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NAGS gene
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Gene

NAGS gene

The NAGS gene provides instructions for making an enzyme essential for the urea cycle, which removes toxic ammonia from the body.

Normal Function

The NAGS gene provides instructions for making the enzyme N-acetylglutamate synthase. This enzyme is needed for the urea cycle, a series of reactions that occurs in liver cells. The urea cycle breaks down excess nitrogen, which is made when protein is used by the body, into a compound called urea. Urea is removed from the body in urine. Removing the excess nitrogen prevents it from accumulating in the form of ammonia, which is toxic at high levels, especially to the brain.

N-acetylglutamate synthase controls the production of a compound called N-acetylglutamate in the mitochondria, the energy-producing centers in cells. N-acetylglutamate is necessary to turn on the enzyme carbamoyl phosphate synthetase I. This enzyme controls the first step of the urea cycle, in which excess nitrogen compounds are incorporated into the cycle to be broken down.

Health Conditions Related to Genetic Changes

N-acetylglutamate synthase deficiency

More than 40 NAGS gene mutations have been identified in people with N-acetylglutamate synthase deficiency, which is characterized by abnormally high levels of ammonia in the blood. This condition can cause extreme tiredness (lethargy), difficulty feeding, problems controlling breathing or body temperature, and seizures in infancy. Affected adults can have episodes of vomiting, confusion, headaches, or other neurological problems.

Most NAGS gene mutations that cause N-acetylglutamate synthase deficiency change single protein building blocks (amino acids) in the N-acetylglutamate synthase enzyme, rendering the enzyme non-functional. Other mutations result in the production of an abnormally short enzyme or prevent any enzyme from being produced at all.

When the function of the N-acetylglutamate synthase enzyme is reduced or eliminated, N-acetylglutamate is produced in lower-than-normal amounts, or not at all. This shortage prevents carbamoyl phosphate synthetase I from being turned on, which prevents the urea cycle from starting. As a result, excess nitrogen is not converted to urea for removal, and ammonia accumulates in the blood. The buildup of ammonia damages tissues in the brain and causes the neurological problems and other signs and symptoms of the deficiency.

Other Names for This Gene

  • ARGA
  • MGC133025
  • NAGS_HUMAN

Frequently Asked Questions

In infants, warning signs can include extreme tiredness (lethargy), difficulty feeding, vomiting, problems controlling breathing or body temperature, and seizures. In adults, symptoms might include episodes of vomiting, confusion, severe headaches, unusual behavior, or other neurological problems. These symptoms require immediate medical attention as high ammonia levels can be life-threatening.
Dietary management is crucial and typically involves a carefully controlled low-protein diet to limit the production of ammonia. This often requires close monitoring by a metabolic dietitian. Special medical foods and formulas may be used to ensure adequate nutrition while minimizing protein intake. Regular small meals are often recommended to prevent periods of fasting, which can worsen hyperammonemia.
During an acute ammonia crisis, immediate treatment focuses on rapidly lowering ammonia levels. This often involves intravenous medications like ammonia scavengers (e.g., sodium phenylacetate and sodium benzoate), glucose to provide energy and reduce protein breakdown, and sometimes dialysis. Long-term management includes a low-protein diet and N-carbamylglutamate, a medication that acts as a substitute for N-acetylglutamate to activate the urea cycle.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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