Document Detail

Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome.
MedLine Citation:
PMID:  20724949     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Decreased exhaled nitric oxide levels (FE(NO)) have been described in patients with sickle cell disease (SCD) and a history of acute chest syndrome (ACS) when compared with non-ACS controls. Oral arginine supplementation has been shown to increase FE(NO) in healthy participants, but its effect in SCD patients is not known.
OBJECTIVE: To determine the effect of oral arginine intake on FENO in sickle cell patients with and without history of ACS, and in healthy controls.
HYPOTHESIS: No differences in the FE(NO) increase were seen in SCD patients with a history of ACS (ACS+) compared with healthy controls (HC) and SCD patients without history of ACS (ACS-).
MATERIALS AND METHODS: ACS+ (n=6), ACS- (n=9), and HC (n=7) patients were studied. At baseline, and after the administration of escalating doses of oral L-arginine (0.1, 0.2, and 0.4 g/kg), serial measurements were made of the following: FE(NO), plasma concentrations of arginine, ornithine, citrulline, aspartate, glutamate, arginine/ornithine ratio, nitrite, nitrate, heart rate (HR), respiratory rate (RR), blood pressure (BP), oxygen saturation (SpO2), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC).
MAIN RESULTS: At baseline, FE(NO) did not differ among the groups. ACS- and ACS+ groups were deficient in arginine, and had decreased FEV1, FVC, and SaO2 when compared with HC patients. After arginine supplementation, FE(NO), arginine, ornithine, citrulline, nitrite, and the arginine/ornithine ratio increased similarly in all groups. Changes from baseline for HR, BP, SpO2, RR, FEV1, and FVC were minimal and similar in all groups.
CONCLUSIONS: In contrast to our earlier study, ACS+ patients had similar FE(NO) values when compared with ACS- and HC patients. All SCD patients were arginine deficient at baseline and showed impairment in respiratory physiology when compared with HC patients. After arginine supplementation, FE(NO) concentration increased in all groups to a similar degree, and lung function and physiologic parameters were minimally affected. The physiologic significance of alterations in FE(NO) in SCD patients and its relationship to ACS predilection requires further delineation.
Kevin Joseph Sullivan; Niranjan Kissoon; Eric Sandler; Cynthia Gauger; Melanie Froyen; Laurie Duckworth; Martha Brown; Suzanne Murphy
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Publication Detail:
Type:  Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of pediatric hematology/oncology     Volume:  32     ISSN:  1536-3678     ISO Abbreviation:  J. Pediatr. Hematol. Oncol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-06     Completed Date:  2010-10-25     Revised Date:  2011-10-06    
Medline Journal Info:
Nlm Unique ID:  9505928     Medline TA:  J Pediatr Hematol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e249-58     Citation Subset:  IM    
Department of Anesthesia and Critical Care Medicine, Nemours Children's Clinic, Jacksonville, Florida 32207, USA.
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MeSH Terms
Acute Chest Syndrome / drug therapy*,  metabolism*
Acute Disease
Administration, Oral
Anemia, Sickle Cell / drug therapy*,  metabolism*
Arginine / administration & dosage*,  blood,  pharmacokinetics
Aspartic Acid / blood
Breath Tests
Citrulline / blood
Glutamic Acid / blood
Nitrates / blood
Nitric Oxide / metabolism*
Nitrites / blood
Ornithine / blood
Young Adult
Reg. No./Substance:
0/Nitrates; 0/Nitrites; 10102-43-9/Nitric Oxide; 372-75-8/Citrulline; 56-84-8/Aspartic Acid; 56-86-0/Glutamic Acid; 7006-33-9/Ornithine; 74-79-3/Arginine
Comment In:
J Pediatr Hematol Oncol. 2010 Oct;32(7):e247-8   [PMID:  20724948 ]

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