decreases the rate of TCAC, whereas Glu is both a neurotransmitter and a precursor to GABA, another neurotransmitter. (p.734) Link with the citric acid cycle The urea cycle and the citric acid cycle are independent cycles but are linked. One of the nitrogen atoms in the urea cycle is obtained from the transamination of oxaloacetate to aspartate. The fumarate that is produced in step three is also an intermediate in the citric acid cycle and is returned to that cycle. Urea cycle disorders Urea cycle disorders are rare and affect about one in 35,000 people in the United States. Genetic defects in the enzymes involved in the cycle can occur, which usually manifest within a few days after birth. The recently born child will typically experience varying bouts of vomiting and periods of lethargy. Ultimately, the infant may go into a coma and develop brain damage. New-borns with UCD are at a much higher risk of complications or death due to untimely screening tests and misdiagnosed cases. The most common misdiagnosis is neonatal sepsis. Signs of UCD can be present within the first 2 to 3 days of life, but the present method to get confirmation by test results can take too long. This can potentially cause complications such as coma or death. Urea cycle disorders may also be diagnosed in adults, and symptoms may include delirium episodes, lethargy, and symptoms similar to that of a stroke. On top of these symptoms, if the urea cycle begins to malfunction in the liver, the patient may develop cirrhosis. This can also lead to sarcopenia (the loss of muscle mass). Mutations lead to deficiencies of the various enzymes and transporters involved in the urea cycle, and cause urea cycle disorders. If individuals with a defect in any of the six enzymes used in the cycle ingest amino acids beyond what is necessary for the minimum daily requirements, then the ammonia that is produced will not be able to be converted to urea. These individuals can experience hyperammonemia, or the build-up of a cycle intermediate. Individual disorders N-Acetylglutamate synthase (NAGS) deficiency Carbamoyl phosphate synthetase (CPS) deficiency Ornithine transcarbamoylase (OTC) deficiency Citrullinemia type I (Deficiency of argininosuccinic acid synthase) Argininosuccinic aciduria (Deficiency of argininosuccinic acid lyase) Argininemia (Deficiency of arginase) Hyperornithinemia, hyperammonemia, homocitrullinuria (HHH) syndrome (Deficiency of the mitochondrial ornithine transporter) All urea cycle defects, except OTC deficiency, are inherited in an autosomal recessive