Long-term treatment of SOD1 ALS with tofersen: a multicentre experience in 17 patients.

BACKGROUND: In Amyotrophic Lateral Sclerosis (ALS) patients with SOD1 mutation the intrathecal administration of tofersen slowed down the progression of disease in a controlled clinical study, but results were not statistically significant. METHODS: In this multicentre, observational study, we evaluated a cohort of 27 ALS-SOD1 patients who were treated with tofersen, focussing on 17 patients who were followed for at least 48 weeks (median period of 84 weeks, range 48-108). We compared the clinical slopes, as measured by ALSFRS-R, MRC scale and Forced Vital Capacity, during tofersen treatment with retrospective data at 1 year prior to therapy. Cerebrospinal fluid (CSF) and serum neurofilament light chains (NFL) were measured in all patients. RESULTS: Cumulative evaluation of the ALSFRS-R and MRC progression rates showed a statistically significant change during treatment with respect to the period prior to therapy (p = 0.023 and p = 0.007, respectively). The analysis of individual patients showed that nine of the seventeen patients substantially stabilized or slightly improved. Four patients deteriorated during treatment, while in the remaining patients the very slow course did not allow to identify significant changes. CSF and serum NFL concentration markedly decreased in the near totality of patients. Increased levels of white blood cells and proteins in the CSF were found in 60% of patients. Such alterations were clinically asymptomatic in all but two patients who showed an acute pure motor radiculitis, which responded to steroid therapy. CONCLUSIONS: Clinical findings and NFL analysis strongly suggest that tofersen may have a disease-modifying effect in a subset of SOD1-ALS patients.

Identification of the Novel Streptococcus equi subsp. zooepidemicus Sequence Type 525 in Donkeys of Abruzzo Region, Italy.

Streptococcus equi sub. zooepidemicus (SEZ) is described as a commensal bacterium of several animal species, including humans. Growing evidence supports the potential role of SEZ in the onset and progression of severe clinical manifestations of diseases in horses and other animals. In the present communication, we describe the diagnostic procedure applied to characterize the streptococcal infections caused by a novel SEZ sequence type (ST525) in donkeys raised on a farm in Abruzzo, Italy. The diagnostic process began with anamnesis and anatomopathological analysis, which revealed a severe bacterial suppurative bronchopneumonia associated with systemic vascular damage and haemorrhages. Then, SEZ infection was confirmed by applying an integrative diagnostic strategy that included standard bacterial isolation techniques, analytical tools for bacteria identification (MALDI-TOF MS), and molecular analysis (qPCR). Furthermore, the application of the whole-genome sequencing approach helped us to identify the bacterial strains and the virulence factors involved in animal diseases. The novel SEZ-ST525 was identified in two cases of the disease. This new sequence type was isolated from the lung, liver, and spleen in Case 1, and from retropharyngeal lymph nodes in Case 2. Moreover, the presence of the virulence gene mf2, a virulence factor carried by prophages in Streptococcus pyogenes, was also found for the first time in an SEZ strain. The results of the present study highlight the need to apply an integrated diagnostic approach for the identification and tracking of pathogenic strains of SEZ, shedding new light on the re-evaluation of these bacteria as a causative agent of disease in animals and humans.

Evaluating the contribution of the gene TARDBP in Italian patients with amyotrophic lateral sclerosis.

BACKGROUND AND OBJECTIVES: Genetic variants in the gene TARDBP, encoding TDP-43 protein, are associated with amyotrophic lateral sclerosis (ALS) in familial (fALS) and sporadic (sALS) cases. Objectives of this study were to assess the contribution of TARDBP in a large cohort of Italian ALS patients, to determine the TARDBP-associated clinical features and to look for genotype-phenotype correlation and penetrance of the mutations. METHODS: A total of 1992 Italian ALS patients (193 fALS and 1799 sALS) were enrolled in this study. Sanger sequencing of TARDBP gene was performed in patients and, when available, in patients' relatives. RESULTS: In total, 13 different rare variants were identified in 43 index cases (10 fALS and 33 sALS) with a cumulative mutational frequency of 2.2% (5.2% of fALS, 1.8% of sALS). The most prevalent variant was the p.A382T followed by the p.G294V. Cognitive impairment was detected in almost 30% of patients. While some variants, including the p.G294V and the p.G376D, were associated with restricted phenotypes, the p.A382T showed a marked clinical heterogeneity regarding age of onset, survival and association with cognitive impairment. Investigations in parents, when possible, showed that the variants were inherited from healthy carriers and never occurred de novo. CONCLUSIONS: In our cohort, TARDBP variants have a relevant frequency in Italian ALS patients and they are significantly associated with cognitive impairment. Clinical presentation is heterogeneous. Consistent genotype-phenotype correlations are limited to some mutations. A marked phenotypic variability characterizes the p.A382T variant, suggesting a multifactorial/oligogenic pathogenic mechanism.

Treatment of benzodiazepine-refractory status epilepticus: A retrospective, cohort study.

INTRODUCTION: Status epilepticus (SE) is a frequent neurological emergency, derived from the failure of mechanisms responsible for seizure termination. The present study aims to compare the efficacy of the most common antiseizure medications (ASMs) employed for the treatment of benzodiazepine-refractory SE. METHODS: We performed a retrospective cohort study of all SE episodes treated in our hospital between January 2016 and December 2020. Inclusion criteria were: age ≥ 18 years; a diagnosis of status epilepticus. Exclusion criteria were: status epilepticus resolved by initial therapy with benzodiazepines; impossibility to retrieve medical records. We considered as effective the ASM that was the last drug introduced or increased in dose before termination of SE and without changes in the co-medication. RESULTS: A total of 244 episodes in 219 patients were included in the study. The mean age of the final study cohort was 63.6 ± 19.2, with 108 (49%) men. In the total cohort, phenytoin (PHT) showed the highest response rate (57.6%), followed by lacosamide (LCM) (40.7%) and valproate (VPA) (39.8%). The comparative efficacy among the different drugs was significantly different (p < 0.001). In the pairwise comparisons, VPA was superior to levetiracetam (LEV) (response rate: 39.75% vs 24.71%; p = 0.004), but not to LCM. Phenytoin had a significantly higher resolution rate compared to VPA (response rate: 57.63% vs 39.75%; p = 0.02) and LEV (response rate: 57.63% vs 24.71; p < 0.001). The clinical predictors of anaesthetics administration were a disorder of consciousness upon clinical presentation, previous diagnosis of epilepsy, and younger age. CONCLUSION: In our cohort of SE, PHT showed higher effectiveness in terminating established SE, as well as refractory SE in the subgroup of patients treated with anaesthetics.

Analysis of STMN2 CA repeats in italian ALS patients shows no association.

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease caused by a complex interaction of genetic and environmental factors. Recently, a polymorphic intronic CA repeat in STMN2 gene has been proposed as risk factor for ALS. The presence of long/long CA genotype, especially if one allele had 24 CA, was reported to be significantly associated with the disease in a cohort of sporadic ALS patients. We tested an Italian cohort of 366 ALS patients and 353 healthy controls and we found no association between CA length and ALS risk.

Thr124Met myelin protein zero mutation mimicking motor neuron disease.

Mutations in myelin protein zero (MPZ) are associated with heterogeneous manifestations. In this study, we report clinical, electrophysiological, pathological, and muscle MRI findings from two relatives with MPZ Thr124Met variants, disclosing different phenotypes. The proband was a 73-year-old female with a 12-year-story of atrophy, weakness, and fasciculations in her proximal and distal lower limbs. EMG examination showed neurogenic signs with active denervation together with reduced sensory action potentials, without sensory symptoms. The initial diagnosis was of a slowly progressive lower motor neuron disease (MND) with subclinical sensory axonal neuropathy. Two years later, the observation of her 60-year-old nephew, who had a distal sensory-motor neuropathy, prompted the analysis of inherited neuropathies-related genes and revealed a MPZ Thr124Met mutation in both cases. Our findings expand the clinical spectrum of MPZ-related neuropathy and highlight that Thr124Met mutation may cause a syndrome mimicking MND. The challenging issue to detect sensory features in the diagnostic MND work up is discussed.

Novel variants and cellular studies on patients' primary fibroblasts support a role for NEK1 missense variants in ALS pathogenesis.

In the last few years, NEK1 has been identified as a new gene related to amyotrophic lateral sclerosis (ALS). Loss-of-function variants have been mostly described, although several missense variants exist, which pathogenic relevance remains to be established. We attempted to determine the contribution of NEK1 gene in an Italian cohort of 531 sporadic and familial amyotrophic lateral sclerosis (ALS) patients applying massive parallel sequencing technologies. We filtered results of NEK1 gene and identified 20 NEK1 rare variants (MAF < 0.01) in 22 patients. In particular, we found two novel frameshift variants (p.Glu929Asnfs*12 and p.Val1030Ilefs*23), 18 missense variants, including the p.Arg261His in three patients, and a novel variant in the start codon, the p.Met1?, which most likely impairs translation initiation. To clarify the role of NEK1 missense variants we investigated NEK1 expression in primary fibroblast cultures. We obtained skin biopsies from four patients with NEK1 variants and we assessed NEK1 expression by western blot and immunofluorescence. We detected a decrease in NEK1 expression in fibroblasts from patients with NEK1 variants, suggesting that missense variants in NEK1 gene may have a pathogenic role. Moreover, we observed additional variants in ALS related genes in seven patients with NEK1 variants (32%), further supporting an oligogenic ALS model.

Coexistence of variants in TBK1 and in other ALS-related genes elucidates an oligogenic model of pathogenesis in sporadic ALS.

Variants in tank-binding kinase 1 (TBK1) are responsible for a significant proportion of amyotrophic lateral sclerosis (ALS) cases. In the present study, we analyzed variants in TBK1 extracted by targeted sequencing of 32 genes in a group of 406 Italian patients with ALS. We identified 7 different TBK1 variants in 7 sporadic cases, resulting in a frequency of 1.7%. Three patients had missense variants (p.R357Q, p.R358H, and p.R724C), one patient had a small deletion (p.E618del), and 3 had truncating variants (p.Y482*, p.R229*, and p.N681*). Notably, we found that 4 patients had an additional variant in ALS-related genes: 2 in OPTN and 2 in the 3'UTR region of FUS. By studying an independent group of 7 TBK1-mutated patients previously reported, we found another variant in the 3'UTR region of FUS in one patient. The presence of a second variant in TBK1 variant carriers is an interesting finding that needs to be investigated in larger cohorts of patients. These findings suggest that TBK1 belongs to the category of genes conferring a significantly increased risk but not sufficient to cause disease.

Possíveis decorrências da suplementação da glutamina no sistema imunológico e na melhora do desempenho de praticantes de exercício físico / Possible decorations of glutamine supplementation in the immunological system and in improving the performance of physical exercise practice

A glutamina é o aminoácido livre mais abundante no organismo humano, responsável por desempenhar diversas funções fisiológicas. Em situação de hipercatabolismo como estresse, trauma, infecções e condições de exercícios físicos extremos, sua produção pelos tecidos se torna insuficiente para suprir suas necessidades, classificando este aminoácido como condicionalmente essencial. Durante o exercício exaustivo, a glutamina é utilizada para síntese de trifosfato de adenosisa (ATP) reduzindo sua disponibilidade para o sistema de defesa antioxidante e imune. Dessa forma, a suplementação da glutamina vem sendo estudada como uma possibilidade de recuperar o sistema imune e melhorar o desempenho de atletas em períodos de exercícios exaustivos. O presente estudo teve como objetivo verificar o efeito da suplementação da glutamina no sistema imunológico sobre os diferentes tipos de exercício físico. Foi realizada uma pesquisa bibliográfica a partir de artigos publicados junto ao banco de dados do Google acadêmico, Scielo e Bireme. A suplementação da glutamina, aliada ao exercício físico, parece melhorar o sistema imune, porém há necessidade de mais estudos para comprovar sua efetividade no auxílio ergogênico para melhorar o desempenho físico(AU)

Glutamine is the most abundant free amino acid in the human body, responsible for performing many physiological functions. In a situation of hypercatabolism such as stress, trauma, infections and extreme physical exercises conditions, its production from the tissues becomes insufficient to supply its needs, classifying this amino acid as conditionally essential. During exhaustive exercise, glutamine is used for adenosine triphosphate (ATP) synthesis reducing its availability to the immune and antioxidant defense system. In this way, glutamine supplementation has been studied as a possibility to recover the immune system and to improve the performance of athletes in periods of exhaustive exercises. The current study aims to verify the effect of glutamine supplementation on the immune system on the different types of physical exercise. A bibliographic search was done from articles published with the database of academic Google, Scielo and Bireme. Glutamine supplementation, combined with physical exercise, seems to improve the immune system, but there is a need for further studies to prove its effectiveness in ergogenic assistance to improve physical performance(AU)

Small fibre neuropathy in mitochondrial diseases explored with sudoscan.

OBJECTIVE: Polyneuropathy in mitochondrial diseases (MDs) is relatively common and widely investigated, but few data are instead reported about small fibres involvement. METHODS: In order to investigate the involvement of small fibres in MDs we performed extensive neurophysiological test (nerve conduction studies; sympathetic skin response; sudoscan) in 27 patients with genetic diagnosis of MD (7 m.3243A > G; 4 m.8344A > G; 9 single mtDNA deletion; 7 multiple mtDNA deletions). RESULTS: NCS showed a polyneuropathy in 11/27 cases (41%). The incidence was very high in POLG1 (100%), m.8344A > G (75%) and m.3243A > G (43%), while only 11% of patients with single deletion had evidence of large fibres involvement. Sympathetic skin response was abnormal only in three patients (one progressive external ophthalmoplegia with single mtDNA deletion; one patient with m.3243A > G mutation; one patient with POLG1 mutation). Sudoscan revealed the presence of an autonomic small fibres dysfunction in 9/27 cases (33%), most of them (7/9) carrying a single mtDNA deletion. Sudoscan data were also confirmed in a sub-group of patients by laser evoked potentials study. Considering only patients with single mtDNA deletion 7/9 (78%) showed abnormal results at sudoscan. CONCLUSIONS: Small fibre neuropathy is another feature to investigate in mitochondrial diseases and seems specifically associated with the presence of single mtDNA deletion. SIGNIFICANCE: The correct identification through specific neurophysiological tests of small fibres involvement in MDs represents another tile in this challenging diagnosis.

Uma breve revisão: a utilização da suplementação de creatina no treinamento de força / A brief review: the use of creatine supplementation on strength training

O presente estudo tem como objetivo verificar a eficácia da suplementação de creatina no treinamento de força. A creatina é uma substância não essencial encontrada no organismo, derivada de três aminoácidos: glicina L-arginina e metionina. Foi realizada uma pesquisa bibliográfica, a partir de artigos publicados junto ao banco de dados Google acadêmico, Bireme e Scielo. A creatina é produzida de forma endógena pelo fígado, rins e pâncreas, podendo também ser adquirida através da alimentação. A suplementação de creatina vem sendo utilizada por atletas com características de força máxima, explosiva e velocidade. A suplementação de creatina durante um curto período não aumenta e nem altera a taxa de filtração glomerular, portanto conclui-se que a creatina, quando suplementada de forma adequada promove uma melhoria no desempenho do treinamento de força e não provoca efeitos colaterais graves(AU)

This study has the aims to determine the effectiveness of creatine supplementation on strength training. The creatine is not essential substance found in the body derived from three amino acids: glycine, L-arginine and methionine. A bibliographic search was carried out basea on articles published by the Academic Google, Bireme and Scielo. Creatine is produced endogenously by the liver, kidneys and pancreas and can also be acquired through diet. Creatine supplementation has been used by athletes with maximum strength characteristics, and explosive speed. Creatine supplementation for a short period and does not increase or change glomerular filtration rate, so it follows that creatine when supplemented appropriately promotes an improvement in the performance of strength training and do not cause serious side effects(AU)

Deficiências nutricionais na cirurgia bariátrica / Nutritional deficiencies in surgery bariatric

Quando clinicamente a reeducação alimentar, uso de medicamentos e a prática de atividades físicas se torna ineficientes, a cirurgia bariátrica é a principal opção para tratamento da obesidade grau III. O paciente submetido à cirurgia bariátrica sofre mudanças anatômicas e fisiológicas que são realizadas durante o procedimento cirúrgico e juntamente com algumas deficiências nutricionais já presentes, resultam em uma diminuição maior ainda de vitaminas e minerais, dentre as principais estão o cálcio, vitamina B12, ferro e vitamina D. O objetivo deste estudo é verificar as deficiências nutricionais ocorridas devido à carência de nutrientes em pacientes submetidos à cirurgia bariátrica. Foi realizada uma pesquisa bibliográfica a partir dos artigos publicados junto ao banco de dados Medline, Lilacs e Scielo, selecionadas publicações escritas desde o início do ano de 2000 até o ano de 2014. O paciente após realizar a cirurgia bariátrica deve ter um suporte nutricional durante todo o tempo de adaptação à nova rotina de alimentação, aprendendo a fazer escolhas de alimentos saudáveis e com valor nutricional adequado, prevenindo assim as deficiências nutricionais e obtendo um bom resultado do tratamento proposto

When clinically dietary reeducation, use of medications and physical activity becomes inefficient, bariatric surgery is the main option for the treatment of morbid obesity. The patient undergoing bariatric surgery suffers anatomical and physiological changes that take place during the surgical procedure and with some nutritional deficiencies already present, resulting in a greater decrease even of vitamins and minerals, among the most important are calcium, vitamin B12, iron and vitamin D. the aim of this study is to assess the nutritional deficiencies that occurred due to the lack of nutrients in patients undergoing bariatric surgery. Was carried out a literature search from articles published by the Medline, Lilacs and Scielo, selected publications written since the beginning of the year 2000 until the year 2014. The patient after performing bariatric surgery should have a nutritional support was held during all the time to adapt to new eating routine, learning to make healthy food choices and proper nutritional value, thereby preventing nutritional deficiencies and getting a good result of treatment

Efeitos do treinamento de força em pessoas portadoras do diabetes mellitus tipo 2 / Strength training effects on persons with diabetes mellitus type 2

Esta revisão de literatura teve como objetivo, representar dados científicos especializados, indexados em bases de dados eletrônicos, sobre os efeitos que o treinamento de força pode proporcionar aos portadores do Diabetes Mellitus tipo 2 e os cuidados necessários ao se praticar este tipo de modalidade de treinamento físico. Sendo uma doença crônica, o diabetes reduz a expectativa de vida e está associada ao desenvolvimento de outras doenças, por isso à necessidade de busca por formas de tratamento e prevenção. O treinamento de força pode proporcionar melhora na absorção de glicose, aumento de massa magra, aumento das respostas metabólicas em repouso e composição corporal. Portanto a intervenção do treinamento de força atua de forma benéfica na prevenção e tratamento dessa enfermidade

This literature review aimed to represent specialized scientific data indexed in electronic databases, on the effects that strength training can provide to holders of type 2 diabetes and the necessary precautions when practicing this type of physical training mode. Being a chronic disease, diabetes reduces life expectancy and is associated with the development of other diseases, so the need to search for ways of treatment and prevention. Strength training can provide improved absorption of glucose, lean mass increase, increase in metabolic responses at rest and body composition. Therefore the intervention of strength training acts in a beneficial way to prevent and treat this disease

Charcot-Marie-Tooth type 2 and distal hereditary motor neuropathy: Clinical, neurophysiological and genetic findings from a single-centre experience.

OBJECTIVES: CMT is a group of heterogeneous motor and sensory neuropathies divided into demyelinating (CMT1) and axonal forms (CMT2). Distal Hereditary Motor Neuropathy (dHMN) is a motor neuropathy/neuronopathy which resembles CMT. Final genetic diagnosis is poor in CMT2 and in dHMN when compared with CMT1. Our aim is to report clinical, neurophysiological and genetic findings in a cohort of patients with axonal inherited neuropathies. PATIENTS AND METHODS: We report clinical, neurophysiological and genetic findings from 45 patients with CMT2 or dHMN, coming from 39 unrelated families, observed in our Institute of Neurology over a 20-year period. RESULTS: Clinical and electrophysiological examinations showed that 38 patients had CMT2 and 7 patients presented dHMN. Extensive genetic evaluation showed 6 mutations in MFN2, 4 mutations in HSPB1, 2 mutations in BSCL2, 3 mutations in GJB1, 1 mutation in MPZ. CONCLUSION: Since next-generation sequencing will not be easily accessible, epidemiological data and clinical "phenotyping" remain the best strategy for clinicians to reach a correct genetic diagnosis in CMT2 and dHMN patients.

Os efeitos da suplementação de ACR sobre a fadiga no exercício de endurance / The effects of ACR supplementation on fatigue in endurance exercise

Nove são os aminoácidos considerados essenciais ao organismo, ou seja, necessitam ser adquiridos através da dieta. Dentre eles a Isoleucina, Leucina e Valina são consideradas de cadeia ramificada (ACR). Supõe-se que esses aminoácidos estejam envolvidos no processo de fadiga central, aumentando a performance do indivíduo. O presente estudo tem como objetivo identificar os efeitos da suplementação de Branched Chained Amino Acids (BCAA) sobre o estado de fadiga em exercícios de endurance. Foi realizada uma pesquisa bibliográfica a partir dos artigos publicados junto ao banco de dados Bireme, Lilacs, Scielo, Google Acadêmico e livros. Conclui-se que não há evidências científicas que comprovam os efeitos dos ACR na diminuição da fadiga central em exercícios de endurance, apenas na diminuição da incidência de lesão muscular

Nine amino acids are considered essential to the organism, so, need to be acquired from the diet. Among them Isoleucine, Leucine and Valine are considered branched-chain (BCAA). It is assumed that these amino acids are involved in the central fatigue process, increasing the performance of the individual. This study aims to identify the effects of supplementation of Branched Chained Amino Acids (BCAA) on the state of fatigue in endurance exercise. A literature search from articles published was carried out by the Bireme database, Lilacs, Scielo, Google Scholar and books. We conclude that there is no scientific evidence to prove the effects of BCAA in decreased central fatigue in endurance exercise, only in reducing the incidence of muscle injury

Influence of nitric oxide in the improvement of muscle power

ABSTRACTOBJECTIVETo evaluate whether nitric oxide (NO) supplementa-tion is directly related to increased muscle power in response to strength exercise trainingMETHODSThe study included 36 individuals who underwent training for eight weeks (three times per week) with weights, who were randomly divided into two groups, both receiving the same training protocol, but one group used 3g of arginine, as a precursor of NO, and the other received placeboRESULTSThere was no significant difference between groups, only a significant difference for both groups between moments: before and after the training protocolCONCLUSIONOral administration of arginine asso-ciated with a training program did not increase the muscular power of individuals. Level of Evidence I, Study Type: Highquality randomized trial with statistically significant diffe-rence or no statistically significant difference but narrow confidence intervals.

"Myo-cardiomyopathy" is commonly associated with the A8344G "MERRF" mutation.

The objective of the study was to better characterize the clinical phenotype associated with the A8344G "MERRF" mutation of mitochondrial DNA. Fifteen mutated patients were extensively investigated. The frequency of main clinical features was: exercise intolerance and/or muscle weakness 67 %, respiratory involvement 67 %, lactic acidosis 67 %, cardiac abnormalities 53 %, peripheral neuropathy 47 %, myoclonus 40 %, epilepsy 40 %, ataxia 13 %. A restrictive respiratory insufficiency requiring ventilatory support was observed in about half of our patients. One patient developed a severe and rapidly progressive cardiomyopathy requiring cardioverter-defibrillator implantation. Five patients died of overwhelming, intractable lactic acidosis. Serial muscle MRIs identified a consistent pattern of muscle involvement and progression. Cardiac MRI showed non-ischemic late gadolinium enhancement in the left ventricle inferolateral part as early sign of myocardial involvement. Brain spectroscopy demonstrated increased peak of choline and reduction of N-acetylaspartate. Lactate was never detected in brain areas, while it could be documented in ventricles. We confirm that muscle involvement is the most frequent clinical feature associated with A8443G mutation. In contrast with previous reports, however, about half of our patients did not develop signs of CNS involvement even in later stages of the disease. The difference may be related to the infrequent investigation of A8344G mutation in 'pure' mitochondrial myo-cardiomyopathy, representing a bias and a possible cause of syndrome's underestimation. Our study highlights the importance of lactic acidosis and respiratory muscle insufficiency as critical prognostic factors. Muscle and cardiac MRI and brain spectroscopy may be useful tools in diagnosis and follow-up of MERRF.

Influence of nitric oxide in the improvement of muscle power.

OBJECTIVE: To evaluate whether nitric oxide (NO) supplementa-tion is directly related to increased muscle power in response to strength exercise training. METHODS: The study included 36 individuals who underwent training for eight weeks (three times per week) with weights, who were randomly divided into two groups, both receiving the same training protocol, but one group used 3g of arginine, as a precursor of NO, and the other received placebo. RESULTS: There was no significant difference between groups, only a significant difference for both groups between moments: before and after the training protocol. CONCLUSION: Oral administration of arginine asso-ciated with a training program did not increase the muscular power of individuals. Level of Evidence I, Study Type: Highquality randomized trial with statistically significant diffe-rence or no statistically significant difference but narrow confidence intervals.