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Its effect on clinical outcome is still debated, and despite encouraging findings, this treatment is not currently considered part of the usual care of these patients.29 l-Ornithine phenylacetate activates the urea cycle and glutamine synthase, thanks to l-ornithine, and conjugates glutamine and glycine to eliminate them, thanks to phenylacetate

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Oxidative stress is also a contributor to muscle wasting, as ROS are well-known stimulators of apoptotic pathways, showing that oxidative stress is a factor in muscle wasting ( Fig