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Table 5 eNOS reaction the three critical arms

From: Is type 2 diabetes mellitus a vascular disease (atheroscleropathy) with hyperglycemia a late manifestation? The role of NOS, NO, and redox stress.

IF THE eNOS REACTION IS UNCOUPLED: THEN THE REACTION IS:

(L-arginine is not converted to NO and L-citrulline).

TREATMENT PARADIGM:

   (1) Prevent competitive inhibition by ADMA (Reduce substrates: LDL-C, Triglycerides, Homocysteine, and Glucotoxicity formation. Prevent L-arginine from being converted to nitroarginine by nitrosylation. Reducing Redox Stress – A-FLIGHT toxicities reduction of ROS. ARGININE SUPPLEMENTATION.

   (2) Prevent hs-CRP from decreasing eNOS by lowering hs-CRP and preventing glycation of Enos enzyme. Aggressive treatment of elevated substrates.

   (3) Add FOLIC ACID not only to lower Hcy and ADMA levels but also to restore BH2, BH3 to the active catalytic cofactor BH4. Use the RAAS acronym and prevent the A-FLIGHT Toxicities (ROS) from developing i.e. decrease the manifold toxicities of MS, IR, PD and overt T2DM.

BE AGGRESSIVE AND TREAT TO KNOWN GOALS: