The goal of this clinical trial is to learn whether L-glutamine can help lower pulmonary artery pressure in adults with non-transfusion-dependent thalassemia (NTDT).

The main questions it aims to answer are:

Does L-glutamine reduce pulmonary artery pressure after 60 days of treatment?

Is the effect of L-glutamine different from standard care alone?

Researchers will compare two groups:

Intervention group: Participants receive oral L-glutamine in addition to their standard treatment.

Control group: Participants continue with standard treatment only.

Participants will:

Take either L-glutamine (by mouth) or standard care for 60 days. Undergo echocardiography at the beginning and end of the study to measure pulmonary artery pressure.

Attend follow-up visits to monitor safety, adherence, and possible side effects.

Inclusion Criteria:

• Adults (≥18 years), any sex.
• Diagnosis of non-transfusion-dependent β-thalassemia (NTDT).
• Pulmonary artery pressure (PAP) > 35 mmHg estimated by Doppler echocardiography at screening.
• Able and willing to provide written informed consent.
• On a stable standard-of-care regimen (e.g., chelation and/or hydroxyurea) per treating physician judgment.

Exclusion Criteria:

• Age <18 years.
• Refusal or inability to provide informed consent.
• Hepatic dysfunction: ALT >3× upper limit of normal.
• Renal dysfunction: serum creatinine >2× upper limit of normal.
• Known hypersensitivity to L-glutamine.
• Pregnancy or breastfeeding.
• Use of amino-acid/protein supplements within the past 3 months.
• History of other cardiac diseases associated with pulmonary hypertension (per investigator assessment).

Individual participant data will not be shared because of the small sample size, the single-center design, and the need to protect patient privacy. Only aggregated results will be reported in publications or presentations.