 LOLA stimulates the urea cycle which metabolizes ammonia to urea in the liver 16,17. In the periportal hepatocytes that synthesize urea, ornithine serves as an activator of ornithine transcarbamoylase and carbamoyl phosphate synthetase. In addition, ornithine can acts as a substrate for urea genesis. Hence, LOLA can activate the periportal urea cycle in the liver. Aspartate and ornithine, after conversion to alpha- ketoglutarate, also serves as carbon sources for perivenous glutamine synthesis. In the skeletal muscle, LOLA upregulates glutamine synthesis by substrate provision for glutamine synthetase, although decreased muscle mass in cirrhosis does not allow this synthesis to be significant. Ammonia is consumed during urea formation and glutamine synthesis, and thereby LOLA decreases blood ammonia levels. Urea and glutamine after further metabolism can be excreted via the kidneys. LOLA thus activates the two important metabolic pathways in the human body for the detoxification of ammonia. In cirrhosis, there is some remaining liver cell mass that retains capacity to detoxify ammonia as opposed to acute liver failure. 