title: Rescue Treatment with L-Citrulline Inhibits Hypoxia-Induced Pulmonary Hypertension in Newborn Pigs.
abstract: Infants with cardiopulmonary disorders associated with hypoxia develop pulmonary hypertension. We previously showed that initiation of oral L-citrulline before 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. The objective of this study was to determine whether starting L-citrulline after the onset of pulmonary hypertension inhibits disease progression and improves NO production by recoupling endothelial NO synthase (eNOS). Hypoxic and normoxic (control) piglets were studied. Some hypoxic piglets received oral L-citrulline starting on Day 3 of hypoxia and continuing 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). Pulmonary vascular resistance was lower in L-citrulline-treated hypoxic piglets than in untreated hypoxic piglets but was higher than in normoxic controls. NO production and eNOS dimer-to-monomer ratios were greater in pulmonary arteries from L-citrulline-treated than from untreated hypoxic animals but were lower than in normoxic controls. 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.
authors.affiliation: 1 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.|2 Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Candice D
authors.initials: CD
authors.lastname: Fike
authors.affiliation: 1 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Anna
authors.initials: A
authors.lastname: Dikalova
authors.affiliation: 1 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Kaplowitz
authors.affiliation: 3 Division of Genetics and Metabolism, Children's National Medical Center, Washington, District of Columbia; and.
authors.forename: Gary
authors.initials: G
authors.lastname: Cunningham
authors.affiliation: 3 Division of Genetics and Metabolism, Children's National Medical Center, Washington, District of Columbia; and.
authors.forename: Marshall
authors.initials: M
authors.lastname: Summar
authors.affiliation: 4 Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, New York, New York.
authors.forename: Judy L
authors.initials: JL
authors.lastname: Aschner
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001120:Arginine / Q000097:blood; D015687:Cell Hypoxia; D002956:Citrulline / Q000008:administration & dosage*; D004353:Drug Evaluation, Preclinical; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000378:metabolism; D034421:Sus scrofa
chemical_list: D002956:Citrulline; D001120:Arginine
keywords: nitric oxide signaling; superoxide; uncoupled eNOS