Chronic lung disease in neonates and infants can lead to progressive hypoxia-induced pulmonary hypertension. The development of pulmonary hypertension has been associated with increasing mortality in certain infants, and the therapies available are inadequate. Fike et al set out to determine whether starting L-citrulline (in newborn piglets) after the onset of pulmonary hypertension inhibits disease progression and improves nitric oxide production by recoupling endothelial nitric oxide synthase.
The authors found that oral L-citrulline treatment started after disease onset improves nitric oxide production by recoupling endothelial nitric oxide synthase and inhibits the further development of chronic hypoxia-induced pulmonary hypertension in this piglet model. This is an important translational study with novel treatment implications. Some clinical studies have already been done using prophylactic L-citrulline supplementation. However, more work using the supplement after the physiologic insult has occurred are clearly needed, and this study provides a strong background for further investigation.
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