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Abstract
The plasma concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is the resultant of many processes at cellular and organ levels. Post-translational methylation of arginine residues of pro teins plays a crucial role in the regulation of their functions, which include processes such as transcription, translation and RNA splicing. Because protein methylation is irreversible, the methylation signal can be turned off only by proteolysis of the entire protein. Consequently, most methylated proteins have high turnover rates. Free ADMA, which is formed during proteolysis, is actively degraded by the intracellular enzyme dimethylarginine dimethylaminohydrolase (DDAH). Some ADMA escapes degradation and leaves the cell via cationic amino acid transporters. These trans porters also mediate uptake of ADMA by neighboring cells or distant organs, thereby facilitating active interorgan transport. Clearance of ADMA from the plasma occurs in small part by urinary excretion, but the bulk of ADMA is degraded by intracellular DDAH, after uptake from the circulation. This review discusses the various processes involved in ADMA metabolism: protein methylation, proteolysis of methylated proteins, metabolism by DDAH, and interorgan transport. In addition, the role of the kidney and the liver in the clearance of ADMA is highlighted.
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Affiliation(s)
- Tom Teerlink
- 1Department of Clinical Chemistry, VU University Medical
Center, Amsterdam, The Netherland
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2
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Abstract
Hyperhomocysteinemia is a risk factor for cardiovascular disease and stroke. Like many other cardiovascular risk factors, hyperhomocysteinemia produces endothelial dysfunction due to impaired bioavailability of endothelium-derived nitric oxide (NO). The molecular mechanisms responsible for decreased NO bioavailabil ity in hyperhomocysteinemia are incompletely understood, but emerging evidence suggests that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, may be a key mediator. Homocysteine is produced during the synthesis of ADMA and can alter ADMA metabolism by inhibiting dimethylarginine dimethy laminohydrolase (DDAH). Several animal and clinical studies have demonstrated a strong association between plasma total homocysteine, plasma ADMA, and endothelial dysfunction. These observations suggest a model in which elevation of ADMA may be a unifying mechanism for endothelial dysfunction during hyper homocysteinemia. The recent development of transgenic mice with altered ADMA metabolism should provide further mechanistic insights into the role of ADMA in hyperhomocysteinemia.
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Zincir S, Zincir SB, Doruk A, Erdem M, Celik C, Ak M, Garip B, Yükselir C, Karaahmetoğlu B. Asymmetric dimethylarginine (ADMA) and treatment response relationship in male patients with first-episode schizophrenia: a controlled study. Psychiatry Res 2014; 220:76-80. [PMID: 25095755 DOI: 10.1016/j.psychres.2014.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
Nitric oxide (NO) is thought to be involved in the pathogenesis of schizophrenia as well as many neuropsychiatric disease. Asymmetric dimethylarginine (ADMA) reduces the level of NO by inhibiting nitric oxide synthase (NOS) enzyme. In this study it is aimed to be investigated ADMA in patients with first-episode schizophrenia. In this study, according to DSM-IV diagnostic criteria for schizophrenia-like psychotic disorder, 49 male first-episode schizophrenia patients-whose mean age was 23.4±3.5 year-and age and education matched 30 healthy male subjects were included for comparison. ADMA levels of the patients were measured before and after 2 months of therapy. In order to rule out the conditions that may affect the levels of ADMA, people whose physical examination and laboratory findings were within normal range were included in the study. In this study plasma ADMA levels of first-episode schizophrenia patients and control group were 3.6±1.5 µmol/L and 1.02±1.02 respectively. After 2 months of antipsychotic treatment plasma ADMA levels of the schizophrenia patients decreased compared to baseline. There was no relationship between the ADMA levels and the clinical severity of the disease. It is considered to be the role of ADMA in the etiopathogenesis of schizophrenia.
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Affiliation(s)
- Serkan Zincir
- Golcük Military Hospital, Department of Psychiatry, Golcük, 41650 Kocaeli, Turkey.
| | | | - Ali Doruk
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Murat Erdem
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Cemil Celik
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Mehmet Ak
- Medicana Hospital, Department of Psychiatry, Konya, Turkey
| | - Beyazıt Garip
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
| | - Cihad Yükselir
- Gülhane Military Medical Academy, Department of Psychiatry, Ankara, Turkey
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Emeksiz HC, Serdaroglu A, Biberoglu G, Gulbahar O, Arhan E, Cansu A, Arga M, Hasanoglu A. Assessment of atherosclerosis risk due to the homocysteine-asymmetric dimethylarginine-nitric oxide cascade in children taking antiepileptic drugs. Seizure 2012; 22:124-7. [PMID: 23266348 DOI: 10.1016/j.seizure.2012.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 11/19/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to assess the atherogenicity risk of antiepileptics in children by investigating the cascade, "hyperhomocysteinemia (HHcy)→asymmetric dimethylarginine (ADMA) increase→nitric oxide (NO) decrease", which is thought to contribute to the developmental process of atherosclerosis. METHODS The participants included 53 epilepsy patients who received either valproic acid (VPA, n=26) or oxcarbazepine (OXC, n=27). Twenty-four healthy sex- and age-matched children served as controls. Fasting plasma total homocysteine (tHcy), ADMA and NO levels were measured. RESULTS The differences in Hcy, ADMA, NO, vitamin B(12) and folate levels between VPA, OXC and control groups were all insignificant (p>0.05 for all). In the patient group (VPA and OXC groups), 22.6% of the children (12/53) had tHcy levels above the normal cutoff (13.1μmol/l) for children and 17% of the children (9/53) had tHcy levels of greater than 15μmol/l which is accepted as the critical value for an increased atherosclerosis risk (p<0.05 for both). The difference in rate of HHcy between VPA and OXC groups was statistically insignificant (p>0.05, for both cut off levels of HHCy). There was a positive correlation of tHcy levels and antiepileptic drug treatment duration in the patient group (r=+0.276, p<0.05). CONCLUSION HHcy may develop in patients using OXC. Contrary to some previous publications, our data do not suggest that OXC is safer than VPA in terms of HHcy risk. Further prospective, large scale and longer term studies investigating all suggested pathways responsible for development of atherosclerosis due to HHcy should be conducted to define the exact mechanism responsible for AEDs related atherosclerosis.
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Do cardiac risk factors affect the homocysteine and asymmetric dimethylarginine relationship in patients with coronary artery diseases? Clin Biochem 2012; 45:1325-30. [DOI: 10.1016/j.clinbiochem.2012.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/14/2012] [Accepted: 06/19/2012] [Indexed: 12/31/2022]
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Increased asymmetric dimethylarginine level after antiepileptic drug treatment may be independent of the changes in plasma homocysteine level. Seizure 2012; 21:232. [DOI: 10.1016/j.seizure.2011.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 11/16/2022] Open
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Rocha MS, Teerlink T, Janssen MCH, Kluijtmans LAJ, Smulders Y, Jakobs C, Tavares de Almeida I, Rivera I, Castro R, Blom HJ. Asymmetric dimethylarginine in adults with cystathionine β-synthase deficiency. Atherosclerosis 2012; 222:509-11. [PMID: 22484094 DOI: 10.1016/j.atherosclerosis.2012.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 03/05/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
Abstract
In hyperhomocysteinemia (HHcy), an independent risk factor for cardiovascular diseases, endothelial dysfunction due to reduced bioavailability of nitric oxide is a consistent finding. However, the underlying mechanisms remain unknown. Increased levels of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) have been associated with HHcy, and may contribute, at least in part, for the homocysteine-induced endothelial dysfunction, but whether cystathionine β-synthase (CBS) deficiency is associated with increased ADMA has hardly been investigated. To address this question, we measured total homocysteine (tHcy), ADMA and symmetric dimethylarginine (SDMA) in plasma of 22 adult CBS deficient patients, using established HPLC techniques. Results showed that in CBS deficient patients with elevated levels of tHcy (median (total range): 33 (14-237) μmol/L), both ADMA and SDMA levels were normal. Moreover, tHcy and ADMA concentrations were not correlated (r(s)=0.017, p=0.94). Our results favor the hypothesis that the negative vascular effects of HHcy have an ADMA-independent etiology.
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Affiliation(s)
- Monica S Rocha
- Department of Clinical Chemistry, Metabolic Unit, Institute for Cardiovascular Research (ICAR-VU), VU University Medical Center, Amsterdam, The Netherlands
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Sniezawska A, Dorszewska J, Rozycka A, Przedpelska-Ober E, Lianeri M, Jagodzinski PP, Kozubski W. MTHFR, MTR, and MTHFD1 gene polymorphisms compared to homocysteine and asymmetric dimethylarginine concentrations and their metabolites in epileptic patients treated with antiepileptic drugs. Seizure 2011; 20:533-40. [DOI: 10.1016/j.seizure.2011.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 03/29/2011] [Accepted: 04/01/2011] [Indexed: 01/08/2023] Open
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Tousoulis D, Bouras G, Antoniades C, Marinou K, Papageorgiou N, Miliou A, Hatzis G, Stefanadi E, Tsioufis C, Stefanadis C. Methionine-induced homocysteinemia impairs endothelial function in hypertensives: the role of asymmetrical dimethylarginine and antioxidant vitamins. Am J Hypertens 2011; 24:936-42. [PMID: 21490695 DOI: 10.1038/ajh.2011.65] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nitric oxide synthase (NOS) inhibitor asymmetrical dimethylarginine (ADMA) is synthesized by the methylation of arginine as part of the methionine/homocysteine cycle. However, the mechanisms regulating ADMA synthesis in hypertension are unclear. METHODS We investigated the role of ADMA and antioxidants in endothelial dysfunction during methionine-induced homocysteinemia in hypertensives. Thirty-nine hypertensives and forty-nine normotensive controls underwent methionine loading (100 mg methionine/kg BW), after being randomized to receive vitamin C (2 g) and E (800 IU) or placebo. Endothelium-dependent dilation (EDD) was evaluated by plethysmography (baseline and 4-h post-methionine loading (4-h PML)). RESULTS Hypertensives had higher homocysteine at baseline (P < 0.001) and 4-h PML (P < 0.05), whereas methionine increased homocysteine in all groups. EDD was decreased in both vitamins and placebo groups in controls (P < 0.01 for both) and vitamins- and placebo-treated hypertensives (P < 0.05 and P < 0.01, respectively). In controls, ADMA was increased in both vitamin- and placebo groups (P < 0.01 for both) at 4-h PML. Hypertensives had higher ADMA at baseline (P < 0.01 vs. normotensive) and remained unchanged at 4-h PML (P = NS in placebo and vitamins treated). CONCLUSIONS ADMA is elevated in hypertensives but remains unchanged after methionine loading, suggesting that ADMA plays an important role in endothelial dysfunction in hypertensives, but it is not responsible for homocysteine-induced endothelial dysfunction in these patients.
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Gad MZ, Hassanein SI, Abdel-Maksoud SM, Shaban GM, Abou-Aisha K, Elgabarty HA. Assessment of serum levels of asymmetric dimethylarginine, symmetric dimethylarginine andl-arginine in coronary artery disease. Biomarkers 2010; 15:746-52. [DOI: 10.3109/1354750x.2010.519784] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Asymmetric dimethylarginine levels and carotid intima-media thickness in obese patients with polycystic ovary syndrome and their relationship to metabolic parameters. Fertil Steril 2010; 93:1227-33. [DOI: 10.1016/j.fertnstert.2008.10.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/21/2022]
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Aktoz T, Aktoz M, Tatlı E, Kaplan M, Turan FN, Barutcu A, Atakan IH, Demir M, Altun A. Assessment of the relationship between asymmetric dimethylarginine and severity of erectile dysfunction and coronary artery disease. Int Urol Nephrol 2010; 42:873-9. [DOI: 10.1007/s11255-009-9696-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Trabetti E. Homocysteine,MTHFR gene polymorphisms, and cardio-cerebrovascular risk. J Appl Genet 2008; 49:267-82. [DOI: 10.1007/bf03195624] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dayal S, Rodionov RN, Arning E, Bottiglieri T, Kimoto M, Murry DJ, Cooke JP, Faraci FM, Lentz SR. Tissue-specific downregulation of dimethylarginine dimethylaminohydrolase in hyperhomocysteinemia. Am J Physiol Heart Circ Physiol 2008; 295:H816-25. [PMID: 18567702 DOI: 10.1152/ajpheart.01348.2007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide (NO) synthase, has been proposed to be a mediator of vascular dysfunction during hyperhomocysteinemia. Levels of ADMA are regulated by dimethylarginine dimethylaminohydrolase (DDAH). Using both in vitro and in vivo approaches, we tested the hypothesis that hyperhomocysteinemia causes downregulation of the two genes encoding DDAH (Ddah1 and Ddah2). In the MS-1 murine endothelial cell line, the addition of homocysteine decreased NO production but did not elevate ADMA or alter levels of Ddah1 or Ddah2 mRNA. Mice heterozygous for cystathionine beta-synthase (Cbs) and their wild-type littermates were fed either a control diet or a high-methionine/low-folate (HM/LF) diet to produce varying degrees of hyperhomocysteinemia. Maximal relaxation of the carotid artery to the endothelium-dependent dilator acetylcholine was decreased by approximately 50% in Cbs(+/-) mice fed the HM/LF diet compared with Cbs(+/+) mice fed the control diet (P < 0.001). Compared with control mice, hyperhomocysteinemic mice had lower levels of Ddah1 mRNA in the liver (P < 0.001) and lower levels of Ddah2 mRNA in the liver, lung, and kidney (P < 0.05). Downregulation of DDAH expression in hyperhomocysteinemic mice did not result in an increase in plasma ADMA, possibly due to a large decrease in hepatic methylation capacity (S-adenosylmethionine-to-S-adenosylhomocysteine ratio). Our findings demonstrate that hyperhomocysteinemia causes tissue-specific decreases in DDAH expression without altering plasma ADMA levels in mice with endothelial dysfunction.
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Affiliation(s)
- Sanjana Dayal
- Dept. of Internal Medicine, Univ. of Iowa, C32 GH, Iowa City, IA 52242, USA
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Wang J, Sim AS, Wang XL, Salonikas C, Moriatis M, Naidoo D, Wilcken DEL. Relations between markers of renal function, coronary risk factors and the occurrence and severity of coronary artery disease. Atherosclerosis 2008; 197:853-9. [PMID: 17826782 DOI: 10.1016/j.atherosclerosis.2007.07.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2007] [Revised: 07/30/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE While renal failure greatly increases coronary risk, mild renal impairment is not usually considered a major risk factor. To explore this we assessed relations between measures of mild impairment of renal function and coronary artery disease (CAD) together with other risk factors. METHODS AND RESULTS In 408 consecutive patients aged 75 years or less with angiographically defined normal or obstructed coronary arteries and an estimated glomerular filtration rate (eGFR) >45 mL/min per 1.73 m(2), we assessed relations between severity of CAD and levels of plasma cystatin C, creatinine, eGFR, lipid profile, C-reactive protein (CRP), homocysteine, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). With univariate ANOVA, the severity of CAD was significantly associated with all indices of renal function: increased plasma cystatin C (p=0.003) and creatinine (p=0.004) and decreased eGFR (p=0.008). An elevated plasma cystatin C was associated with increases in ADMA, SDMA, CRP, homocysteine and age. ADMA, SDMA, CRP and homocysteine levels were not associated with CAD severity. eGFR was negatively associated only with SDMA and homocysteine. In multivariate analysis, increased plasma cystatin C predicted both the occurrence and the severity of CAD more strongly than other measures of renal function. CONCLUSIONS We conclude that mild renal impairment detected by elevated cystatin C is associated with both the occurrence and the severity of CAD, independent of the other risk factors we measured and that mild renal impairment results in increased plasma levels of homocysteine, ADMA and SDMA. Our findings suggest a possible mechanistic link between CAD and mild renal impairment in which cystatin C may serve as an early marker for CAD and may also participate directly in atherogenesis.
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Affiliation(s)
- Jun Wang
- Department of Cardiovascular Medicine, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
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Ebesunun M, Agbedana E, Taylor G, Oladapo O. Plasma lipoprotein (a), homocysteine, and other cardiovascular disease (CVD) risk factors in Nigerians with CVD. Appl Physiol Nutr Metab 2008; 33:282-9. [PMID: 18347683 DOI: 10.1139/h07-186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Elevated plasma lipoprotein (a) (Lp(a)) and total homocysteine (tHcy) concentrations, as well as fat distributions, are associated with cardiovascular disease (CVD) risk. The purpose of this study was to evaluate plasma Lp(a), tHcy, percentage body fat, anthropometric indices, and blood pressure (BP) and their relationships with each other in well-defined, hospital-based, CVD patients in a Nigerian African community. One hundred seventy patients suffering from hypertensive heart disease, hypertension, ischaemic heart disease, and myocardial infraction with the mean age of 45.3 ± 1.3 years and 58 apparently healthy volunteers with the mean age of 44.8 ±1.2 years were selected. Anthropometric indices and BP were measured. Percentage body fat, body mass index, and waist-to-hip ratio (WHR) were calculated. Plasma Lp(a) and tHcy concentrations were determined. The results showed significant increases in BP, skinfold thickness (SFT) variables, and WHR in all of the CVD patients. Plasma Lp(a) was also significantly increased (p < 0.001), whereas the slight increase in the mean tHcy was not statistically significant. Positive significant correlations were found between systolic BP, triceps, SFT, and percentage body fat (p < 0.01), whereas significant correlations were found between some body composition variables, tHcy, and systolic BP (p < 0.05). Our findings provide supportive evidence for altered plasma Lp(a) concentration in addition to some other traditional CVD risk factors in Nigerians. The role of homocysteine is not well defined.
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Affiliation(s)
- M.O. Ebesunun
- Chemical Pathology, University College Hospital Ibadan, School of Medical Laboratory Science, Ibadan, Oyo 002 234, Nigeria
- Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
| | - E.O. Agbedana
- Chemical Pathology, University College Hospital Ibadan, School of Medical Laboratory Science, Ibadan, Oyo 002 234, Nigeria
- Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
| | - G.O.L. Taylor
- Chemical Pathology, University College Hospital Ibadan, School of Medical Laboratory Science, Ibadan, Oyo 002 234, Nigeria
- Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
| | - O.O. Oladapo
- Chemical Pathology, University College Hospital Ibadan, School of Medical Laboratory Science, Ibadan, Oyo 002 234, Nigeria
- Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo 002 234, Nigeria
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Schmitt B, Wolters M, Kressel G, Hülsmann O, Ströhle A, Kühn-Velten WN, Lichtinghagen R, Bub A, Barth SW, Stichtenoth DO, Hahn A. Effects of combined supplementation with B vitamins and antioxidants on plasma levels of asymmetric dimethylarginine (ADMA) in subjects with elevated risk for cardiovascular disease. Atherosclerosis 2007; 193:168-76. [PMID: 16876171 DOI: 10.1016/j.atherosclerosis.2006.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 05/22/2006] [Accepted: 06/02/2006] [Indexed: 11/25/2022]
Abstract
Elevated plasma asymmetric dimethylarginine (ADMA) concentrations have been suggested as a potential risk factor for cardiovascular disease (CVD). Studies indicate a linkage between hyperhomocysteinemia, oxidative stress and ADMA metabolism. We tested the hypothesis that combined supplementation of B vitamins and antioxidants reduces ADMA concentrations in subjects with at least two CVD risk factors. A total of 123 men and women (58+/-8.1 years) were randomly assigned to take either a preparation including B vitamins and antioxidants (verum) or placebo for 6 months in a double-blind design. Blood concentrations of ADMA, symmetric dimethylarginine (SDMA), L-arginine, B vitamins, total homocysteine (tHcy), alpha-tocopherol, antioxidant capacity (TEAC), and oxLDL were measured pre- and post-intervention. Treatment with verum significantly decreased tHcy (-2.14 micromol/L; P<0.001) and significantly increased TEAC values (+39.3 microM; P<0.022), but no effect on ADMA was observed. OxLDL was significantly reduced in verum (-7.3 U/L; P=0.001) and placebo (-9.2U/L; P<0.001). At baseline, significant correlations were found only between ADMA and SDMA (r=0.281; P=0.002), L-arginine/ADMA and SDMA (r=-0.294; P<0.001), L-arginine/ADMA and oxLDL (r=-0.281; P=0.016), and L-arginine/ADMA and age (r=-0.231; P=0.010). Our results indicate that combined supplementation of B vitamins and antioxidants is not an adequate strategy to reduce ADMA plasma levels in subjects with elevated CVD risk.
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Affiliation(s)
- B Schmitt
- Nutrition Physiology and Human Nutrition Unit, Institute of Food Science, University of Hannover, Wunstorfer Str. 14, D-30453 Hannover, Germany.
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Eldibany MM, Caprini JA. Hyperhomocysteinemia and thrombosis: an overview. Arch Pathol Lab Med 2007; 131:872-84. [PMID: 17550314 DOI: 10.5858/2007-131-872-hatao] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Homocysteine, a sulfur-containing amino acid, absent in natural diets, is a metabolic intermediary in transmethylation and transsulfuration reactions. Such reactions are essential to normal cellular growth, differentiation, and function. Excess homocysteine is associated with vascular disease and related disorders. OBJECTIVE To review homocysteine metabolism, the pathogenesis and classification of hyperhomocysteinemia, and the published literature investigating the association of homocysteine and methylenetetrahydrofolate reductase defects with arterial and venous thromboembolism and related disorders. The role of vitamin supplementation in patients with hyperhomocysteinemia is addressed. DATA SOURCES Published medical and scientific literature. Articles addressing the objectives were selected and reviewed. Pertinent studies and conclusions were summarized, grouped, and contrasted. CONCLUSIONS The association of hyperhomocysteinemia and arterial and venous thrombosis is controversial. Severe hyperhomocysteinemia is associated with atherosclerosis. The effect of mild hyperhomocysteinemia is less certain. Coinheritance of methylenetetrahydrofolate reductase defects and factor V Leiden is likely to increase the risk of venous thromboembolism. The association of methylenetetrahydrofolate reductase defects combined with no additional thrombophilic risk factors with venous thrombosis is less clear. High doses of folic acid to lower homocysteine levels might not be necessary.
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Affiliation(s)
- Mohamed M Eldibany
- Department of Pathology and Laboratory Medicine, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA.
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Surdacki A, Stochmal E, Szurkowska M, Bode-Böger SM, Martens-Lobenhoffer J, Stochmal A, Klecha A, Kawecka-Jaszcz K, Dubiel JS, Huszno B, Szybiński Z. Nontraditional atherosclerotic risk factors and extent of coronary atherosclerosis in patients with combined impaired fasting glucose and impaired glucose tolerance. Metabolism 2007; 56:77-86. [PMID: 17161229 DOI: 10.1016/j.metabol.2006.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 08/30/2006] [Indexed: 01/16/2023]
Abstract
Partially inconsistent data exist on mutual relations between nontraditional atherosclerotic risk factors, including the magnitude of insulin resistance (IR), as well as on their relevance for atherogenesis in the metabolic syndrome. Subjects exhibiting combined impaired fasting glucose and impaired glucose tolerance (IFG/IGT) are exposed to an exceptionally high risk for atherogenesis and development of type 2 diabetes mellitus. Because of islet Beta-cell dysfunction, the usefulness of commonly used indices of IR is limited in IFG/IGT. Our aim was to assess the relationship between extent of angiographic coronary artery disease (CAD) and nontraditional atherosclerotic risk factors (including IR by a clamp-based golden standard method) in IFG/IGT. Fifty-three subjects (32 men, 21 women; mean age, 55 +/- 11 years) with stable angina, preserved left ventricular systolic function, and IFG/IGT were divided into 3 groups: group A (no coronary stenoses >50%, n = 22), group B (1-vessel CAD, n = 15), and group C (2/3-vessel CAD, n = 16). Insulin sensitivity was quantified by a hyperinsulinemic euglycemic clamp technique and expressed as M. M value, plasma homocysteine (Hcy) level, and asymmetric dimethyl-L-arginine (ADMA)/L-arginine ratio were independent determinants of CAD extent as shown by forward stepwise discriminant function analysis. Compared with group A (M = 32.7 +/- 9.3 micromol/kg fat-free mass [FFM] per minute; Hcy, 8.1 +/- 1.4 micromol/L), lower M and higher Hcy levels were found in group B (M = 16.9 +/- 8.2 micromol/kg FFM per minute, P < .001; Hcy, 11.2 +/- 2.9 micromol/L, P = .003) and C (M = 16.4 +/- 7.8 micromol/kg FFM per minute, P < .001; Hcy, 12.8 +/- 3.9 micromol/L, P < .001). The ADMA/L-arginine ratio was increased in group C (0.0078 +/- 0.0011) compared with group A (0.0063 +/- 0.0013, P = .03) and B (0.0058 +/- 0.0012, P = .01). Multivariate correlates (P < .05) of plasma Hcy concentrations were M (beta = -.34 +/- .12, P = .008), creatinine clearance (beta = -.23 +/- .10, P = .03) and fasting insulin (beta = .25 +/- .12, P = .04). This indicates an additive contribution of IR, plasma Hcy, and elevated ADMA/L-arginine ratio to the extent of angiographic CAD in combined IFG/IGT.
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Affiliation(s)
- Andrzej Surdacki
- 2nd Department of Cardiology, Jagiellonian University, 31-501 Cracow, Poland.
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20
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Ilhan N, Seckin D, Ilhan N, Ozbay Y. Abnormal asymmetric dimethylarginine/nitric oxide balance in patients with documented coronary artery disease: relation to renal function and homocysteine. J Thromb Thrombolysis 2006; 23:205-11. [PMID: 17160550 DOI: 10.1007/s11239-006-9024-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND As an endogenous inhibitor of nitric oxide production, asymmetric dimethylarginine (ADMA) is reported to be associated with coronary artery disease (CAD). METHODS We measured plasma levels of ADMA, nitrate + nitrite (NOx), total homocysteine (tHCY), and renal function in 106 people with angiographic evidence of coronary artery disease (CAD), including 46 with single vessel disease and 60 with double/triple vessel disease, and in 70 age-matched individuals without any angiography evidence of CAD. Also the levels of these parameters were evaluated according to their history of MI. Plasma tHcy and ADMA were measured by HPLC and the levels of NOx using the Griess reaction. RESULTS Levels of ADMA, ACE and tHcy levels were significantly higher and NO level was significantly lower in CAD patients compared with controls but there were no significant differences among patients with or without history of MI and between patients with single compared to those with double/triple vessel disease. Additionally a negative correlation was found between ADMA-NOx (r = -0.396, p = 0.001) and between tHcy-NOx (r = -0.262, p = 0.027). In the entire study group, ADMA level was significantly higher in patients with creatinine clearance (CrCl) < 91 mL/min than in patients with CrCl > or = 91 mL/min (0.60 +/- 0.23 micromoles/L versus 0.49 +/- 0.25 micromoles/L, p = 0.05). CONCLUSIONS We suggest that there is an abnormal plasma ADMA-to-NO balance in patients with documented CAD and that this may be due at least in part to an associated reduction in renal function.
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Affiliation(s)
- Necip Ilhan
- Department of Biochemistry, Firat University, Elazig, Türkiye
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Antoniades C, Tousoulis D, Marinou K, Vasiliadou C, Tentolouris C, Bouras G, Pitsavos C, Stefanadis C. Asymmetrical dimethylarginine regulates endothelial function in methionine-induced but not in chronic homocystinemia in humans: effect of oxidative stress and proinflammatory cytokines. Am J Clin Nutr 2006; 84:781-8. [PMID: 17023704 DOI: 10.1093/ajcn/84.4.781] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Homocystinemia is a metabolic abnormality associated with endothelial dysfunction and increased cardiovascular disease risk. The underlying mechanisms of these effects, however, are obscure. OBJECTIVE We examined the effect of asymmetrical dimethylarginine (ADMA) on endothelial dysfunction in methionine-induced and chronic homocystinemia and evaluated the regulatory role of oxidative stress and proinflammatory cytokines on the release of ADMA. DESIGN In this double-blind, placebo-controlled parallel group study, 30 subjects of both sexes (15 with homocystinemia and 15 healthy controls) underwent methionine loading, with simultaneous administration of a combination of vitamin C (2 g) plus alpha-tocopherol (800 IU) or placebo. Endothelial function in forearm resistance vessels and concentrations of ADMA, oxidized LDL, and proinflammatory cytokines were determined at baseline and 4 h after methionine loading. RESULTS Both chronic and methionine-induced homocystinemia were associated with increased oxidized LDL (P < 0.01), higher expression of the proinflammatory cytokine interleukin 6 (P < 0.05), and endothelial dysfunction (P < 0.01). Although ADMA rapidly increased in acute homocystinemia (P < 0.01) and was correlated with forearm hyperemic response at 4 h after methionine loading (r = -0.722, P = 0.0001), it was not higher in subjects with high versus low fasting homocysteine. High-dose antioxidant treatment prevented methionine-induced elevation of oxidized LDL and interleukin 6 but failed to prevent the increase in ADMA or endothelial dysfunction. CONCLUSIONS Both chronic and methionine-induced homocystinemia are characterized by increased oxidative stress and proinflammatory cytokines, which may contribute to the development of endothelial dysfunction. However, the ADMA pathway is activated only in acute homocystinemia by mechanisms not mediated by oxidized LDL or proinflammatory stimuli.
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Affiliation(s)
- Charalambos Antoniades
- Athens University Medical School, 1st Cardiology Department, Hippokration Hospital, Athens, Greece
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22
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Abstract
Hyperhomocysteinemia is a risk factor for cardiovascular disease and stroke. Like many other cardiovascular risk factors, hyperhomocysteinemia produces endothelial dysfunction due to impaired bioavailability of endothelium-derived nitric oxide (NO). The molecular mechanisms responsible for decreased NO bioavailability in hyperhomocysteinemia are incompletely understood, but emerging evidence suggests that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthase, may be a key mediator. Homocysteine is produced during the synthesis of ADMA and can alter ADMA metabolism by inhibiting dimethylarginine dimethylaminohydrolase (DDAH). Several animal and clinical studies have demonstrated a strong association between plasma total homocysteine, plasma ADMA, and endothelial dysfunction. These observations suggest a model in which elevation of ADMA may be a unifying mechanism for endothelial dysfunction during hyperhomocysteinemia. The recent development of transgenic mice with altered ADMA metabolism should provide further mechanistic insights into the role of ADMA in hyperhomocysteinemia.
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Affiliation(s)
- Sanjana Dayal
- Department of Internal Medicine, University of Iowa, Iowa City 52242, USA
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23
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Abstract
The plasma concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is the resultant of many processes at cellular and organ levels. Post-translational methylation of arginine residues of proteins plays a crucial role in the regulation of their functions, which include processes such as transcription, translation and RNA splicing. Because protein methylation is irreversible, the methylation signal can be turned off only by proteolysis of the entire protein. Consequently, most methylated proteins have high turnover rates. Free ADMA, which is formed during proteolysis, is actively degraded by the intracellular enzyme dimethylarginine dimethylaminohydrolase (DDAH). Some ADMA escapes degradation and leaves the cell via cationic amino acid transporters. These transporters also mediate uptake of ADMA by neighboring cells or distant organs, thereby facilitating active interorgan transport. Clearance of ADMA from the plasma occurs in small part by urinary excretion, but the bulk of ADMA is degraded by intracellular DDAH, after uptake from the circulation. This review discusses the various processes involved in ADMA metabolism: protein methylation, proteolysis of methylated proteins, metabolism by DDAH, and interorgan transport. In addition, the role of the kidney and the liver in the clearance of ADMA is highlighted.
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Affiliation(s)
- Tom Teerlink
- Metabolic Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands.
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Siroen MPC, Teerlink T, Nijveldt RJ, Prins HA, Richir MC, van Leeuwen PAM. The Clinical Significance of Asymmetric Dimethylarginine. Annu Rev Nutr 2006; 26:203-28. [PMID: 16848705 DOI: 10.1146/annurev.nutr.26.061505.111320] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In 1992, asymmetrical dimethylarginine (ADMA) was first described as an endogenous inhibitor of the arginine-nitric oxide (NO) pathway. From then, its role in regulating NO production has attracted increasing attention. Nowadays, ADMA is regarded as a novel cardiovascular risk factor. The role of the kidney and the liver in the metabolism of ADMA has been extensively studied and both organs have proven to play a key role in the elimination of ADMA. Although the liver removes ADMA exclusively via degradation by the enzyme dimethylarginine dimethylaminohydrolase (DDAH), the kidney uses both metabolic degradation via DDAH and urinary excretion to eliminate ADMA. Modulating activity and/or expression of DDAH is still under research and may be a potential therapeutic approach to influence ADMA plasma levels. Interestingly, next to its association with cardiovascular disease, ADMA also seems to play a role in other clinical conditions, such as critical illness, hepatic failure, and preeclampsia. To elucidate the clinical significance of ADMA in these conditions, the field of research must be enlarged.
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Affiliation(s)
- Michiel P C Siroen
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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25
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Spoelstra-de Man AME, Teerlink T, Brouwer CB, Rauwerda JA, Stehouwer CDA, Smulders YM. No effect of B vitamins on ADMA levels in patients at increased cardiovascular risk. Clin Endocrinol (Oxf) 2006; 64:495-501. [PMID: 16649966 DOI: 10.1111/j.1365-2265.2006.02497.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Asymmetric dimethylarginine (ADMA) is a recently identified potent cardiovascular risk factor. ADMA levels are increased in hyperhomocysteinaemia and the metabolism of ADMA is linked with that of homocysteine in several ways. Treatment with B vitamins effectively reduces homocysteine levels, but studies investigating the effect on ADMA levels are scarce and show conflicting results. In this study we evaluated the effect of treatment with B vitamins on ADMA levels in two high cardiovascular risk populations. METHODS In study I, 110 siblings of patients with clinical atherosclerotic disease and postmethionine hyperhomocysteinaemia were treated with 5 mg of folic acid and 250 mg of pyridoxine or placebo, and were analysed after 1 year. In study II, 41 patients with type 2 diabetes and mild hyperhomocysteinaemia were analysed after 6 months treatment with 5 mg of folic acid or placebo. RESULTS A correlation between baseline homocysteine and ADMA levels was found, which was partly due to confounding by renal function. Homocysteine levels decreased by 43% in study I and by 28% in study II. In both studies, treatment with B vitamins had no effect at all on ADMA, arginine/ADMA ratio and SDMA levels. This result was confirmed in multiple linear regression analyses with adjustment for baseline values and gender. CONCLUSIONS Our studies indicate that B vitamins, despite causing a substantial reduction in plasma homocysteine levels, have no beneficial effect on ADMA levels.
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Affiliation(s)
- A M E Spoelstra-de Man
- Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Wilcken DEL, Wang J, Sim AS, Green K, Wilcken B. Asymmetric dimethylarginine in homocystinuria due to cystathionine beta-synthase deficiency: relevance of renal function. J Inherit Metab Dis 2006; 29:30-7. [PMID: 16601865 DOI: 10.1007/s10545-006-0208-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2005] [Accepted: 12/02/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Vascular disease is associated with increased plasma asymmetric dimethylarginine (ADMA) and homocysteine, and both are increased in renal failure. In cystathionine beta-synthase deficiency (CBS) there is severe hyperhomocysteinaemia, precocious vascular disease, and endothelial dysfunction. We investigated whether ADMA levels are elevated in CBS patients with and without renal impairment, and whether lowering plasma homocysteine also lowers ADMA. METHODS We measured plasma homocysteine, arginine, asymmetric and symmetric dimethylarginines, nitrate + nitrite, creatinine and cystatin C in 23 CBS-deficient patients and 24 age-matched controls. RESULTS In the patients, nitrate + nitrite and the ratio L: -arginine/ADMA were markedly reduced (21.6 +/- 6.1 vs 57.7 +/- 7.5 micromol/L and 132.9 +/- 24.7 vs 181.9 +/- 56.1, respectively, p < 0.001 for both), reflecting endothelial dysfunction. Plasma ADMA for the group was moderately increased (0.55 +/- 0.08 vs 0.49 +/- 0.07 micromol/L, p = 0.018), but this was due to significantly higher levels than controls in only those 7 of the 23 patients who had elevated cystatin C levels (0.59 +/- 0.08 vs 0.49 +/- 0.07 mg/L, p = 0.007). Posttreatment total homocysteine in patients varied widely (15-285, median 92 micromol/L), but was not correlated with ADMA or other measured variables. In three newly-diagnosed patients, marked reduction of total homocysteine during treatment produced minimal changes in ADMA. CONCLUSIONS ADMA levels were significantly increased only in the CBS-deficient patients with elevated cystatin C levels, and not in those with normal renal function. The reported relationship between hyperhomocysteinaemia and ADMA may not be direct, but could be secondary to reduced renal function.
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Teerlink T. Measurement of asymmetric dimethylarginine in plasma: methodological considerations and clinical relevance. Clin Chem Lab Med 2005; 43:1130-8. [PMID: 16197310 DOI: 10.1515/cclm.2005.197] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Asymmetric dimethylarginine (ADMA) is a potent inhibitor of nitric oxide synthase and is regarded as a novel risk factor for cardiovascular disease. The metabolic pathways of ADMA and homocysteine are strongly intertwined. First, during synthesis of ADMA, two equivalents of homocysteine are formed. Second, homocysteine has been shown to inhibit the ADMA-degrading enzyme dimethylarginine dimethylaminohydrolase. Finally, homocysteine, either directly or by increasing oxidative stress, may promote release of free ADMA by accelerating protein degradation. Currently used techniques for the quantification of ADMA in plasma are mostly based on liquid chromatography with fluorimetric or mass spectrometric detection. Plasma ADMA has a very narrow concentration distribution, with an inter-individual coefficient of variation of approximately 12%, and even slightly elevated ADMA concentrations are associated with increased cardiovascular disease risk. Therefore, to generate useful results in clinical research, high precision of the assay used for the quantification of ADMA assay is a matter of prime importance. Assays with a high coefficient of variation may lead to low statistical power in clinical trials and to a severe underestimation of the strength of associations in epidemiological studies.
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Affiliation(s)
- Tom Teerlink
- Metabolic Laboratory, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands.
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Schnabel R, Blankenberg S, Lubos E, Lackner KJ, Rupprecht HJ, Espinola-Klein C, Jachmann N, Post F, Peetz D, Bickel C, Cambien F, Tiret L, Münzel T. Asymmetric dimethylarginine and the risk of cardiovascular events and death in patients with coronary artery disease: results from the AtheroGene Study. Circ Res 2005; 97:e53-9. [PMID: 16100045 DOI: 10.1161/01.res.0000181286.44222.61] [Citation(s) in RCA: 289] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As a competitive inhibitor of endothelial nitric oxide synthase, asymmetric dimethylarginine (ADMA) has been related to atherosclerotic disease. Little is known about the prognostic impact of baseline ADMA determination. In a prospective cohort of 1908 patients with coronary artery disease, we assessed baseline serum concentration of ADMA in 1874 consecutive patients with coronary artery disease. One hundred fourteen individuals developed the primary end point of death from cardiovascular causes or nonfatal myocardial infarction during a mean follow-up of 2.6+/-1.2 years. Median concentrations of ADMA levels were higher among individuals who subsequently developed the primary end point than among those who did not (0.70 versus 0.63 micromol/L; P<0.001). The risk of future cardiovascular event was associated with increasing thirds of baseline ADMA (P for trend, <0.001) such that individuals in the highest third at entry had a hazard ratio 2.48 times higher than those in the lowest third (95% confidence interval, 1.52 to 4.06; P<0.001). This relationship remained nearly unchanged after adjustment for most potential confounders. Prediction models that simultaneously incorporated ADMA, B-type natriuretic peptide, C-reactive protein, and creatinine in addition to traditional risk factors revealed B-type natriuretic peptide (hazard ratio, 1.96; 95% confidence interval, 1.3 to 3.0; P=0.002) and ADMA (hazard ratio, 1.90; 95% confidence interval, 1.3 to 2.8; P=0.001) as the strongest risk predictors. High levels of baseline ADMA independently predict future cardiovascular risk. ADMA has prognostic value beyond traditional risk factors and novel biomarkers and might guide therapeutic strategies.
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Affiliation(s)
- Renate Schnabel
- Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
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Wang J, Sim AS, Wang XL, Salonikas C, Naidoo D, Wilcken DEL. Relations between plasma asymmetric dimethylarginine (ADMA) and risk factors for coronary disease. Atherosclerosis 2005; 184:383-8. [PMID: 15939423 DOI: 10.1016/j.atherosclerosis.2005.05.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Revised: 04/27/2005] [Accepted: 05/04/2005] [Indexed: 01/21/2023]
Abstract
BACKGROUND Elevated plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide production, are reported to be associated with coronary artery disease (CAD). METHODS We measured plasma levels of ADMA and related compounds, nitrate+nitrite (NO(x)), total homocysteine (tHCY) and assessed renal function and lipid profiles in 145 patients--75 with triple vessel coronary disease and 70 with no detectable coronary disease. RESULTS Levels of ADMA, l-arginine, l-arginine/ADMA and plasma NO(x) were not different in the two groups but smokers with triple vessel disease had higher ADMA and lower NO(x) levels than the non-smokers, relationships also present for all smokers and non-smokers in the two groups combined. In all 145 patients ADMA, symmetric dimethylarginine (SDMA) and tHCY levels were significantly higher in patients with glomerular filtration rate (GFR) <81 mL/min/1.73 m(2) than in patients with GFR> or =81 mL/min/1.73 m(2). There was a modest positive correlation between tHCY and ADMA and both were strongly correlated with SDMA which is excreted by the kidney. ADMA, SDMA and tHCY were negatively correlated with GFR. CONCLUSIONS We suggest that the reported ADMA increases in CAD patients are due to an associated reduction in renal function and to smoking habit.
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Affiliation(s)
- Jun Wang
- Department of Cardiovascular Medicine, University of New South Wales, Prince of Wales Hospital, Sydney, Australia
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