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We found that insufficient arginine\/nitric oxide synthesis limits blood flow in the intestinal microvasculature, leading to hypoxia, mucosa damage and NEC in the premature intestine after formula feeding. Formula feeding led to increased intestinal hypoxia in pups at postnatal day 1(P1) and P5, but not in more mature pups at P9. Accordingly, blood flow in the intestinal microvasculature increased after formula feeding only in P9 pups. mRNA profiling revealed that regulators of arginine\/nitric oxide synthesis are at higher levels in endothelial cells of the intestine of P9 than P1 pups. Importantly, arginine supplementation increased intestinal microvasculature blood flow, and prevented NEC, whereas an arginine antagonist exacerbated NEC. Our results suggest that balancing intestinal oxygen demand and supply in the premature intestine by modulating arginine\/nitric oxide could be used to prevent NEC.<\/jats:p>","DOI":"10.1242\/dmm.040998","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T15:06:37Z","timestamp":1573225597000},"source":"Crossref","is-referenced-by-count":37,"title":["Formula Feeding and Immature Gut Microcirculation Promote Intestinal Hypoxia leading to Necrotizing Enterocolitis"],"prefix":"10.1242","author":[{"given":"Yong","family":"Chen","sequence":"first","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhki","family":"Koike","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Chi","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalla","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9775-528X","authenticated-orcid":false,"given":"Hiromu","family":"Miyake","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8298-8344","authenticated-orcid":false,"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Lee","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Delgado-Olgu\u00edn","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada"},{"name":"Heart & Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agostino","family":"Pierro","sequence":"additional","affiliation":[{"name":"Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"237","published-online":{"date-parts":[[2019,1,1]]},"reference":[{"key":"2021042700232765600_DMM040998C1","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1016\/S0022-3476(05)81124-2","article-title":"Pathology of neonatal necrotizing enterocolitis: a ten-year experience","volume":"117","author":"Ballance","year":"1990","journal-title":"J. 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