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Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome.

Abstract

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.

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  • Authors+Show Affiliations

    ,

    Department of Anesthesia and Critical Care Medicine, Nemours Children's Clinic, Jacksonville, Florida 32207, USA. ksulliva@nemours.org

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    Source

    MeSH

    Acute Chest Syndrome
    Acute Disease
    Administration, Oral
    Adolescent
    Anemia, Sickle Cell
    Arginine
    Aspartic Acid
    Breath Tests
    Child
    Citrulline
    Female
    Glutamic Acid
    Humans
    Male
    Nitrates
    Nitric Oxide
    Nitrites
    Ornithine
    Young Adult

    Pub Type(s)

    Comparative Study
    Controlled Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20724949

    Citation

    Sullivan, Kevin Joseph, et al. "Effect of Oral Arginine Supplementation On Exhaled Nitric Oxide Concentration in Sickle Cell Anemia and Acute Chest Syndrome." Journal of Pediatric Hematology/oncology, vol. 32, no. 7, 2010, pp. e249-58.
    Sullivan KJ, Kissoon N, Sandler E, et al. Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome. J Pediatr Hematol Oncol. 2010;32(7):e249-58.
    Sullivan, K. J., Kissoon, N., Sandler, E., Gauger, C., Froyen, M., Duckworth, L., ... Murphy, S. (2010). Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome. Journal of Pediatric Hematology/oncology, 32(7), pp. e249-58. doi:10.1097/MPH.0b013e3181ec0ae5.
    Sullivan KJ, et al. Effect of Oral Arginine Supplementation On Exhaled Nitric Oxide Concentration in Sickle Cell Anemia and Acute Chest Syndrome. J Pediatr Hematol Oncol. 2010;32(7):e249-58. PubMed PMID: 20724949.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effect of oral arginine supplementation on exhaled nitric oxide concentration in sickle cell anemia and acute chest syndrome. AU - Sullivan,Kevin Joseph, AU - Kissoon,Niranjan, AU - Sandler,Eric, AU - Gauger,Cynthia, AU - Froyen,Melanie, AU - Duckworth,Laurie, AU - Brown,Martha, AU - Murphy,Suzanne, PY - 2010/8/21/entrez PY - 2010/8/21/pubmed PY - 2010/10/26/medline SP - e249 EP - 58 JF - Journal of pediatric hematology/oncology JO - J. Pediatr. Hematol. Oncol. VL - 32 IS - 7 N2 - 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. SN - 1536-3678 UR - https://www.unboundmedicine.com/medline/citation/20724949/Effect_of_oral_arginine_supplementation_on_exhaled_nitric_oxide_concentration_in_sickle_cell_anemia_and_acute_chest_syndrome_ L2 - http://Insights.ovid.com/pubmed?pmid=20724949 DB - PRIME DP - Unbound Medicine ER -