This research establishes the need for an adequate supply of Nitric Oxide (NO) when using hydroxyurea to boost the fetal hemoglobin level. This raises questions as to what the best way to enhance NO production using supplements. L-carntine, L-arginine and combinations of Alpha Lipoic Acid and Acetyl L-Carnitine, or L-arginine and lysine are all possibilities.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC151872/In summary, our results strongly suggest that HbF
induction by hydroxyurea is mediated by the NOdependent
activation of sGC. It is important to note
that these effects can also be mediated by other NOdonor
compounds. These findings open the door to
new therapeutic strategies based on NO delivery by
NO donors, arginine salt administration, or increasing
NO synthase expression or activity or based on
the amplification of NO signal transduction with
phosphodiesterase inhibitors. Modulation of this
system may allow for the discovery of additive or
synergistic regimens that increase responsiveness
and reduce morbidity associated with hydroxyurea
therapy. Furthermore, individual variations in NO
signal amplification secondary to NO scavenging or
sGC/phosphodiesterase activities may help explain
the well-appreciated variable responsiveness to
hydroxyurea treatment.