L-ARGININE, THE SUBSTRATE FOR nitric oxide (NO) synthesis, is deficient in sickle cell disease (SCD). [1][2][3][4] Increased NO consumption by cell free plasma hemoglobin 5 and reactive oxygen species 6,7 leads to decreased NO bioavailability 8,9 that is exacerbated by decreased availability of the NO synthase substrate L-arginine. This state of resistance to NO is accompanied by a compensatory up-regulation of NO synthase and non-NO-dependent vasodilators. [10][11][12][13] Under conditions of low arginine concentration, NO synthase is uncoupled, producing reactive oxygen species in lieu of NO, 14,15 potentially further reducing NO bioavailability in SCD and enhancing oxidative stress. Recent reports of elevated arginase activity in SCD [16][17][18] offer another avenue for decreasedargininebioavailability.Arginase, an enzyme that converts L-arginine to ornithine and urea, can limit NO bioavailability through increased consumption of the substrate for NO synthase. [19][20][21] Arginase, which is found predominantly