title: Patterns of arginine and nitric oxide in patients with sickle cell disease with vaso-occlusive crisis and acute chest syndrome.
abstract: OBJECTIVE
  Our objective was to evaluate L-arginine and nitric oxide metabolite (NOx) levels in children with sickle cell disease (SCD) at steady-state and during vaso-occlusive crisis (VOC). Because alterations in nitric oxide production may have an important role in the pathophysiology of SCD, our second aim was to determine if a relationship exists between these levels and vaso-occlusive crisis (VOC).
  
  
  METHODS
  Plasma L-arginine and serum NOx levels were examined in 36 patients with SCD with 39 episodes of VOC and 10 children with SCD at steady-state. Daily levels were obtained in children requiring hospitalization.
  
  
  RESULTS
  Steady-state L-arginine levels were normal in children with SCD. L-arginine levels were low, however, in children with VOC (37.4 +/- 2.7 vs. 53.6 +/- 4.6 micromol/L; P = 0.008) but returned to baseline during hospitalization. In contrast, NOx levels were normal at presentation but decreased during hospitalization for both patients with VOC and patients with acute chest syndrome (ACS) (21.1 +/- 2.0, 17.4 +/- 2.4, and 12.3 +/- 1.6 micromol/L, respectively; P < 0.05). In the patients with VOC who had ACS develop, L-arginine decreased to the lowest levels at the time of the ACS diagnosis, correlating with decreasing NOx levels.
  
  
  CONCLUSIONS
  These data suggest that there may be a relationship between the L-arginine-nitric oxide pathway and vaso-occlusion in SCD. Low arginine levels during VOC could reflect a state of acute substrate depletion that results in a decrease in nitric oxide production.
authors.affiliation: Department of Emergency Medicine, Children's Hospital Oakland, California 94609, USA. johnclaud@home.com
authors.forename: C R
authors.initials: CR
authors.lastname: Morris
authors.forename: F A
authors.initials: FA
authors.lastname: Kuypers
authors.forename: S
authors.initials: S
authors.lastname: Larkin
authors.forename: E P
authors.initials: EP
authors.lastname: Vichinsky
authors.forename: L A
authors.initials: LA
authors.lastname: Styles
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D001120:Arginine / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007238:Infarction; D008297:Male; D009569:Nitric Oxide / Q000097:blood*; D010146:Pain; D013577:Syndrome; D013909:Thorax
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide; D001120:Arginine