title: The Assessment of short-term effect of L-Citrulline on endothelial function via FMD to NMD ratio in known CAD patients: A randomized, cross-over clinical trial (Clinical trial number: NCT02638727).
abstract: BACKGROUND
  Recent studies have confirmed the essential and paramount role of the L-Citrulline on the nitric oxide regulation and the endothelial function improvement.
  
  
  METHODS
  In this cross-over clinical trial, thirty patients, diagnosed with coronary artery disease (CAD) and flow mediated dilation to nitroglycerin dependent vasodilation (FMD/NMD) ratio less than 1, were included. The patients were randomly divided into two groups of 15 patients and underwent treatment by L-Citrulline or placebo for 15 days, in 2 step protocol. The indicators of assessment in the current study were the ratio of the FMD/NMD and FMD value.
  
  
  RESULTS
  In the current cross-over clinical trial, the mean of FMD to NMD ratio and mean FMD value of all patients before starting the protocol were 0.91 ± 0.08 and 4.04 ± 0.51 mm, respectively. The final results of study showed that following L-Citrulline administration, mean FMD to NMD ratio and mean FMD value were enhanced to: 1.03 ± 0.09 and 4.96 ± 0.72 mm, respectively, which were statistically significant (P<0.001 and P<0.001, respectively). However, following placebo administration, mean FMD to NMD ratio and mean FMD value were receded to: 0.92 ± 0.09 and 4.06 ± 0.22 mm, respectively, which were not statistically significant (P = 0.75 and P = 0.89, respectively). Moreover, the improvement of mean FMD to NMD ratio (0.12 ± 0.02) and mean FMD value (0.92 ± 0.16 mm), following L-Citrulline administration, were statistically significant in comparison with the change of mean FMD to NMD ratio (0.01 ± 0.002) and mean FMD value (0.02 ± 0.003), following placebo administration (P<0.001 and P<0.001, respectively).
  
  
  CONCLUSIONS
  L-Citrulline treatment can lead to improvement of the endothelial function in patients diagnosed with CAD which are assessed via FMD to NMD ratio FMD value enhancements.
authors.forename: Morteza
authors.initials: M
authors.lastname: Safi
authors.forename: Mohammad Parsa
authors.initials: MP
authors.lastname: Mahjoob
authors.forename: Saeed
authors.initials: S
authors.lastname: Nateghi
authors.forename: Isa
authors.initials: I
authors.lastname: Khaheshi
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Akbarzadeh
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Naderian
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000187:drug effects*; D002956:Citrulline / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy*; D018592:Cross-Over Studies; D004730:Endothelium, Vascular / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D005996:Nitroglycerin / Q000008:administration & dosage; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D002956:Citrulline; D009569:Nitric Oxide; D005996:Nitroglycerin