MSTN and Hyperammonemia: Hyperammonemia decreases muscle protein synthesis by (1) myostatin activation via NF-κB-dependent pathways [53] (2) promoting oxidative stress and impaired mitochondrial function due to the loss of the TCA cycle intermediate, α-ketoglutarate [50]; and (3) increased skeletal muscle autophagy of proteins nitrated due to hyperammonemia [53].