Rescue Treatment with L-Citrulline Inhibits Hypoxia-induced Pulmonary Hypertension in Newborn Pigs


Source: ATS Journals


Rationale: Infants with cardiopulmonary disorders associated with hypoxia develop pulmonary hypertension. We previously showed that initiation of oral L-citrulline prior to and continued throughout hypoxic exposure, improves nitric oxide (NO) production and ameliorates pulmonary hypertension in newborn piglets. Rescue treatments, initiated after the onset of pulmonary hypertension, better approximate clinical strategies. Mechanisms by which L-citrulline improves NO production merit elucidation. Objective: Determine whether starting L-citrulline after the onset of pulmonary hypertension inhibits disease progression and improves NO production by re-coupling endothelial nitric oxide synthase (eNOS). Methods: Hypoxic and normoxic (control) piglets were studied. Some hypoxic piglets received oral L-citrulline starting on day three of hypoxia and continued throughout the remaining 7 days of hypoxic exposure. Catheters were placed for hemodynamic measurements and pulmonary arteries were dissected to assess NO production and eNOS dimer-to-monomer ratios (a measure of eNOS coupling). Measurements and Main Results: Pulmonary vascular resistance was lower in L-citrulline treated hypoxic piglets than in untreated hypoxic piglets, but higher than in normoxic controls. NO production and eNOS dimer-to-monomer ratios were greater in pulmonary arteries from L-citrulline-treated than untreated hypoxic animals, but lower than in normoxic controls. Conclusions: When started after disease onset, oral L-citrulline treatment improves NO production by recoupling eNOS and inhibits the further development of chronic hypoxia-induced pulmonary hypertension in newborn piglets. Oral L-citrulline may be a novel strategy to halt or reverse pulmonary hypertension in infants suffering from cardiopulmonary conditions associated with hypoxia.


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