title: Effects of L-arginine pretreatment on nitric oxide metabolism and hepatosplanchnic perfusion during porcine endotoxemia.
abstract: BACKGROUND
  Sepsis is accompanied by an increased need for and a decreased supply of arginine, reflecting a condition of arginine deficiency.
  
  
  OBJECTIVE
  The objective was to evaluate the effects of l-arginine pretreatment on arginine-nitric oxide (NO) production and hepatosplanchnic perfusion during subsequent endotoxemia.
  
  
  METHODS
  In a randomized controlled trial, pigs (20-25 kg) received 3 μg . kg(-1) . min(-1) lipopolysaccharide (LPS; 5 endotoxin units/ng) intravenously and saline resuscitation. l-Arginine (n = 8; 5.3 μmol . kg(-1) . min(-1)) or saline (n = 8) was infused starting 12 h before LPS infusion and continued for 24 h after the endotoxin infusion ended. Whole-body appearance rates, portal-drained viscera (PDV), and liver fluxes of arginine, citrulline, NO, and arginine de novo synthesis were measured by using stable-isotope infusion of [(15)N(2)]arginine and [(13)C-(2)H(2)]citrulline. Hepatosplanchnic perfusion was assessed by using a primed continuous infusion of para-aminohippuric acid and jejunal intramucosal partial pressure of carbon dioxide and was related to systemic hemodynamics.
  
  
  RESULTS
  Arginine supplementation before LPS increased whole-body NO production in the PDV but not in the liver. Furthermore, it increased blood flow in the portal vein but not in the aorta and hepatic artery. During endotoxin infusion, arginine pretreatment was associated with an increased whole-body arginine appearance and NO production in the gut. Additional effects included a preserved mean arterial pressure, the prevention of an increase in pulmonary arterial pressure, an attenuated metabolic acidosis, and an attenuated increase in the intramucosal partial pressure of carbon dioxide.
  
  
  CONCLUSIONS
  Arginine treatment starting before endotoxemia appears to be beneficial because it improves hepatosplanchnic perfusion and oxygenation during prolonged endotoxemia, probably through an enhancement in NO synthesis, without causing deleterious systemic side effects.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands, Maastricht, Netherlands. m.poeze@ah.unimaas.nl
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
authors.forename: Maaike J
authors.initials: MJ
authors.lastname: Bruins
authors.forename: Fons
authors.initials: F
authors.lastname: Kessels
authors.forename: Yvette C
authors.initials: YC
authors.lastname: Luiking
authors.forename: Wouter H
authors.initials: WH
authors.lastname: Lamers
authors.forename: Nicolaas E P
authors.initials: NE
authors.lastname: Deutz
mesh_terms: D000138:Acidosis / Q000517:prevention & control; D000818:Animals; D001120:Arginine / Q000172:deficiency / Q000494:pharmacology* / Q000627:therapeutic use; D001419:Bacteria / Q000737:chemistry*; D001794:Blood Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000378:metabolism; D019587:Dietary Supplements; D004195:Disease Models, Animal; D019446:Endotoxemia / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D041981:Gastrointestinal Tract / Q000378:metabolism; D008070:Lipopolysaccharides; D008099:Liver / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism; D009092:Mucous Membrane / Q000378:metabolism; D009569:Nitric Oxide / Q000096:biosynthesis*; D011169:Portal Vein / Q000187:drug effects*; D011897:Random Allocation; D013152:Splanchnic Circulation / Q000187:drug effects* / Q000502:physiology; D013552:Swine
chemical_list: D008070:Lipopolysaccharides; D002245:Carbon Dioxide; D009569:Nitric Oxide; D001120:Arginine