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Sustained-release l-arginine offers clinical benefits for children with sickle cell anemia, case-control study shows

Highlights

  • Case-control trial involving 60 children with sickle cell anemia
  • Sickle cell anemia (steady stage) is associated with l-arginine deficiency
  • Sustained-release l-arginine significantly improves low plasma l-arginine and nitric oxide levels
  • Effective amount is 350-3,500 mg, twice daily, depending on body weight, for 8 weeks

Summary

This case-control study investigated the ability of sustained-release L-arginine supplementation to increase plasma levels of l-arginine and nitric oxide (NO) in children with sickle cell anemia.

The authors note that sickle cell disease (SCD), an autosomal recessive disorder, is a global public health problem of particular concern in sub-Saharan Africa as well as the most common genetic disease affecting African-Americans. L-arginine is the substrate for NO, the major endothelium-derived relaxing factor in normal physiology. A deficiency of l-arginine develops over time in patients with SCD, which is associated with complications of the disease.

For this study, the researchers enrolled 60 children (mean age 7 years, range 1-14 years) diagnosed with sickle cell disease (steady stage) as confirmed by homozygosity for hemoglobin-S, who presented to the sickle cell clinic unit of the Federal Teaching Hospital in Gombe, Nigeria.

The children were randomly assigned to treatment or to be an age- and gender-matched placebo control. Treatment consisted of sustained release l-arginine supplementation, providing 350 mg to 3,500 mg, twice daily, depending on body weight, for 8 weeks.

Baseline and 8-week follow up evaluations were completed for plasma levels of nitric oxide and L-arginine, as well as clinical outcome. The minimum sample size to detect differences in the outcome measures was determined to be 35 participants. Results were presented as mean +/- standard error. Student t-test and analysis of variance (ANOVA) were used for data comparison with differences considered significant at P<.05.

Results indicate that l-arginine supplementation significantly (P=.002) increased the mean plasma level of L-arginine after 8 weeks, compared to baseline (from 6.4 +/- 1.0 mmol/L to 45.9 +/- 1.3 mmol/L). Likewise, l-arginine supplementation significantly (P<.001) increased the mean plasma level of nitric oxide after 8 weeks, compared to baseline (from 2.0 +/- 0.4 mol/L to 48.2 +/- 2.5 mol/L). Plasma levels of l-arginine and nitric oxide were also found to be low in this patient population.

These findings suggest that supplementing with sustained-release l-arginine (350 mg to 3,500 mg, twice daily, for 8 weeks) helps restore normal plasma levels of l-arginine and nitric oxide in children with sickle cell anemia.

Study treatment and placebo products were provided by Endurance Products (Sherwood, Oregon).

Reference

Abubakar S, Erhabor O, Issac IZ, et al. L-Arginine and nitric oxide levels among children with sickle cell disease in a steady state in Federal Teaching Hospital Gombe, northeastern Nigeria. Int Blood Res Rev. 2018;8(1): 1-7.