Pathophysiology of cerebral oedema in acute liver failure

Figure 1 The ‘Trojan Horse’ hypothesis. This illustrates the synthesis of glutamine via the enzyme glutamine synthetase; its transport into mitochondria via the glutamine transporter (GLN-Tx); its hydrolysis by phosphate-activated glutaminase (PAG) resulting in glutamate (GLU) and ammonia (NH₄⁺) production and the subsequent generation of reactive oxygen species (ROS). MSO: L-methionine S-sulfoximinel; GS: Glutamine synthetase.