From the Guidelines
Arginine supplementation, particularly when combined with other nutrients like zinc and antioxidants, has been shown to improve wound healing in malnourished patients with pressure ulcers. This amino acid plays a crucial role in promoting tissue repair and enhancing the healing process by serving as a precursor to nitric oxide, which improves blood flow to wounded areas, delivering essential oxygen and nutrients needed for healing 1. Arginine also supports collagen synthesis, which is crucial for rebuilding damaged tissue and forming scar tissue. Additionally, it enhances immune function by stimulating T-cell activity, helping to prevent infection in wounds.
For wound healing support, arginine can be taken orally as a supplement, and typical supplemental doses range from 3-6 grams daily, divided into multiple doses. However, it's essential to note that the benefits of arginine supplementation may depend on the patient's nutritional status and the presence of concomitant health problems. A study by Cereda et al. found that supplementation with an oral nutritional formula enriched with arginine, zinc, and antioxidants improved pressure ulcer healing in malnourished patients compared to an isocaloric isonitrogenous formula 1.
It's also important to consider the potential interactions and contraindications of arginine supplementation. People with herpes infections should use arginine cautiously as it may trigger outbreaks, and those with liver or kidney disease should consult healthcare providers before supplementing. Arginine works best when combined with proper wound cleaning, keeping the area moist, and adequate nutrition, including sufficient protein, vitamin C, and zinc, which all support the body's natural healing mechanisms. According to the ESPEN guideline on clinical nutrition and hydration in geriatrics, nutritional interventions, including arginine supplementation, are indicated in malnourished older patients with pressure ulcers, as they may support healing of pressure ulcers 1.
In terms of specific recommendations, the ESPEN guideline suggests that arginine supplementation may be beneficial in malnourished patients with pressure ulcers, but the grade of recommendation is downgraded to B due to the limited number of high-quality studies available 1. Further research is needed to fully understand the effects of arginine supplementation on wound healing and to determine the optimal dosage and duration of treatment. However, based on the current evidence, arginine supplementation, particularly when combined with other nutrients, appears to be a promising adjunctive therapy for wound healing in malnourished patients with pressure ulcers.
From the Research
Role of Arginine in Wound Care
- Arginine, a conditionally indispensable amino acid, has been found to have wound healing properties 2, 3, 4, 5, 6
- The 2019 international guideline by the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance recommends the use of a high-protein, high-calorie oral nutrition supplement fortified with arginine and other antioxidants to treat adults with stage 2 or greater pressure injury and who are malnourished or at risk of malnutrition 2
- Studies have shown that arginine supplementation can enhance wound healing in older adults in acute and long-term care settings, as evidenced by significant reductions in wound size and improvements in wound healing when compared with oral nutrition supplementation alone 3
Mechanism of Action
- Arginine is the sole substrate for nitric oxide (NO) synthesis, which plays a crucial role in wound healing 4
- The metabolism of arginine via the NO pathway is one mechanism by which arginine enhances wound healing 4
- Arginine-based materials have been developed to accelerate wound healing, with arginine exhibiting excellent biosafety, antimicrobial properties, and therapeutic effects on wound healing 5
Clinical Evidence
- Current evidence suggests that arginine supplementation in conjunction with oral nutrition supplementation may promote wound healing in older adult patients in acute care and LTC settings 3
- However, a definitive conclusion about the use of arginine supplementation alone to promote wound healing cannot be drawn due to limitations in the available literature 3
- Well-designed clinical trials are required to determine whether arginine supplementation is effective in enhancing healing of acute and chronic wounds in humans and how much arginine is recommended to meet metabolic needs during the phases of wound healing 6