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Ng YYH, Dora KA, Lemmey HA, Lin J, Alden J, Wallis L, Donovan L, Shorthose O, Leiper FC, Leiper J, Garland CJ. Asymmetric Dimethylarginine Enables Depolarizing Spikes and Vasospasm in Mesenteric and Coronary Resistance Arteries. Hypertension 2024; 81:764-775. [PMID: 38226470 PMCID: PMC10956675 DOI: 10.1161/hypertensionaha.123.22454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Increased vasoreactivity due to reduced endothelial NO bioavailability is an underlying feature of cardiovascular disease, including hypertension. In small resistance arteries, declining NO enhances vascular smooth muscle (VSM) reactivity partly by enabling rapid depolarizing Ca2+-based spikes that underlie vasospasm. The endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA) is metabolized by DDAH1 (dimethylarginine dimethylaminohydrolase 1) and elevated in cardiovascular disease. We hypothesized ADMA might enable VSM spikes and vasospasm by reducing NO bioavailability, which is opposed by DDAH1 activity and L-arginine. METHODS Rat isolated small mesenteric arteries and myogenic rat-isolated intraseptal coronary arteries (RCA) were studied using myography, VSM intracellular recording, Ca2+ imaging, and DDAH1 immunolabeling. Exogenous ADMA was used to inhibit NO synthase and a selective DDAH1 inhibitor, NG-(2-methoxyethyl) arginine, to assess the functional impact of ADMA metabolism. RESULTS ADMA enhanced rat-isolated small mesenteric arteries vasoreactivity to the α1-adrenoceptor agonist, phenylephrine by enabling T-type voltage-gated calcium channel-dependent depolarizing spikes. However, some endothelium-dependent NO-vasorelaxation remained, which was sensitive to DDAH1-inhibition with NG-(2-methoxyethyl) arginine. In myogenically active RCA, ADMA alone stimulated depolarizing Ca2+ spikes and marked vasoconstriction, while NO vasorelaxation was abolished. DDAH1 expression was greater in rat-isolated small mesenteric arteries endothelium compared with RCA, but low in VSM of both arteries. L-arginine prevented depolarizing spikes and protected NO-vasorelaxation in rat-isolated small mesenteric artery and RCA. CONCLUSIONS ADMA increases VSM electrical excitability enhancing vasoreactivity. Endothelial DDAH1 reduces this effect, and low levels of DDAH1 in RCAs may render them susceptible to endothelial dysfunction contributing to vasospasm, changes opposed by L-arginine.
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Affiliation(s)
- Yu Y. Hanson Ng
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Kim A. Dora
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Hamish A.L. Lemmey
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - JinHeng Lin
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - James Alden
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Lillian Wallis
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Lucy Donovan
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Oliver Shorthose
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
| | - Fiona C. Leiper
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, United Kingdom (F.C.L., J. Leiper)
| | - James Leiper
- Institute of Cardiovascular and Medical Sciences, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, United Kingdom (F.C.L., J. Leiper)
| | - Christopher J. Garland
- Department of Pharmacology, University of Oxford, United Kingdom (Y.Y.H.N., K.A.D., H.A.L.L., J. Lin, J.A., L.W., LD., O.S., C.J.G.)
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Singh J, Lee Y, Kellum JA. A new perspective on NO pathway in sepsis and ADMA lowering as a potential therapeutic approach. Crit Care 2022; 26:246. [PMID: 35962414 PMCID: PMC9373887 DOI: 10.1186/s13054-022-04075-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
The nitric oxide pathway plays a critical role in vascular homeostasis. Increased levels of systemic nitric oxide (NO) are observed in preclinical models of sepsis and endotoxemia. This has led to the postulation that vasodilation by inducible nitric oxide synthase (iNOS) generated NO may be a mechanism of hypotension in sepsis. However, contrary to the expected pharmacological action of a nitric oxide synthase (NOS) inhibitor, clinical studies with L-NAME produced adverse cardiac and pulmonary events, and higher mortality in sepsis patients. Thus, the potential adverse effects of NO in human sepsis and shock have not been fully established. In recent years, the emerging new understanding of the NO pathway has shown that an endogenously produced inhibitor of NOS, asymmetric dimethylarginine (ADMA), a host response to infection, may play an important role in the pathophysiology of sepsis as well as organ damage during ischemia–reperfusion. ADMA induces microvascular dysfunction, proinflammatory and prothrombotic state in endothelium, release of inflammatory cytokines, oxidative stress and mitochondrial dysfunction. High levels of ADMA exist in sepsis patients, which may produce adverse effects like those observed with L-NAME. Several studies have demonstrated the association of plasma ADMA levels with mortality in sepsis patients. Preclinical studies in sepsis and ischemia–reperfusion animal models have shown that lowering of ADMA reduced organ damage and improved survival. The clinical finding with L-NAME and the preclinical research on ADMA “bed to bench” suggest that ADMA lowering could be a potential therapeutic approach to attenuate progressive organ damage and mortality in sepsis. Testing of this approach is now feasible by using the pharmacological molecules that specifically lower ADMA.
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Lee Y, Steinbach SML, Basile D, Singh J. A Therapeutic Extracorporeal Device for Specific Removal of Pathologic Asymmetric Dimethylarginine from the Blood. Blood Purif 2022; 51:889-898. [PMID: 35249015 PMCID: PMC9440949 DOI: 10.1159/000522294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/25/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Blood levels of uremic toxin, asymmetric dimethylarginine (ADMA), are strongly associated with mortality in sepsis, renal failure, and cardiovascular and renal disease patients. METHODS An extracorporeal approach to reduce pathological ADMA was developed. The dimethylarginine dimethylaminohydrolase (DDAH) was immobilized on agarose beads to prepare a cartridge. The efficacy of cartridge for ADMA lowering in blood was investigated. RESULTS The DDAH beads and cartridge reduced ADMA from solution or plasma. The magnitude of ADMA removal was dependent on the quantity of DDAH linked to the beads and the flow rate. When tested in association with plasmapheresis, the DDAH-cartridge was highly effective in ADMA removal from the blood and improved the arginine/ADMA ratio in a pig model. CONCLUSION A new, safe, and effective extracorporeal approach to lower ADMA was developed which may have application in improving outcomes in patients with vascular complications and risk of mortality associated with high ADMA.
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Affiliation(s)
- Young Lee
- Indiana Center for Biomedical Innovation, Indianapolis, Indiana, USA,
| | - Sarah ML Steinbach
- Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN, USA
| | - David Basile
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jaipal Singh
- Indiana Center for Biomedical Innovation, Indianapolis, IN, USA,Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA,Vasculonics Inc, Indianapolis, IN, USA
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Gąsecka A, Szwed P, Jasińska K, Fidali O, Kłębukowska A, Eyileten C, Postula M, Szarpak Ł, Mazurek T, Opolski G, Filipiak KJ, Ufnal M. Symmetric Dimethylarginine is Altered in Patients After Myocardial Infarction and Predicts Adverse Outcomes. J Inflamm Res 2021; 14:3797-3808. [PMID: 34408463 PMCID: PMC8364360 DOI: 10.2147/jir.s316078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality worldwide. Damage to the endothelium is the earliest event in atherothrombosis, including AMI. Nitric oxide (NO), an endothelium-derived compound, protects the vasculature from damage. This study evaluated whether an association exists between plasma concentration of endogenous NO-related pathway metabolites linked to AMI and major adverse cardiovascular events (MACE) after AMI. METHODS We compared plasma concentrations of NO-related pathway metabolites in patients after AMI (n=60) and healthy controls (n=27) and investigated the prognostic value of these metabolites for post-AMI MACE development over a median of 3.5-years. In search of biomarkers, we compared plasma concentrations of dimethylarginines (ADMA, SDMA), citrulline, arginine and ornithine using ultra performance liquid chromatograph coupled with a mass spectrometer. RESULTS Patients after AMI had higher concentrations of dimethylarginines, compared to controls (p=0.0068, p<0.0001, respectively). Conversely, the concentration of citrulline was lower in the AMI group (p=0.0006). The concentration of SDMA was higher in patients who developed MACE than in those who did not (p=0.015). SDMA was the only independent predictor of MACE in multivariate analysis (p=0.023). There was an intermediate, negative correlation between plasma SDMA level and platelet reactivity (r=-0.33, p=0.02). CONCLUSION Plasma concentration of dimethylarginines differs between patients with AMI and healthy volunteers. The study's novel finding is that SDMA is an independent predictor of MACE during a 3.5 year follow-up period after AMI.
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Affiliation(s)
- Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Karolina Jasińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Oliwia Fidali
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Aleksandra Kłębukowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Ceren Eyileten
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Marek Postula
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Łukasz Szarpak
- Bialystok Oncology Center, Bialystok, 15-027, Poland
- Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, 03-411, Poland
| | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, 02-097, Poland
| | - Marcin Ufnal
- Department of Experimental Physiology and Pathophysiology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Warsaw, 02-106, Poland
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