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Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 PMCID: PMC9190231 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-arginine is the substrate used by nitric oxide (NO) synthase to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy one bottle containing 1.66 g of L-arginine or one bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT), and their Borg modified 0-10 rating of perceived exertion (BRPE) was assessed before starting and at the end of the treatment. Seventy-five patients receiving L-arginine, and 35 receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-arginine group compared with both baseline and placebo (P < 0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR independently of age, sex, baseline functional capacity, and comorbid conditions. SIGNIFICANCE STATEMENT: This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent of age, sex, comorbid conditions, and baseline functional capacity.
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Affiliation(s)
- Pasquale Mone
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Raffaele Izzo
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Giuseppe Marazzi
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Maria Virginia Manzi
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Paola Gallo
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Giuseppe Campolongo
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Luca Cacciotti
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Domenico Tartaglia
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Giuseppe Caminiti
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Fahimeh Varzideh
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Gaetano Santulli
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
| | - Valentina Trimarco
- Departments of Medicine (Cardiology) and Molecular Pharmacology - Wilf Family Cardiovascular Research Institute, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Einstein-Sinai Diabetes Research Center, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, New York (P.M., F.V., G.S.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.); Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (V.T.), New York, New York (P.M., F.V., G.S.); University of Naples Federico II, Naples, Italy (R.I., M.V.M., P.G., G.S., V.T.); IRCCS San Raffaele, Rome, Italy (G.M., G.Cami.); San Carlo di Nancy Hospital, Rome, Italy (G.Camp.); Madre Giuseppina Vannini Hospital, Rome, Italy (L.C.); and ASL AV, Avellino, Italy (D.T.)
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