Asymmetric dimethylarginine is associated with high-sensitivity C-reactive protein and early carotid atherosclerosis in women with previous gestational diabetes mellitus

Asymmetric dimethylarginine and gestational diabetes mellitus: a systematic review and meta-analysis

PURPOSE

Emerging evidence demonstrates that asymmetric dimethylarginine (ADMA) levels are elevated in patients with or at risk of cardiovascular disease (CVD). Since women with gestational diabetes mellitus (GDM) are at high risk of future CVD, we conducted a systematic review and meta-analysis to compare ADMA concentrations between women with and without GDM during pregnancy and postpartum.

METHODS

PubMed, Google Scholar, EMBASE, and CINAHL databases were searched. The review protocol is registered in PROSPERO (CRD42021276796). Study selection, data extraction, and data analyses were performed in accordance with PRISMA guidelines. Random-effects model was used to quantify ADMA levels in the study groups.

RESULTS

Eleven studies provided data on 1148 women. Mean plasma ADMA concentration was 0.04 μmol/L (95% confidence interval (CI) -0.06-0.15) higher in pregnant women with GDM than those without GDM, but no significant difference was observed. In contrast, our meta-analysis demonstrated a significant increase in postpartum mean ADMA concentration (Mean Difference (MD) 0.11 μmol/L; 95% CI 0.05-0.16) among women with previous GDM compared to women without previous GDM.

CONCLUSION

Elevated ADMA levels in GDM may be a CVD risk factor, suggesting that ADMA may be a potential biomarker for early CVD risk prediction in women with GDM.

Association Between Neutrophil-Lymphocyte Ratio and Gestational Diabetes-A Systematic Review and Meta-Analysis

A growing body of evidence shows that the neutrophil-lymphocyte ratio (NLR) is a surrogate index of systemic inflammation in several chronic diseases. Conflicting associations between NLR and gestational diabetes mellitus (GDM) have been reported in individual studies. This meta-analysis sought to investigate the association between NLR and GDM. The PubMed, EMBASE, and Google Scholar databases were searched to identify relevant articles. The pooled standardized mean difference with 95% CI was calculated using a random-effects model. Subgroup and meta-regression analysis were carried out to control for the effects of GDM diagnostic criteria, ethnicity, body mass index (BMI), and age. Eleven eligible articles were included, containing 1271 participants with GDM and 1504 controls. Pooled outcomes indicated a higher NLR in GDM pregnancies than in normoglycemic controls (SMD = 0.584; 95% CI, 0.339–0.830; P < .001), although extensive heterogeneity between studies was noted. Subgroup analysis revealed that the higher pooled estimate in GDM was not affected by diagnostic criteria, ethnicity, or BMI, although matching for BMI reduced heterogeneity between studies. This meta-analysis supports the higher NLR in GDM described by some individual studies.

Blunted cerebral oxygenation during exercise in women with gestational diabetes mellitus: associations with macrovascular function and cardiovascular risk factors

AIM/HYPOTHESIS

This cross-sectional, observational, controlled study examined cerebral oxygenation during exercise, an index of cerebrovascular function and cortical activation, in pregnancies complicated by gestational diabetes mellitus (GDM) and unaffected pregnancies. The association of cerebral oxygenation with macrovascular and cardiovascular function indices was also evaluated.

MATERIAL AND METHODS

Vascular function and structure [aortic pulse-wave-velocity (PWV), augmentation index (AI), carotid intima-media thickness], as well as 24-hour ambulatory blood pressure (BP) were assessed in women with GDM (n = 21) and uncomplicated pregnancies (n = 16), at 26-32 gestational weeks. Changes in cerebral oxygenation [oxy- (O₂Hb), deoxy- (HHb) and total- (tHb) hemoglobin] were continuously recorded by near-infrared spectroscopy (NIRS) during intermittent handgrip exercise. Beat-by-beat BP and systemic vascular resistance (SVR) were assessed (Finapres).

RESULTS

Women with GDM had higher AI than controls. During exercise, women with GDM maintained a smaller force (p < 0.05), despite similar ratings of perceived exertion. Despite similar increases in BP during exercise, the GDM group exhibited a lower average and total (AUC) increase in cerebral-O₂Hb than controls (p < 0.05). In addition, GDM exhibited a slower rate of cerebral-O₂Hb decay during recovery (p < 0.05). SVR was lower in GDM compared to controls throughout the protocol (p < 0.01). Cerebral oxygenation indices were correlated with PWV and AI (p < 0.05).

CONCLUSIONS

This study provided novel evidence for blunted cerebral oxygenation during exercise in women with GDM compared to uncomplicated pregnancies, suggesting a link between reduced cerebrovascular function with exercise intolerance in GDM. Cerebral oxygenation during physical stress was correlated with macrovascular function and cardiovascular risk factors. More studies are needed to examine whether this impaired cerebral oxygenation reflects early cerebrovascular disease.

Asymmetric dimethylarginine contributes to retinal neovascularization of diabetic retinopathy through EphrinB2 pathway

Diabetic retinopathy (DR) is a leading cause of vision loss with retinal neovascularization. This study aims to investigate whether Asymmetric dimethylarginine (ADMA) impacts the pathogenesis of DR via focusing on promoting retinal neovascularization and its underlying molecular mechanisms. Diabetic rats were induced by a single intraperitoneal injection of streptozotocin (STZ) for 20 weeks. ADMA levels in aqueous and the influence of hypoxia on ADMA and angiogenesis in RF/6A cells were examined. The effects and underlying molecular mechanisms of ADMA on neovascularization of RF/6A cells were further evaluated by administration of ADMA, DDAH siRNA or ephrinB2 siRNA. Results showed that ADMA levels were elevated in both aqueous from diabetic rats and culture medium in RF/6A cells pretreated with hypoxia. Administration of ADMA directly promoted proliferation, migration, adhesion and tube formation of RF/6A cells, which was further confirmed by DDAH1 siRNA or DDAH2 siRNA. In addition, ephrinB2 expression was increased under diabetic conditions, and the angiogenic effects of ADMA were blocked by ephrinB2 siRNA. In conclusion, ADMA contributes to the neovascularization of retina in diabetic mellitus, which is regulated by ephrinB2.

Asymmetric dimethylarginine and arginine metabolites in women with and without a history of gestational diabetes

AIMS

Dysregulation of arginine metabolism, as evidenced by increased circulating levels of asymmetric dimethylarginine (ADMA), has been proposed as an early event in the natural history of cardiovascular disease. Since the diagnosis of gestational diabetes mellitus (GDM) identifies a patient population at increased future risk of cardiovascular disease later in life, we sought to characterize arginine metabolism in women with and without a history of recent GDM.

METHODS

In this prospective observational cohort study, 225 women (72 who had GDM; 153 who did not) underwent cardiometabolic characterization, including oral glucose tolerance test, at 1- and 3-years postpartum. Circulating ADMA and its stereoisomer symmetric dimethylarginine (SDMA) were measured by liquid chromatography-mass spectrometry at both visits.

RESULTS

Serum ADMA and SDMA were not significantly different between the GDM and non-GDM groups at either 1-year or 3-years postpartum. On multiple linear regression analyses, high-density-lipoprotein cholesterol (t=-2.62, p=0.009) and creatinine (t=-2.62, p=0.01) were independently associated with ADMA at 3-years, while creatinine (t=7.09, p<0.0001) and BMI (t=-2.24, p=0.026) predicted SDMA.

CONCLUSION

Women with recent GDM do not exhibit altered serum concentrations of ADMA or SDMA at 1- and 3-years postpartum, suggesting that ADMA dysregulation is not a feature of their cardiometabolic profile in the early years after delivery.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: are they useful for predicting gestational diabetes mellitus during pregnancy?

OBJECTIVE

We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be utilized to screen for gestational diabetes mellitus (GDM).

SUBJECTS AND METHODS

NLR and PLR were assessed by retrospective analysis of 762 healthy and pregnant women with GDM. The patients were stratified into four groups, as follows: GDM (n=144), impaired glucose tolerance (n=76), only screen positive (n=238), and control (n=304).

RESULTS

The leukocyte, neutrophil, and lymphocyte counts were significantly higher in the study groups compared with the control group (P=0.001; P<0.01). There were no statistically significant differences between the groups with respect to the NLR and PLR (P>0.05).

CONCLUSION

We do not recommend that blood NLR and PLR can be used to screen for GDM. However, increase in the leukocyte count is an important marker for GDM as it provides evidence of subclinical inflammation.

Asymmetric dimethylarginine, a biomarker of cardiovascular complications in diabetes mellitus

Cardiovascular (CV) complications are an essential causal element of prospect in diabetes mellitus (DM), with carotid atherosclerosis being a common risk factor for prospective crisis of coronary artery diseases and/or cerebral infarction in DM subjects. From another point of view, asymmetric dimethylarginine (ADMA) has been established as an inhibitor of endogenous nitric oxide synthesis and the relationship between ADMA and arteriosclerosis has been reported. In our study with 87 type 2 DM (T2DM) patients, we have examined whether ADMA and other CV risk factors are the useful predictors of DMCV complications. After the measurement of the respective CV risk factors, we have followed the enrolled T2DM patients for 5 years. We have finally analyzed 77 patients. DMCV complications developed in 15 cases newly within 5 years, and 4 cases recurred. The concentrations of ADMA in plasma were markedly more elevated in 19 DM patients with CV complications than in 58 DM patients without CV complications. Urinary albumin (U-Alb), mean intimal-medial thickness (IMT) and ankle brachial index (ABI) were also higher in patients with CV complications. Multiple regression analyses showed that U-Alb had an influence on the high level of ADMA (standardized β = 6.59, P = 0.00014) independently of age, systolic BP, fibrinogen, mean IMT, plaque score, and ABI. The review indicates what is presently known regarding plasma ADMA that might be a new and meaningful biomarker of CV complications in DM subjects.