doi: 10.1161/01.CIR.0000138900.92435.9A
(Circulation. 2004;110:e71.)
© 2004 American Heart Association, Inc.
Correspondence |
L-Arginine "Paradox" in Coronary Atherosclerosis
Cardiology Unit, Hippokration Hospital, Athens University Medical School, Athens, Greece, drtousoulis{at}hotmail.com
To the Editor:
Miner et al1 in a recent work used the steady-state 15N2-arginine to examine the transorgan L-arginine gradients in the peripheral and coronary circulation. They found that during acetylcholine infusion a significant gradient was detected, indicating that the stimulation of NOS induces arginine transport.
A body of evidence suggests that L-arginine supplementation improves endothelium-dependent vasomotor responses. This response to elevated extracellular L-arginine despite high intracellular L-arginine concentration has been called the "arginine paradox."
We2–4 have examined the acute effects of intracoronary infusion of L-arginine in patients with stable angina and advanced atherosclerosis. L-Arginine administration was associated with significant dilatation of stenoses of proximal segments of both "normal" and diseased arteries, and of distal segments of diseased arteries (P<0.01). No significant changes were associated with D-arginine administration. The magnitude of dilatation of stenoses and all segments of both "normal" and diseased coronaries was greater after L-arginine (P<0.05), but not after D-arginine and substance P infusion, than it was after saline and substance P infusion. Administration of D- or L-arginine did not change the magnitude of substance P–induced dilatation.2 The dilation of proximal and distal segments in response to low-dose L-arginine was greater in patients with a serum cholesterol level 
200 mg/dL than in patients with a level >200 mg/dL, whereas the response was the same in smokers and nonsmokers.3 During L-arginine infusion a larger proportion of complex stenoses than smooth stenoses dilated by >10%, and the magnitude of dilatation was greater at the site of complex stenoses (P<0.05).4 Our intracoronary studies indicate that acute intracoronary L-arginine supplementation may improve endothelium-dependent vasodilation in coronary arteries in patients with coronary artery disease and support the theory of "arginine paradox."
References
1. Miner SE, Al-Hesayen A, Kelly S, Benson T, Thiessen JJ, Young VR, Parker JD. L-arginine transport in the human coronary and peripheral circulation. Circulation. 2004; 109: 1278–1283.
2. Tousoulis D, Tentolouris C, Crake T, Katsimaglis G, Stefanadis C, Toutouzas P, Davies GJ. Effects of L- and D-arginine on the basal tone of human diseased coronary arteries and their responses to substance P. Heart. 1999; 81: 505–511.
3. Tentolouris C, Tousoulis D, Davies GJ, Stefanadis C, Toutouzas P. Serum cholesterol level cigarette smoking and vasomotor responses to L-arginine in narrowed epicardial coronary arteries. Am J Cardiol. 2000; 85: 500–503.[CrossRef][Medline] [Order article via Infotrieve]
4. Tousoulis D, Davies GJ, Tentolouris C, Goumas G, Stefanadis C, Toutouzas P. Vasomotor effects of L- and D-arginine in stenotic atheromatous coronary plaque. Heart. 2001; 86: 296–301.
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