Elevated plasma concentrations of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine in citrullinemia

Citrullinemia is an inborn error of the urea cycle with deficiency of the argininosuccinate synthase. It is characterized by elevated concentrations of l-citrulline and decreased levels of l-arginine in body fluids. Asymmetric dimethylarginine is an endogenous inhibitor of nitric oxide synthase that converts l-arginine to l-citrulline and nitric oxide (NO). Asymmetric dimethylarginine is hydrolyzed by the enzyme dimethylarginine dimethylaminohydrolase to l-citrulline and dimethylamine. Elevation of l-citrulline in citrullinemia prompted us to study the l-arginine/NO pathway in this disorder. In 8 children with citrullinemia (3 days to 3 years of age), elevated plasma levels of asymmetric dimethylarginine (P = .028) were found compared with age-matched healthy children. We hypothesize that the l-arginine/NO pathway plays a role in the pathophysiology of citrullinemia.