2008, Number 6
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ABSTRACTArginine has a role as an amino acid precursor of nitric oxide, a molecule produced from arginine in many tissues by nitric oxide synthase enzyme. Arginine is a semi-essential amino acid with major physiological functions. Within the vascular endothelium,nitric oxide behaves as a vasodilator, antiatherogenic and anti-plaque aggregation agent. Nitric oxide synthase has high affinity for its substrate, arginine, which is found in high levels in the endothelium. Its functionality is conditioned by variations in levels of arginine, due to nutritional intake. This is the so called «arginine paradox». However, the existence of an endogenous nitric oxide synthase inhibitor, known as asymmetric dimethylarginine, has been recently demonstrated and explains this paradox. Arginine’s effect on immune system, and its roles in immunonutrition in clinical path of critically ill patients, remains unproven and needs further study. Until more information will be available, in these patients nutritional support should focus primarily on preventing nutritional deficiencies rather than on immunomodulation. Oxygen-derived free radicals play an important role in the development of disease in critically ill patients. Normally, antioxidants such as vitamin C, E or enzymes such as superoxide dismutase neutralize oxygen free radicals. The endothelial dysfunction represents a great cardiovascular risk.
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