Carbamoyl phosphate synthetase 1 (CPS1) and ornithine transcarbamylase (OTC) deficiencies are rare urea cycle disorders, which can lead to life-threatening hyperammonemia. Liver transplantation (LT) provides a cure and offers an alternative to medical treatment and life-long dietary restrictions with permanent impending risk of hyperammonemia. Nevertheless, in most patients, metabolic aberrations persist after LT, especially low plasma citrulline levels, with questionable clinical impact. So far, little is known about these alterations and there is no consensus, whether l-citrulline substitution after LT improves patients' symptoms and outcomes. In this multicentre, retrospective, observational study of 24 patients who underwent LT for CPS1 (n = 11) or OTC (n = 13) deficiency, 25% did not receive l-citrulline or arginine substitution. Correlation analysis revealed no correlation between substitution dosage and citrulline levels (CPS1, p = 0.8 and OTC, p = 1). Arginine levels after liver transplantation were normal after LT independent of citrulline substitution. Native liver survival had no impact on mental impairment (p = 0.67). Regression analysis showed no correlation between l-citrulline substitution and failure to thrive (p = 0.611) or neurological outcome (p = 0.701). Peak ammonia had a significant effect on mental impairment (p = 0.017). Peak plasma ammonia levels correlate with mental impairment after LT in CPS1 and OTC deficiency. Growth and intellectual impairment after LT are not significantly associated with l-citrulline substitution.

Background: Biliary atresia (BA) causes neonatal cholestasis and rapidly progresses into cirrhosis if left untreated. Kasai portoenterostomy may delay cirrhosis. BA remains among the most common indications for liver transplantation (LT) during childhood. Liver function and gut microbiome are interconnected. Disturbed liver function and enterohepatic signaling influence microbial diversity. We, herein, investigate the impact of LT and reestablishment of bile flow on gut microbiome–bile acid homeostasis in children with BA before (pre, n = 10), 3 months (post3m, n = 12), 12 months (post12m, n = 9), and more than 24 months (post24 + m, n = 12) after LT. Methods: We analyzed the intestinal microbiome of BA patients before and after LT by 16S-rRNA-sequencing and bioinformatics analyses, and serum primary and secondary bile acid levels. Results: The gut microbiome in BA patients exhibits a markedly reduced alpha diversity in pre ( p = 0.015) and post3m group ( p = 0.044), and approximated healthy control groups at later timepoints post12m ( p = 1.0) and post24 + m ( p = 0.74). Beta diversity analysis showed overall community structure similarities of pre and post3m ( p = 0.675), but both differed from the post24 + m ( p < 0.001). Longitudinal analysis of the composition of the gut microbiome revealed the Klebsiella genus to show increased abundance in the post24 + m group compared with an age-matched control ( p = 0.029). Secondary bile acid production increased 2+ years after LT ( p = 0.03). Multivariable associations of microbial communities and clinical metadata reveal several significant associations of microbial genera with tacrolimus and mycophenolate mofetil–based immunosuppressive regimens. Conclusions: In children with BA, the gut microbiome shows strongly reduced diversity before and shortly after LT, and approximates healthy controls at later timepoints. Changes in diversity correlate with altered secondary bile acid synthesis at 2+ years and with the selection of different immunosuppressants.

A holistic, nontargeted mass spectrometric analysis of any herbal material and preparation is intimately connected to fast chemical profiling and visualization of secondary plant metabolite classes or single compounds. High-resolution mass spectral data enable a broad variety of analytical possibilities. Often a fast and comprehensive overview on compound classes (phytochemical profiling) is needed before single-substance considerations. We present a fast approach for the initial characterization and substance class profiling using relative mass defect plots for the visualization of herbal compositions. From a dataset of 1160 common plant metabolites that represent a varied mixture of molecular classes in polarity, glycosylation, and alkylation, manually annotated for substance classes, the relative mass defects were calculated using theoretical molecular masses. For the calculation of the relative mass defect, a new approach incorporating two correction functions to obtain correct relative mass defect results also for large hydrocarbons, and a multitude of polyhalogenated molecules was developed. Using the Khachyan algorithm, elliptical areas clustering substance classes within the relative mass defect plots were calculated. The resulting novel relative mass defect plots provide a quick way of two-dimensional substance class mapping directly from high-resolution mass spectral data and may be considered as a unique fingerprint for herbals, part of them or herbal preparations. We show that adding the retention time as a third dimension improves the resolution power of the two-dimensional relative mass defect plot and offers the possibility for a more detailed substance class mapping.