BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the leading chronic 
hepatic condition worldwide and new approaches to management and treatment are 
limited.
SUMMARY: L-ornithine L-aspartate (LOLA) has hepatoprotective properties in 
patients with fatty liver of diverse etiology and results of a multicenter 
randomized clinical trial reveal that 12 weeks treatment with oral LOLA (6-9 
g/d) results in a dose-related reduction in activities of liver enzymes and 
triglycerides together with significant improvements of liver/spleen CT ratios. 
A preliminary report described improvements of hepatic microcirculation in 
patients with non-alcoholic steatohepatitis (NASH) following treatment with 
LOLA. Mechanisms responsible for the beneficial effects of LOLA in NAFLD/NASH 
involve, in addition to its established ammonia-lowering effect, metabolic 
transformations of the LOLA-constituent amino acids L-ornithine and L-aspartate 
into L-glutamine, L-arginine, and glutathione. These metabolites have 
well-established actions implicated in the prevention of lipid peroxidation, 
improvement of hepatic microcirculation in addition to anti-inflammatory, and 
anti-oxidant properties. Key Messages: (1) LOLA is effective for the treatment 
of key indices in NAFLD/NASH. (2) Mechanisms other than LOLA's ammonia-lowering 
action have been postulated. (3) Further assessments in the clinical setting are 
now required.