevated ammonia levels in this patient population remain an underestimated pathogenetic factor in routine clinical practice. This article presents two clinical observation reports demonstrating the role of hyperammonemia in the clinical picture of NAFLD/MAFLD in female patients of different ages and metabolic status, as well as the efficacy of introduction of L-ornithine-L-aspartate (LOLA) in the combination therapy regimen. Observation report 1: A 65-year-old female patient with MAFLD, metabolic dysfunction (obesity, diabetes), laboratory-confirmed cytolysis, and verified hyperammonemia (ammonia 190 μmol/L). A 12-week LOLA treatment resulted in normalization of ammonia levels (to 56 μmol/L), regression of cytolysis syndromes, and improvement of inflammatory and metabolic parameters. Observation report 2: A 42-year-old female patient with NAFLD/MAFLD, type 2 diabetes, and clinical signs of minimal hepatic encephalopathy (the time to complete the number connection test was 52 seconds). The 3-month treatment with LOLA resulted in improvement of mental status (the time to complete the number connection test was 37 seconds) and normalization of cytolysis and glycemia indicators. Key conclusion: Hyperammonemia is a clinically significant but often underdiagnosed component of NAFLD/MAFLD, and elevated ammonia levels in this patient population remain an underestimated pathogenic factor in routine clinical practice. Its correction with LOLA improves laboratory, cognitive, and functional parameters even without mandatory measurement of ammonia in blood.

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