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Kozlova AA, Rubets E, Vareltzoglou MR, Jarzebska N, Ragavan VN, Chen Y, Martens-Lobenhoffer J, Bode-Böger SM, Gainetdinov RR, Rodionov RN, Bernhardt N. Knock-out of the critical nitric oxide synthase regulator DDAH1 in mice impacts amphetamine sensitivity and dopamine metabolism. J Neural Transm (Vienna) 2023; 130:1097-1112. [PMID: 36792833 PMCID: PMC10460711 DOI: 10.1007/s00702-023-02597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023]
Abstract
The enzyme dimethylarginine dimethylaminohydrolase 1 (DDAH1) plays a pivotal role in the regulation of nitric oxide levels by degrading the main endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA). Growing evidence highlight the potential implication of DDAH/ADMA axis in the etiopathogenesis of several neuropsychiatric and neurological disorders, yet the underlying molecular mechanisms remain elusive. In this study, we sought to investigate the role of DDAH1 in behavioral endophenotypes with neuropsychiatric relevance. To achieve this, a global DDAH1 knock-out (DDAH1-ko) mouse strain was employed. Behavioral testing and brain region-specific neurotransmitter profiling have been conducted to assess the effect of both genotype and sex. DDAH1-ko mice exhibited increased exploratory behavior toward novel objects, altered amphetamine response kinetics and decreased dopamine metabolite 3,4-dihydroxyphenylacetic acid (DOPAC) level in the piriform cortex and striatum. Females of both genotypes showed the most robust amphetamine response. These results support the potential implication of the DDAH/ADMA pathway in central nervous system processes shaping the behavioral outcome. Yet, further experiments are required to complement the picture and define the specific brain-regions and mechanisms involved.
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Affiliation(s)
- Alena A Kozlova
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Elena Rubets
- Division of Angiology, Department of Internal Medicine III, University Center for Vascular Medicine, Technische Universität Dresden, 01307, Dresden, Germany
| | - Magdalini R Vareltzoglou
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Natalia Jarzebska
- Division of Angiology, Department of Internal Medicine III, University Center for Vascular Medicine, Technische Universität Dresden, 01307, Dresden, Germany
| | - Vinitha N Ragavan
- Division of Angiology, Department of Internal Medicine III, University Center for Vascular Medicine, Technische Universität Dresden, 01307, Dresden, Germany
| | - Yingjie Chen
- Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | | | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Magdeburg, Germany
| | - Raul R Gainetdinov
- Institute of Translational Biomedicine and Saint-Petersburg University Hospital, Saint-Petersburg State University, 199034, Saint-Petersburg, Russia
| | - Roman N Rodionov
- Division of Angiology, Department of Internal Medicine III, University Center for Vascular Medicine, Technische Universität Dresden, 01307, Dresden, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
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2
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Ragavan VN, Nair PC, Jarzebska N, Angom RS, Ruta L, Bianconi E, Grottelli S, Tararova ND, Ryazanskiy D, Lentz SR, Tommasi S, Martens-Lobenhoffer J, Suzuki-Yamamoto T, Kimoto M, Rubets E, Chau S, Chen Y, Hu X, Bernhardt N, Spieth PM, Weiss N, Bornstein SR, Mukhopadhyay D, Bode-Böger SM, Maas R, Wang Y, Macchiarulo A, Mangoni AA, Cellini B, Rodionov RN. A multicentric consortium study demonstrates that dimethylarginine dimethylaminohydrolase 2 is not a dimethylarginine dimethylaminohydrolase. Nat Commun 2023; 14:3392. [PMID: 37296100 PMCID: PMC10256801 DOI: 10.1038/s41467-023-38467-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/27/2023] [Indexed: 06/12/2023] Open
Abstract
Dimethylarginine dimethylaminohydrolase 1 (DDAH1) protects against cardiovascular disease by metabolising the risk factor asymmetric dimethylarginine (ADMA). However, the question whether the second DDAH isoform, DDAH2, directly metabolises ADMA has remained unanswered. Consequently, it is still unclear if DDAH2 may be a potential target for ADMA-lowering therapies or if drug development efforts should focus on DDAH2's known physiological functions in mitochondrial fission, angiogenesis, vascular remodelling, insulin secretion, and immune responses. Here, an international consortium of research groups set out to address this question using in silico, in vitro, cell culture, and murine models. The findings uniformly demonstrate that DDAH2 is incapable of metabolising ADMA, thus resolving a 20-year controversy and providing a starting point for the investigation of alternative, ADMA-independent functions of DDAH2.
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Affiliation(s)
- Vinitha N Ragavan
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia
| | - Pramod C Nair
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Cancer Program, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, SA, Australia
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Natalia Jarzebska
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Luana Ruta
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, Perugia, Italy
| | - Elisa Bianconi
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, Perugia, Italy
| | - Silvia Grottelli
- Department of Medicine and Surgery, University of Perugia, P.le L. Sevari 1, Perugia, Italy
| | | | | | - Steven R Lentz
- Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sara Tommasi
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia
| | | | - Toshiko Suzuki-Yamamoto
- Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Masumi Kimoto
- Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Elena Rubets
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sarah Chau
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, NY, USA
| | - Yingjie Chen
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xinli Hu
- Institute of Molecular Medicine, Beijing University, Beijing, China
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter M Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Stefan R Bornstein
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
- School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto von Guericke University, Magdeburg, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- FAU New - Research Center for New Bioactive Compounds, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ying Wang
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, NY, USA
| | - Antonio Macchiarulo
- Department of Pharmaceutical Sciences, University of Perugia, via del Liceo 1, Perugia, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia
| | - Barbara Cellini
- Department of Medicine and Surgery, University of Perugia, P.le L. Sevari 1, Perugia, Italy
| | - Roman N Rodionov
- Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany.
- College of Medicine and Public Health, Flinders University and Flinders Medical Center, Adelaide, SA, Australia.
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Chen S, Martens-Lobenhoffer J, Weissenborn K, Kielstein JT, Lichtinghagen R, Deb-Chatterji M, Li N, Tryc AB, Goldbecker A, Dong Q, Bode-Böger SM, Worthmann H. Correction: Association of dimethylarginines and mediators of inflammation after acute ischemic stroke. J Neuroinflammation 2023; 20:103. [PMID: 37131264 PMCID: PMC10155337 DOI: 10.1186/s12974-023-02775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Shufen Chen
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Department of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-Von-Guericke University of Magdeburg, University Hospital, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Center for Systems Neuroscience (ZSN), Bünteweg 2, 30559, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Na Li
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
- Center for Systems Neuroscience (ZSN), Bünteweg 2, 30559, Hannover, Germany
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Beijing, 100050, China
| | - Anita B Tryc
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Annemarie Goldbecker
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-Von-Guericke University of Magdeburg, University Hospital, Leipziger Strasse 44, 39120, Magdeburg, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30623, Hannover, Germany.
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4
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König C, Martens-Lobenhoffer J, Czorlich P, Westphal M, Bode-Böger SM, Kluge S, Grensemann J. Cerebrospinal fluid penetration of fosfomycin in patients with ventriculitis: an observational study. Ann Clin Microbiol Antimicrob 2023; 22:29. [PMID: 37095559 PMCID: PMC10127017 DOI: 10.1186/s12941-023-00572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/12/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND For treatment of ventriculitis, vancomycin and meropenem are frequently used as empiric treatment but cerebrospinal fluid (CSF) penetration is highly variable and may result in subtherapeutic concentrations. Fosfomycin has been suggested for combination antibiotic therapy, but data are sparse, so far. Therefore, we studied CSF penetration of fosfomycin in ventriculitis. METHODS Adult patients receiving a continuous infusion of fosfomycin (1 g/h) for the treatment of ventriculitis were included. Routine therapeutic drug monitoring (TDM) of fosfomycin in serum and CSF was performed with subsequent dose adaptions. Demographic and routine laboratory data including serum and CSF concentrations for fosfomycin were collected. Antibiotic CSF penetration ratio as well as basic pharmacokinetic parameters were investigated. RESULTS Seventeen patients with 43 CSF/serum pairs were included. Median fosfomycin serum concentration was 200 [159-289] mg/L and the CSF concentration 99 [66-144] mg/L. Considering only the first measurements in each patient before a possible dose adaption, serum and CSF concentrations were 209 [163-438] mg/L and 104 [65-269] mg/L. Median CSF penetration was 46 [36-59]% resulting in 98% of CSF levels above the susceptibility breakpoint of 32 mg/L. CONCLUSION Penetration of fosfomycin into the CSF is high, reliably leading to appropriate concentrations for the treatment of gram positive and negative bacteria. Moreover, continuous administration of fosfomycin appears to be a reasonable approach for antibiotic combination therapy in patients suffering from ventriculitis. Further studies are needed to evaluate the impact on outcome parameters.
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Affiliation(s)
- Christina König
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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5
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Martens-Lobenhoffer J, Angermair S, Bode-Böger SM. Quantification of ceftazidime/avibactam in human plasma and dried blood spots: Implications on stability and sample transport. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1193:123164. [PMID: 35196625 DOI: 10.1016/j.jchromb.2022.123164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 01/03/2023]
Abstract
Ceftazidime is an established third-generation cephalosporin antibiotic frequently administered to intensive care patients. To overcome drug resistance of pathogens, it is combined with the newly developed non-ß-lactam ß-lactamase inhibitor avibactam under the brand name Zavicefta®. To facilitate therapeutic drug monitoring (TDM), we developed a method for the simultaneous quantification of these substances by LC-MS/MS. A problem for TDM is the low stability of the analytes in plasma, requiring transport times of less than 6 h at 23 °C. Thus, we evaluated dried blood spots (DBS) as matrix for better stability. For both analytes, stable isotope labelled internal standards were applied. Plasma samples were prepared by protein precipitation, DBS by liquid extraction. The chromatographic separation took place on a polar-modified C18 column, and detection was achieved by tandem mass spectrometry with ESI ionization in positive mode for ceftazidime and negative mode for avibactam. Calibration was linear in the ranges of 5 - 100 µg/mL for ceftazidime and 1.25 - 25 µg/mL for avibactam in plasma and 2.5 - 50 µg/mL and 0.625 - 12.5 µg/mL in DBS, respectively. Precision was better than 7 % and accuracy better than 10% for plasma as well as for DBS. The stability of ceftazidime and avibactam was better in DBS than in plasma or full blood, extending maximal transport times at 23 °C from 6 h in plasma or full blood to 24 h for DBS samples. However, robust estimation of plasma concentrations from DBS measurements requires validation by future clinical studies.
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Affiliation(s)
| | - Stefan Angermair
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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6
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Martens-Lobenhoffer J, Tomaras S, Feist E, Bode-Böger SM. Quantification of the janus kinase 1 inhibitor upadacitinib in human plasma by LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1188:123076. [PMID: 34871917 DOI: 10.1016/j.jchromb.2021.123076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
Upadacitinib is a selective janus-kinase-1 inhibitor effective in the treatment of autoimmune related diseases like rheumatoid arthritis or psoriatic arthritis. Here, we described a LC-MS/MS method for the quantification of upadacitinib in human plasma applicable for therapeutic drug monitoring. Pexidartinib was used as internal standard. Plasma samples were prepared by acidic protein precipitation and the analytes were separated on a C-18 reversed phase column. Detection took place by tandem mass spectroscopy after ionization in the positive mode and collision induced fragmentation at m/z 381 → 256, 213 for upadacitinib and m/z 418 → 258, 165 for pexidartinib. The calibration function was linear in the range of 0.15 - 150 ng/mL. Precisions and accuracies were better than 10% in intra- as well as inter-day evaluations. The method was applied in therapeutic drug monitoring of patients undergoing treatment for rheumatoid arthritis with the standard dose of 15 mg upadacitinib extended release formulation once daily. At steady state, we found trough levels of 4.13 (3.51 - 11.0) ng/mL, which is comparable to values found in healthy volunteers receiving the same dose (2.8 ± 1.2 ng/mL).
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Affiliation(s)
| | - Stylianos Tomaras
- Department of Rheumatology, Helios Clinic Vogelsang-Gommern, Gommern, Germany
| | - Eugen Feist
- Department of Rheumatology, Helios Clinic Vogelsang-Gommern, Gommern, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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7
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Kopaliani I, Jarzebska N, Billoff S, Kolouschek A, Martens-Lobenhoffer J, Bornstein SR, Bode-Böger SM, Ragavan VN, Weiss N, Mangoni AA, Deussen A, Rodionov RN. Overexpression of dimethylarginine dimethylaminohydrolase 1 protects from angiotensin II-induced cardiac hypertrophy and vascular remodeling. Am J Physiol Heart Circ Physiol 2021; 321:H825-H838. [PMID: 34533401 DOI: 10.1152/ajpheart.00064.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
Cardiovascular complications are the leading cause of death, and elevated levels of asymmetric dimethyarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are implicated in their pathophysiology. We investigated the role of dimethylarginine dimethylaminohydrolase 1 (DDAH1), an enzyme hydrolyzing ADMA, in prevention of cardiovascular remodeling during hypertension. We hypothesized that the animals overexpressing DDAH1 will be protected from angiotensin II (ANG II)-induced end organ damage. Angiotensin II (ANG II) was infused in two doses: 0.75 and 1.5 mg/kg/day in DDAH1 transgenic mice (DDAH1 TG) and wild-type (WT) littermates for 2 or 4 wk. Echocardiography was performed in the first and fourth weeks of the infusion, systolic blood pressure (SBP) was measured weekly, and cardiac hypertrophy and vascular remodeling was assessed by histology. Increase in SBP after 1 wk of ANG II infusion was not different between the groups, whereas TG mice had lower SBP at later time points. TG mice were protected from cardiovascular remodeling after 2 wk of ANG II infusion in the high dose and after 4 wk in the moderate dose. TG mice had higher left ventricular lumen-to-wall ratio, lower cardiomyocyte cross-sectional area, and less interstitial fibrosis compared with WT controls. In aorta, TG mice had less adventitial fibrosis, lower medial thickness with preserved elastin content, lower counts of inflammatory cells, lower levels of active matrix metalloproteinase-2, and showed better endothelium-dependent relaxation. We demonstrated that overexpression of DDAH1 protects from ANG II-induced cardiovascular remodeling and progression of hypertension by preserving endothelial function and limiting inflammation.NEW & NOTEWORTHY We showed that overexpression of dimethylarginine dimethylaminohydrolase 1 (DDAH1) protects from angiotensin II-induced cardiovascular damage, progression of hypertension, and adverse vascular remodeling in vivo. This protective effect is associated with decreased levels of asymmetric dimethylarginine, preservation of endothelial function, inhibition of cardiovascular inflammation, and lower activity of matrix metalloproteinase-2. Our findings are highly clinically relevant, because they suggest that upregulation of DDAH1 might be a promising therapeutic approach against angiotensin II-induced end organ damage.
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Affiliation(s)
- Irakli Kopaliani
- Department of Physiology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Natalia Jarzebska
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
- Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Dresden University of Technology, Dresden, Germany
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Silke Billoff
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
| | - Anne Kolouschek
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
| | | | - Stefan R Bornstein
- University Clinic and Polyclinic III, Dresden University of Technology, Dresden, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vinitha N Ragavan
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Norbert Weiss
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
- University Clinic and Polyclinic III, Dresden University of Technology, Dresden, Germany
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Andreas Deussen
- Department of Physiology, Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Roman N Rodionov
- University Center for Vascular Medicine, Dresden University of Technology, Dresden, Germany
- University Clinic and Polyclinic III, Dresden University of Technology, Dresden, Germany
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8
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Martens-Lobenhoffer J, Bode-Böger SM. Mixed experiences with commercial calibrators and controls for COVID-19 drugs. J Appl Lab Med 2021; 7:617-619. [PMID: 34633412 PMCID: PMC8524534 DOI: 10.1093/jalm/jfab130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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9
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Gerecke LKV, Schmidt JJ, Hafer C, Eden G, Bode-Böger SM, Martens-Lobenhoffer J, Welte T, Kielstein JT. Fosfomycin single- and multiple-dose pharmacokinetics in patients undergoing prolonged intermittent renal replacement therapy. J Antimicrob Chemother 2021; 77:169-173. [PMID: 34586373 DOI: 10.1093/jac/dkab357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fosfomycin is used increasingly in the treatment of MDR bacteria. It is eliminated by renal excretion, but data regarding dosing recommendations for patients undergoing modern means of renal replacement therapies are scarce. OBJECTIVES Evaluation of the pharmacokinetics (PK) of fosfomycin in patients undergoing prolonged intermittent renal replacement therapy (PIRRT) to guide dosing recommendations. METHODS Fosfomycin was given in 11 (7 female) patients with severe infections undergoing PIRRT. Plasma levels were measured at several timepoints on the first day of fosfomycin therapy, as well as 5-6 days into therapy, before and after the dialyser, to calculate its clearance. Fosfomycin was measured in the collected spent dialysate. RESULTS The median (IQR) plasma dialyser clearance for fosfomycin was 183.4 (156.9-214.9) mL/min, eliminating a total amount of 8834 (4556-10 440) mg of fosfomycin, i.e. 73.9% (45.3%-93.5%) of the initial dose. During PIRRT, the fosfomycin half-life was 2.5 (2.2-3.4) h. Data from multiple-dose PK showed an increase in fosfomycin Cmax from 266.8 (166.3-438.1) to 926.1 (446.8-1168.0) mg/L and AUC0-14 from 2540.5 (1815.2-3644.3) to 6714 (4060.6-10612.6) mg·h/L. Dialysis intensity during the study was 1.5 L/h. T>MIC was 100% in all patients. CONCLUSIONS Patients undergoing PIRRT experience significant fosfomycin elimination, requiring a dose of 5 g/8 h to reach adequate plasma levels. However, drug accumulation may occur, depending on dialysis frequency and intensity.
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Affiliation(s)
- Lisa K V Gerecke
- Medical Clinic V
- Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Julius J Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Carsten Hafer
- Medical Clinic V
- Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Gabriele Eden
- Medical Clinic V
- Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Tobias Welte
- Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V
- Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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10
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Schmidt JJ, Bode-Böger SM, Martens-Lobenhoffer J, Hoeper MM, Kielstein JT. Pharmacokinetics of Remdesivir and GS-441524 during PIRRT and Seraph 100 Therapy. Clin J Am Soc Nephrol 2021; 16:1256-1257. [PMID: 34301737 PMCID: PMC8455057 DOI: 10.2215/cjn.17601120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/07/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Julius J. Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Stefanie M. Bode-Böger
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Marius M. Hoeper
- Department of Pulmonary Medicine, Hannover Medical School, Hannover, and German Centre of Lung Research, Hannover, Germany
| | - Jan T. Kielstein
- Nephrology, Rheumatology, and Blood Purification, Medical Clinic V, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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11
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Kopaliani I, Jarzebska N, Brilloff S, Kolouschek A, Martens-Lobenhoffer J, Bornstein S, Bode-Böger S, Weiss N, Deussen A, Rodionov R. Transgenic overexpression of dimethylarginine dimethylaminohydrolase 1 protects from angiotensin II - induced cardiac hypertrophy and vascular remodeling. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Putzer AS, Worthmann H, Grosse GM, Goetz F, Martens-Lobenhoffer J, Dirks M, Kielstein JT, Lichtinghagen R, Budde U, Bode-Böger SM, Weissenborn K, Schuppner R. ADAMTS13 activity is associated with early neurological improvement in acute ischemic stroke patients treated with intravenous thrombolysis. J Thromb Thrombolysis 2020; 49:67-74. [PMID: 31482326 DOI: 10.1007/s11239-019-01941-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.
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Affiliation(s)
- Anne-Sophie Putzer
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Friedrich Goetz
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625, Hannover, Germany
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-Guericke-University of Magdeburg, University Hospital, 39106, Magdeburg, Germany
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V, Academic Teaching Hospital Braunschweig, 38118, Brunswick, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, 30625, Hannover, Germany
| | - Ulrich Budde
- Medilys Laboratory, Asklepios Klinik Altona, 22763, Hamburg, Germany
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-Guericke-University of Magdeburg, University Hospital, 39106, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625, Hannover, Germany.
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13
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Stautemas J, Jarzebska N, Shan ZX, Blancquaert L, Everaert I, de Jager S, De Baere S, Hautekiet A, Volkaert A, Lefevere FBD, Martens-Lobenhoffer J, Bode-Böger SM, Kim CK, Leiper J, Weiss N, Croubels S, Rodionov RN, Derave W. The role of alanine glyoxylate transaminase-2 (agxt2) in β-alanine and carnosine metabolism of healthy mice and humans. Eur J Appl Physiol 2020; 120:2749-2759. [PMID: 32948897 DOI: 10.1007/s00421-020-04501-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Chronic β-alanine supplementation leads to increased levels of muscle histidine-containing dipeptides. However, the majority of ingested β-alanine is, most likely, degraded by two transaminases: GABA-T and AGXT2. In contrast to GABA-T, the in vivo role of AGXT2 with respect to β-alanine metabolism is unknown. The purpose of the present work is to investigate if AGXT2 is functionally involved in β-alanine homeostasis. METHODS Muscle histidine-containing dipeptides levels were determined in AGXT2 overexpressing or knock-out mice and in human subjects with different rs37369 genotypes which is known to affect AGXT2 activity. Further, plasma β-alanine kinetic was measured and urine was obtained from subjects with different rs37369 genotypes following ingestion of 1400 mg β-alanine. RESULT Overexpression of AGXT2 decreased circulating and muscle histidine-containing dipeptides (> 70% decrease; p < 0.05), while AGXT2 KO did not result in altered histidine-containing dipeptides levels. In both models, β-alanine remained unaffected in the circulation and in muscle (p > 0.05). In humans, the results support the evidence that decreased AGXT2 activity is not associated with altered histidine-containing dipeptides levels (p > 0.05). Additionally, following an acute dose of β-alanine, no differences in pharmacokinetic response were measured between subjects with different rs37369 genotypes (p > 0.05). Interestingly, urinary β-alanine excretion was 103% higher in subjects associated with lower AGXT2 activity, compared to subjects associated with normal AGXT2 activity (p < 0.05). CONCLUSION The data suggest that in vivo, β-alanine is a substrate of AGXT2; however, its importance in the metabolism of β-alanine and histidine-containing dipeptides seems small.
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Affiliation(s)
- Jan Stautemas
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium.
| | - Natalia Jarzebska
- University Centre for Vascular Medicine and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Zhou Xiang Shan
- Anhui Institute of Sport Science and Technology, Anhui University of Science and Technology Anhui, Anhui, China
| | - Laura Blancquaert
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
| | - Inge Everaert
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
| | - Sarah de Jager
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
| | - Siegrid De Baere
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Arne Hautekiet
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
| | - Anneke Volkaert
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
| | - Filip B D Lefevere
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
| | | | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-Von-Guericke University, Magdeburg, Germany
| | - Chang Keun Kim
- Exercise and Metabolism Research Center, Zhejiang Normal University, Jinhua, China
| | - James Leiper
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, London, UK
| | - Norbert Weiss
- University Centre for Vascular Medicine and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany
| | - Siska Croubels
- Department of Pharmacology, Toxicology and Biochemistry, Ghent University, Ghent, Belgium
| | - Roman N Rodionov
- University Centre for Vascular Medicine and Department of Internal Medicine, Technische Universität Dresden, Dresden, Germany
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000, Gent, Belgium
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14
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Seffer MT, Martens-Lobenhoffer J, Schmidt JJ, Eden G, Bode-Böger SM, Kielstein JT. Clearance of chloroquine and hydroxychloroquine by the Seraph® 100 Microbinda Affinity Blood Filter -a device approved for the treatment of COVID-19 patients. Ther Apher Dial 2020; 25:237-241. [PMID: 32558210 PMCID: PMC7323047 DOI: 10.1111/1744-9987.13549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
On April 17 2020, the United States Food and Drug Administration granted Coronavirus Disease 2019 (COVID‐19) emergency use authorizations for the Seraph 100 Microbind Affinity Blood Filter. The medical device is aimed to treat critically ill COVID‐19 patients with confirmed or imminent respiratory failure. The aim of this life size in vitro pharmacokinetic study was to investigate the in vitro adsorption of chloroquine and hydroxychloroquine from human plasma using equipment that is also used at the bedside. After start of the hemoperfusion, Pre (Cpre) Seraph plasma levels were obtained at 5 (C5), 10 (C10), 15 (C15), 30 (C30), 60 (C60), and 120 (C120) minutes into the procedure. At two timepoints (5 and 120 minutes) post (Cpost) Seraph plasma levels were determined that were used to calculate the plasma clearance of the Seraph. Both drugs were determined using a validated HPLC method. Median [IQR] plasma clearance of the Seraph for chloroquine/hydroxychloroquine was 1.71 [0.51‐4.38] mL/min/1.79 [0.21‐3.68] mL/min respectively. The lack of elimination was also confirmed by the fact that plasma levels did not change over the 120 minutes treatment. As neither chloroquine nor hydroxychloroquine were removed by the treatment with the Seraph dose adjustments in COVID‐19 patients undergoing this treatment are not necessary.
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Affiliation(s)
- Malin-Theres Seffer
- Medical Clinic V, Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany.,Microbial Proteomics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Julius J Schmidt
- Deparment of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Gabriele Eden
- Medical Clinic V, Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan T Kielstein
- Medical Clinic V, Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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15
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Rodionov RN, Jarzebska N, Schneider A, Rexin A, Sradnick J, Brilloff S, Martens-Lobenhoffer J, Bode-Böger SM, Todorov V, Hugo C, Weiss N, Hohenstein B. ADMA elevation does not exacerbate development of diabetic nephropathy in mice with streptozotocin-induced diabetes mellitus. ATHEROSCLEROSIS SUPP 2020; 40:100-105. [PMID: 31818438 DOI: 10.1016/j.atherosclerosissup.2019.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular disease is nowadays the major cause of mortality and morbidity worldwide. The risk of developing cardiovascular disease is significantly increased in patients with diabetic nephropathy. It has been suggested that asymmetric dimethylarginine (ADMA), an endogenous inhibitor of NO synthases (NOS), may play an important role in the pathogenesis of diabetic nephropathy. ADMA is mainly metabolized by dimethylarginine dimethylaminohydrolase 1 (DDAH1). The goal of this study was to test the hypothesis that elevation of systemic ADMA levels by knocking out DDAH1 would exacerbate functional and structural glomerular abnormalities in a murine model of diabetic nephropathy. METHODS Streptozotocin (STZ) was used to induce diabetes in adult DDAH1 knock-out and wild type mice. Healthy mice served as controls. Mice were sacrificed after 20 weeks of diabetes. Plasma ADMA levels were assessed by isotope-dilution tandem mass spectrometry and albumin by ELISA. Kidneys were used for FACS analysis and were also stained for markers of inflammation, cell proliferation, glomerular cells and cell matrix. RESULTS STZ led to development of diabetes mellitus in all injected animals. Deficiency of DDAH1 led to a significant increase in plasma ADMA levels in healthy and diabetic mice. The diabetic state itself did not influence systemic ADMA levels. Diabetic mice of both genotypes developed albuminuria and had increased glomerulosclerosis index. There were no changes in desmin expression, glomerular cell proliferation rate, matrix expansion and expression of Mac-2 antigen in the diabetic mice of both genotypes as compared to the healthy ones. CONCLUSIONS In summary, STZ-induced diabetes led to the development of early features of diabetic nephropathy. Deficiency of DDAH1 and subsequent increase in systemic ADMA levels did not exacerbate these changes, indicating that ADMA is not the major mediator of diabetic nephropathy in this experiment model.
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Affiliation(s)
- Roman N Rodionov
- University Center for Vascular Medicine, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Natalia Jarzebska
- University Center for Vascular Medicine, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany; Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Technische Universität Dresden, Germany
| | - Alfred Schneider
- Department of Visceral Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Annett Rexin
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Jan Sradnick
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Silke Brilloff
- University Center for Vascular Medicine, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Leipziger Str.44, 39120, Magdeburg, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Leipziger Str.44, 39120, Magdeburg, Germany
| | - Vladimir Todorov
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Christian Hugo
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Norbert Weiss
- University Center for Vascular Medicine, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Bernd Hohenstein
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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16
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Martens-Lobenhoffer J, Hinderhofer M, Tröger U, Bode-Böger SM. Stability of ceftolozane in human plasma and dried blood spots: Implications for transport and storage. J Pharmacol Toxicol Methods 2020; 103:106692. [DOI: 10.1016/j.vascn.2020.106692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 01/15/2023]
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17
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Ziegler NL, Sieweke JT, Biber S, Gabriel MM, Schuppner R, Worthmann H, Martens-Lobenhoffer J, Lichtinghagen R, Bode-Böger SM, Bavendiek U, Weissenborn K, Grosse GM. Markers of endothelial pathology to support detection of atrial fibrillation in embolic stroke of undetermined source. Sci Rep 2019; 9:19424. [PMID: 31857660 PMCID: PMC6923420 DOI: 10.1038/s41598-019-55943-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
A relevant part of embolic strokes of undetermined source (ESUS) is assumed to be cardiogenic. As shown previously, certain biomarkers of endothelial pathology are related to atrial fibrillation (AF). In this long-term follow-up study, we aimed to investigate whether these biomarkers are associated with subsequently diagnosed AF and with atrial cardiopathy. In 98 patients who suffered ischemic stroke of known and unknown origin L-arginine, Asymmetric (ADMA) and Symmetric Dimethylarginine (SDMA) have been measured on follow-up at least one year after index stroke. Stroke-diagnostics were available for all patients, including carotid Intima-Media-Thickness (CIMT) and comprehensive echocardiography studies. CIMT was larger in AF- compared with ESUS-patients (P < 0.001), independently from CHA2DS2VASC in the regression analysis (P = 0.004). SDMA-values were stable over time (P < 0.001; r = 0.788), whereas for ADMA moderate correlation with the initial values could be found (P = 0.007; r = 0.356). According to Kaplan-Meier-analyses, AF-detection rates were associated with CIMT (P = 0.003) and SDMA (P < 0.001). SDMA correlated with left atrial volume-index within the whole collective (P = 0.003, r = 0.322) and within the ESUS-subgroup (P = 0.003; r = 0.446). These associations were independent from CHA2DS2VASC and renal function in the regression analysis (P = 0.02 and P = 0.005, respectively). In conclusion, these results highlight SDMA and CIMT as potential markers of atrial cardiopathy and AF in ESUS-patients.
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Affiliation(s)
- Nora L Ziegler
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Saskia Biber
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Gerrit M Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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18
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Rodionov RN, Begmatov H, Jarzebska N, Patel K, Mills MT, Ghani Z, Khakshour D, Tamboli P, Patel MN, Abdalla M, Assaf M, Bornstein SR, Millan JL, Bode-Böger SM, Martens-Lobenhoffer J, Weiss N, Savinova OV. Homoarginine Supplementation Prevents Left Ventricular Dilatation and Preserves Systolic Function in a Model of Coronary Artery Disease. J Am Heart Assoc 2019; 8:e012486. [PMID: 31304837 PMCID: PMC6662144 DOI: 10.1161/jaha.119.012486] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Homoarginine (hArg) has been shown to be cardioprotective in a model of ischemic heart failure; however, the mechanism remains unknown. hArg can inhibit tissue‐nonspecific alkaline phosphatase (TNAP), an enzyme that promotes vascular calcification. We hypothesized that hArg will exert beneficial effects by reducing calcification in a mouse model of coronary artery disease associated with TNAP overexpression and hypercholesterolemia. Methods and Results TNAP was overexpressed in the endothelium in mice homozygous for a low‐density lipoprotein receptor mutation (wicked high cholesterol [WHC] allele). WHC and WHC–endothelial TNAP mice received placebo or hArg supplementation (14 mg/L in drinking water) starting at 6 weeks of age simultaneously with an atherogenic diet. Outcomes were compared between the groups after 4 to 5 weeks on treatment. Experiments were performed in males, which presented a study limitation. As expected, WHC–endothelial TNAP mice on the placebo had increased mortality (median survival 27 days, P<0.0001), increased coronary calcium and lipids (P<0.01), increased left ventricular end‐diastolic diameter (P<0.0001), reduced ejection fraction (P<0.05), and increased myocardial fibrosis (P<0.0001) compared with WHC mice. Contrary to our hypothesis, hArg neither inhibited TNAP activity in vivo nor reduced coronary artery calcification and atherosclerosis in WHC–endothelial TNAP mice; however, compared with the placebo, hArg prevented left ventricular dilatation (P<0.01), preserved ejection fraction (P<0.05), and reduced myocardial fibrosis (P<0.001). Conclusions The beneficial effect of hArg supplementation in the setting of calcified coronary artery disease is likely due to its direct protective actions on the myocardial response to the ischemic injury and not to the inhibition of TNAP activity and calcification.
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Affiliation(s)
- Roman N Rodionov
- 1 University Center for Vascular Medicine Technische Universität Dresden Dresden Germany
| | - Hoshimjon Begmatov
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Natalia Jarzebska
- 1 University Center for Vascular Medicine Technische Universität Dresden Dresden Germany.,3 Department of Anesthesiology and Intensive Care Unit Medicine Pulmonary Engineering Group University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Ketul Patel
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Matthew T Mills
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Zulaikha Ghani
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Doreen Khakshour
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Pankti Tamboli
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Mitul N Patel
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Mirette Abdalla
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Maryann Assaf
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
| | - Stefan R Bornstein
- 4 Department of Internal Medicine III University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
| | - Jose Luis Millan
- 5 Human Genetics Program Sanford Burnham Prebys Medical Discovery Institute La Jolla CA
| | | | | | - Norbert Weiss
- 1 University Center for Vascular Medicine Technische Universität Dresden Dresden Germany
| | - Olga V Savinova
- 2 Department of Biomedical Sciences New York Institute of Technology College of Osteopathic Medicine Old Westbury NY
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19
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Martens-Lobenhoffer J, Monastyrski D, Tröger U, Bode-Böger SM. Stability of meropenem in plasma versus dried blood spots (DBS). J Pharm Biomed Anal 2019; 170:279-284. [DOI: 10.1016/j.jpba.2019.03.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 12/21/2022]
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20
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Grosse GM, Biber S, Sieweke JT, Martens-Lobenhoffer J, Gabriel MM, Putzer AS, Hasse I, van Gemmeren T, Schuppner R, Worthmann H, Lichtinghagen R, Bode-Böger SM, Bavendiek U, Weissenborn K. Plasma Dimethylarginine Levels and Carotid Intima-Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke. Int J Mol Sci 2019; 20:ijms20030730. [PMID: 30744089 PMCID: PMC6387438 DOI: 10.3390/ijms20030730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/23/2022] Open
Abstract
A relevant part of embolic strokes of undetermined source (ESUS) is assumed to be due to non-detected atrial fibrillation (AF). In this study, we aimed to investigate if markers of endothelial dysfunction and damage may indicate AF risk in embolic stroke. Eighty-eight patients with ischemic stroke confirmed by imaging were assigned to one of three groups: ESUS, AF, or micro-/macroangiopathy. ESUS patients underwent prolonged Holter electrocardiography scheduled for three days. The National Institutes of Health Stroke Scale (NIHSS), the CHA2DS2VASC score, and the carotid intima–media thickness (CIMT) were obtained. Markers of endothelial (dys)function (L-arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA)) were measured at day seven after stroke. ESUS patients were younger and had fewer cardiovascular risk factors than patients with determined stroke etiology. Compared with AF patients, ESUS patients showed significantly lower values of SDMA (p = 0.004) and higher values of L-arginine (p = 0.031), L-arginine/ADMA ratio (p = 0.006), L-arginine/SDMA ratio (p = 0.002), and ADMA/SDMA ratio (p = 0.013). Concordant differences could be observed comparing ESUS patients with those with newly diagnosed AF (p = 0.026; p = 0.03; p = 0.009; p = 0.004; and p = 0.046, respectively). CIMT was significantly larger in AF than in ESUS patients (p < 0.001), and was identified as an AF risk factor independent from CHA2DS2VASC in the regression analysis (p = 0.014). These findings may support future stratification for AF risk in patients who have suffered embolic stroke.
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Affiliation(s)
- Gerrit M Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Saskia Biber
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
- Department of Cardiology, Hannover Medical School, 30625 Hannover, Germany.
| | | | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany.
| | - Maria M Gabriel
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Anne-Sophie Putzer
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Isabel Hasse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Till van Gemmeren
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany.
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany.
| | - Udo Bavendiek
- Department of Cardiology, Hannover Medical School, 30625 Hannover, Germany.
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany.
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21
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Schmidt JJ, Strunk AK, David S, Bode-Böger SM, Martens-Lobenhoffer J, Knitsch W, Scherneck S, Welte T, Kielstein JT. Single- and multiple-dose pharmacokinetics and total removal of colistin in critically ill patients with acute kidney injury undergoing prolonged intermittent renal replacement therapy. J Antimicrob Chemother 2019; 74:997-1002. [DOI: 10.1093/jac/dky511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julius J Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Ann-Kathrin Strunk
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Sascha David
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Wolfgang Knitsch
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Stephan Scherneck
- Institute of Pharmacology, Toxicology and Clinical Pharmacy, Technical University of Braunschweig, Braunschweig, Germany
| | - Tobias Welte
- Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Medical Clinic V
- Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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22
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Kopaliani I, Jarzebska N, Brilloff S, Kolouschek A, Martens-Lobenhoffer J, Bode-Böger SM, Deussen A, Weiss N, Rodionov RN. Abstract 287: Transgenic Overexpression of Dimethylarginine Dimethylaminohydrolase 1 Protects From Angiotensin II - Induced Cardiac Hypertrophy and Vascular Remodeling. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Dimethylarginine dimethylaminohydrolase 1 (DDAH1) hydrolyzes the endogenous inhibitor of nitric oxide synthases asymmetric dimethylarginine (ADMA). DDAH1 is also suggested to have ADMA-independent effects. DDAH1 overexpression lowers ADMA levels and protects from renal interstitial fibrosis and vascular oxidative stress in angiotensin-II-induced hypertension. The current study was designed to test the hypothesis that DDAH1 overexpression protects from angiotensin II-induced cardiac hypertrophy and vascular remodeling.
Methods:
Angiotensin II (AngII) was infused in the doses of 0.75 and 1.5 mg/kg/day, respectively, in DDAH1 transgenic mice (TG) and wild type (WT) littermates via osmotic minipumps. Echocardiography was performed in the first and fourth week after start of the infusion. Systolic blood pressure was measured by the tail-cuff method. Cardiac hypertrophy and vascular remodeling was assessed by histology after 4 weeks of AngII infusion.
Results:
TG mice had decreased plasma and tissue ADMA. Infusion of Ang II resulted in an increase in systolic blood pressure, which was similar between TG and WT mice at week 1, however, TG mice were protected from a further increase in blood pressure. After 4-weeks infusion of AngII TG mice had significantly higher left ventricular lumen to wall ratio, smaller size of cardiomyocytes and reduced myocardial collagen expression compared to WT littermates. TG mice had lower left ventricular posterior wall thickness in systole and diastole as compared to WT controls. The vasomotor function of aortic rings in response to acetylcholine was improved in the TG mice as compared to the WT mice. TG mice had less aortic hypertrophy and fibrosis and more elastin in aorta as compared to WT mice. Aortic infiltration of CD45
+
, CD3
+
, CD8
+
and CD4
+
T-cells was significantly lower in TG than in WT mice.
Conclusion:
This study shows that upregulation of DDAH1 protects from AngII-induced cardiac hypertrophy and vascular remodeling. Upregulation of DDAH1 might be a potential therapeutic approach for protection from AngII – induced end organ damage. We are currently investigating, whether protective effects of DDAH1 are ADMA-dependent or ADMA-independent.
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23
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Dirks M, Grosse G, Böckmann M, Goetz F, Pasedag T, Bode-Böger S, Martens-Lobenhoffer J, Budde U, Lanfermann H, Lichtinghagen R, Weissenborn K, Worthmann H, Schuppner R. ADAMTS-13 Activity Predicts Outcome in Acute Ischaemic Stroke Patients Undergoing Endovascular Treatment. Thromb Haemost 2018; 118:758-767. [DOI: 10.1055/s-0038-1637732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding.
Objectives This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke.
Patients/Methods Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS).
Results Low ADAMTS-13 activity (p = 0.009) and missing of statin therapy (p = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5–6). Patients with unsuccessful reperfusion (mTICI: 0–1) showed higher ADMA levels on admission (p = 0.018). However, this association could not be confirmed in the binary logistic regression analysis.
Conclusion Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke.
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Affiliation(s)
- Meike Dirks
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Gerrit Grosse
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Goetz
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Thomas Pasedag
- Department of Neurology, Hannover Medical School, Hannover, Germany
- Department of Psychiatry, Kliniken der Region Hannover, Langenhagen, Germany
| | - Stefanie Bode-Böger
- Department of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Ulrich Budde
- Medilys Laboratory, Asklepios Clinic Altona, Hamburg, Germany
| | | | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | | | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
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24
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Worthmann H, Li N, Martens-Lobenhoffer J, Dirks M, Schuppner R, Lichtinghagen R, Kielstein JT, Raab P, Lanfermann H, Bode-Böger SM, Weissenborn K. Dimethylarginines in patients with intracerebral hemorrhage: association with outcome, hematoma enlargement, and edema. J Neuroinflammation 2017; 14:247. [PMID: 29237474 PMCID: PMC5729507 DOI: 10.1186/s12974-017-1016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Asymmetric dimethylarginine (ADMA)--the most potent endogenous NO-synthase inhibitor, has been regarded as mediator of endothelial dysfunction and oxidative stress. Considering experimental data, levels of ADMA and its structural isomer symmetric dimethylarginine (SDMA) might be elevated after intracerebral hemorrhage (ICH) and associated with clinical outcome and secondary brain injury. METHODS Blood samples from 20 patients with acute ICH were taken at ≤ 24 h and 3 and 7 days after the event. Nine patients had favorable (modified Rankin Scale (mRS) at 90 days 0-2) outcome, and 11 patients unfavorable outcome (mRS 3-6). Patients' serum ADMA, SDMA, and L-arginine levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Levels were compared to those of 30 control subjects without ICH. For further analysis, patients were grouped according to outcome, hematoma and perihematomal edema volumes, occurrence of hematoma enlargement, and cytotoxic edema as measured by computed tomography and serial magnetic resonance imaging. RESULTS Levels of ADMA--but not SDMA and L-arginine--were elevated in ICH patients compared to controls (binary logistic regression analysis: ADMA ≤ 24 h, p = 0.003; 3 days p = 0.005; 7 days p = 0.004). If patients were grouped according to outcome, dimethylarginines were increased in patients with unfavorable outcome. The binary logistic regression analysis confirmed an association of SDMA levels ≤ 24 h (p = 0.048) and at 3 days (p = 0.028) with unfavorable outcome. ADMA ≤ 24 h was increased in patients with hematoma enlargement (p = 0.003), while SDMA ≤ 24 h was increased in patients with large hematoma (p = 0.029) and perihematomal edema volume (p = 0.023). CONCLUSIONS Our data demonstrate an association between dimethylarginines and outcome of ICH. However, further studies are needed to confirm this relationship and elucidate the mechanisms behind.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.
| | - Na Li
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jens Martens-Lobenhoffer
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Meike Dirks
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
| | - Ralf Lichtinghagen
- Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.,Medical Clinic V, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Stefanie M Bode-Böger
- Department of Clinical Pharmacology, Otto-von-Guericke-University of Magdeburg, University Hospital, Magdeburg, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30623, Hannover, Germany
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25
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Rodionov RN, Heinrich A, Brilloff S, Jarzebska N, Martens-Lobenhoffer J, Bode-Böger SM, Todorov VT, Hugo CP, Weiss N, Hohenstein B. ADMA reduction does not protect mice with streptozotocin-induced diabetes mellitus from development of diabetic nephropathy. ATHEROSCLEROSIS SUPP 2017; 30:319-325. [DOI: 10.1016/j.atherosclerosissup.2017.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Rodionov RN, Burdin D, Brilloff S, Todorov V, Jarzebska N, Martens-Lobenhoffer J, Hofmann A, Morawietz H, Hilgers K, Cordasic N, Jacobi J, Maas R, Chen Y, Bode-Böger SM, Hugo CP, Hohenstein B, Weiss N. Abstract 185: Transgenic Overexpression of Alanine-glyoxylate Aminotransferase 2 in Mice Lowers Asymmetric Dimethylarginine and Improves Vasomotor Function. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It has been demonstrated in various studies that ADMA (asymmetric dimethylarginine), an inhibitor of nitric oxide synthase, is associated with the increased risk of cardiovascular diseases. There are two known pathways of ADMA metabolism: hydrolysis to citrulline by dimethylarginine dimethylaminohydrolases (DDAH) and transamination by alanine-glyoxylate aminotransferase 2 (AGXT2) with formation of asymmetric dimethylguanidino valeric acid (ADGV). The second pathway is still poorly understood. The goal of the current study was to test the hypothesis that transgenic overexpression of AGXT2 leads to lowering of plasma levels of ADMA and improvement of vasomotor function.
Methods and Results:
We generated transgenic mice (TG) with ubiquitous overexpression of
AGXT2
under control of the chicken beta actin (CAG) promoter. qPCR and Western Blot were used to confirm the ubiquitous expression of the transgene. HPLC-MS/MS was used to generate biochemical data. Systemic ADMA levels were decreased by 15% (p<0.05) in the TG mice, whereas ADGV plasma levels were six times higher in comparison with wild type animals (p<0.001). Heart and lung of TG animals exhibited 2 times lower tissue ADMA content in comparison with wild type littermates (p<0.05). In further experiments, we crossed the AGXT2 TG mice with DDAH1 KO mice and showed that upregulation of AGXT2 protects DDAH1 KO mice from elevation of plasma ADMA levels and restores endothelium-dependent vasodilation in aortic rings. In the current experiments we are assessing whether AGXT2 overexpression also protects DDAH1 KO mice from hypertension.
Conclusion:
In the current study we demonstrated that upregulation of AGXT2 leads to lowering of ADMA levels and improvement of endothelium-dependent relaxation
in vivo
in the settings of DDAH1 deficiency
.
AGXT2 thereby may be a potential drug target for long-term reduction of systemic ADMA levels in cardiovascular pathologies. This is especially important, because all the efforts to develop pharmacological ADMA-lowering interventions by means of upregulation of DDAH have not been successful so far.
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Affiliation(s)
- Roman N Rodionov
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dmitri Burdin
- Dept of General Physiology, Saint-Petersburg State Univ, Saint-Petersburg, Russian Federation
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Vladimir Todorov
- Dept of Nephrology, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Anja Hofmann
- Div of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Div of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
| | - Karl Hilgers
- Dept of Nephrology and Hypertensiology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nada Cordasic
- Dept of Nephrology and Hypertensiology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Jacobi
- Dept of Nephrology and Hypertensiology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Renke Maas
- Institute of Clinical and Experimental Pharmacology and Toxicology, Friedrich-Alexander Univ, Erlangen, Germany
| | - YingJie Chen
- Cardiovascular Div, Dept of Medicine, Univ of Minnesota, Minnesota, MN
| | | | - Christian P Hugo
- Dept of Nephrology, Technische Universität Dresden, Dresden, Germany
| | - Bernd Hohenstein
- Dept of Nephrology, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
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27
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Rodionov RN, Brilloff S, Jarzebska N, Kolouschek A, Martens-Lobenhoffer J, Bode-Böger SM, Weiss N, Deussen A, Kopaliani I. Abstract 382: Transgenic Overexpression of Dimethylarginine Dimethylaminohydrolase 1 Protects From Angiotensin II-induced Cardiac Hypertrophy. Arterioscler Thromb Vasc Biol 2017. [DOI: 10.1161/atvb.37.suppl_1.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
ADMA (asymmetric dimethylarginine) is an endogenous inhibitor of nitric oxide synthase. ADMA can be metabolized to citrulline by dimethylarginine dimethylaminohydrolase (DDAH). DDAH1 overexpression lowers ADMA and protects from angiotensin II - induced renal interstitial fibrosis and vascular oxidative stress. The goal of the current study was to test the hypothesis that transgenic overexpression of DDAH1 protects from angiotensin II-induced cardiac hypertrophy.
Methods and Results:
DDAH1 transgenic mice grew and developed normally and had decreased plasma ADMA levels. Angiotensin II was infused for four weeks in the dose of 0.75 mg/kg/day in DDAH1 transgenic mice and wild type littermates via osmotic minipumps. Echocardiography was performed in the first and fourth week after start of the infusion on anaesthetized mice. After 4 weeks of angiotensin II infusion wild type mice developed cardiac hypertrophy. The DDAH1 transgenic mice had higher left ventricular lumen to wall ratio compared to the wild type mice (1.76 ± 0.18 vs 1.15 ± 0.22, P<0.01). They also had lower left ventricular posterior wall thickness in systole and diastole as compared to the wild type controls (1.18 ± 0.03 mm vs 1.95 ± 0.16 mm, P<0.001 and 0.81 ± 0.03 mm vs 1.62 ± 0.25 mm, P<0.001, respectively).
Conclusion:
We demonstrated that upregulation of DDAH1 protects from angiotensin II-induced cardiac hypertrophy. Our findings suggest that ADMA plays a role in angiotensin II - induced myocardial remodeling. Upregulation of DDAH1 might be a potential approach for protection from angiotensin II - induced end organ damage.
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Affiliation(s)
- Roman N Rodionov
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anne Kolouschek
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | | | | | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Deussen
- Institute of Physiology, Technische Universität Dresden, Dresden, Germany
| | - Irakli Kopaliani
- Institute of Physiology, Technische Universität Dresden, Dresden, Germany
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28
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Martens-Lobenhoffer J, Bode-Böger SM. Quantification of meropenem in human plasma by HILIC – tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1046:13-17. [DOI: 10.1016/j.jchromb.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/05/2017] [Accepted: 01/12/2017] [Indexed: 11/27/2022]
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Abstract
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and its accumulation has been associated with cardiovascular disease. We aimed to investigate the role of ADMA in endothelial cell senescence. Endothelial cells were cultured until the tenth passage. ADMA was replaced every 48 hours starting at the fourth passage. ADMA significantly accelerated senescence-associated β-galactosidase activity. Additionally, the shortening of telomere length was significantly speeded up and telomerase activity was significantly reduced. This effect was associated with an increase of oxidative stress: both allantoin, a marker of oxygen free radical generation, and intracellular reactive oxygen species increased significantly after ADMA treatment compared with control, whereas nitric oxide synthesis decreased. Furthermore, ADMA-increased oxidative stress was accompanied by a decrease in the activity of dimethylarginine dimethylaminohydrolase, the enzyme that degrades ADMA, which could be prevented by the antioxidant pyrroli-dine dithiocarbamate. Exogenous ADMA also stimulated secretion of monocyte chemotactic protein-1 and interleukin-8. Co-incubation with the methyltransferase inhibitor S-adenosylhomocysteine abolished the effects of ADMA. These data suggest that ADMA accelerates senescence, probably via increased oxygen radical formation by inhibiting nitric oxide elaboration. This study provides evidence that modest changes of intracellular ADMA levels are associated with significant effects on slowing down endothelial senescence.
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Affiliation(s)
- Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, University Hospital Otto-von-Guericke University, Magdeburg, Germany,
| | - Fortunato Scalera
- Institute of Clinical Pharmacology, University Hospital Otto-von-Guericke University, Magdeburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, University Hospital Otto-von-Guericke University, Magdeburg, Germany
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30
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Burdin DV, Kolobov AA, Brocker C, Soshnev AA, Samusik N, Demyanov AV, Brilloff S, Jarzebska N, Martens-Lobenhoffer J, Mieth M, Maas R, Bornstein SR, Bode-Böger SM, Gonzalez F, Weiss N, Rodionov RN. Diabetes-linked transcription factor HNF4α regulates metabolism of endogenous methylarginines and β-aminoisobutyric acid by controlling expression of alanine-glyoxylate aminotransferase 2. Sci Rep 2016; 6:35503. [PMID: 27752141 PMCID: PMC5067591 DOI: 10.1038/srep35503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023] Open
Abstract
Elevated levels of circulating asymmetric and symmetric dimethylarginines (ADMA and SDMA) predict and potentially contribute to end organ damage in cardiovascular diseases. Alanine-glyoxylate aminotransferase 2 (AGXT2) regulates systemic levels of ADMA and SDMA, and also of beta-aminoisobutyric acid (BAIB)-a modulator of lipid metabolism. We identified a putative binding site for hepatic nuclear factor 4 α (HNF4α) in AGXT2 promoter sequence. In a luciferase reporter assay we found a 75% decrease in activity of Agxt2 core promoter after disruption of the HNF4α binding site. Direct binding of HNF4α to Agxt2 promoter was confirmed by chromatin immunoprecipitation assay. siRNA-mediated knockdown of Hnf4a led to an almost 50% reduction in Agxt2 mRNA levels in Hepa 1–6 cells. Liver-specific Hnf4a knockout mice exhibited a 90% decrease in liver Agxt2 expression and activity, and elevated plasma levels of ADMA, SDMA and BAIB, compared to wild-type littermates. Thus we identified HNF4α as a major regulator of Agxt2 expression. Considering a strong association between human HNF4A polymorphisms and increased risk of type 2 diabetes our current findings suggest that downregulation of AGXT2 and subsequent impairment in metabolism of dimethylarginines and BAIB caused by HNF4α deficiency might contribute to development of cardiovascular complications in diabetic patients.
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Affiliation(s)
- Dmitry V Burdin
- Department of Physiology, Saint Petersburg State University, 199034 Saint Petersburg, Russia
| | - Alexey A Kolobov
- Department of Biochemistry, Saint Petersburg State University, 199034 Saint Petersburg, Russia
| | - Chad Brocker
- National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | | | - Nikolay Samusik
- Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Anton V Demyanov
- Institute of Highly Pure Biopreparations, 197110 Saint Petersburg, Russia
| | - Silke Brilloff
- University Center for Vascular Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Natalia Jarzebska
- University Center for Vascular Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | | | - Maren Mieth
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Frank Gonzalez
- National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Norbert Weiss
- University Center for Vascular Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Roman N Rodionov
- University Center for Vascular Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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Schmidt JJ, Bode-Böger SM, Wilhelmi M, Omar M, Martens-Lobenhoffer J, Welte T, Kielstein JT. Pharmacokinetics and total removal of fosfomycin in two patients undergoing intermittent haemodialysis and extended dialysis: prescription needs to avoid under-dosing. J Antimicrob Chemother 2016; 71:2673-4. [DOI: 10.1093/jac/dkw187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodionov RN, Burdin DV, Kolobov AA, Demyanov AV, Soshnev AA, Brocker C, Samusik N, Brilloff S, Jarzebska N, Martens-Lobenhoffer J, Reetz T, Maas R, Bode-Böger SM, Gonzalez F, Weiss N. Abstract 461: Hepatic Nuclear Factor 4 Alpha as a Regulator of Alanine: Glyoxylate Aminotransferase 2 Expression and Systemic Levels of Endogenous Methylarginines. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Endogenous methylarginines have been proposed as markers and potentially mediators of cardiovascular diseases. Alanine:glyoxylate aminotransferase 2 (AGXT2) is the only enzyme capable of regulation of plasma levels of all three endogenous methylarginines. It has also been demonstrated that AGXT2 and its alternative substrate beta-aminoisobutyric acid (BAIB) can play an important modulatory role in lipid metabolism. Using bioinformatic analysis we identified a highly conserved putative binding site for the diabetes-associated transcription factor hepatic nuclear factor 4 alpha (HNF4A) in the mammalian AGXT2 promoter region. The aim of this study was to test the hypothesis that HNF4a is the major regulator of AGXT2 expression and activity.
Methods and results:
We introduced several point mutations in the putative HNF4A binding site and investigated their influence on activity of the murine
Agxt2
promoter using luciferase reporter assay. The mutated constructs decreased the activity of the reporter gene by 75% as compared to the native promoter sequence. We showed direct binding of HNF4a to
Agxt2
promoter using chromatin immunoprecipitation. We were able to demonstrate that siRNA-mediated knockdown of HNF4a leads to 50% reduction of
Agxt2
expression in the murine hepatic cell line Hepa 1-6. In the
in-vivo
part of the project we showed that liver-specific
Hnf4a
knockout mice have a 90% reduction in liver
Agxt2
mRNA levels, a 85% decrease in liver AGXT2 activity and significantly increased plasma levels of endogenous methylarginines and BAIB.
Conclusions:
In the current study we showed direct binding of HNF4a to the mammalian AGXT2 promoter region. We also demonstrated using
in-vitro
and
in-vivo
approaches that HNF4A is the major regulator of
Agxt2
expression and has direct influence on systemic levels of endogenous methylarginines and BAIB. These findings suggest a novel link between NO-mediated impairment of vascular and renal function and lipid metabolism.
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Affiliation(s)
- Roman N Rodionov
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dmitri V Burdin
- Dept of General Physiology, Saint-Petersburg State Univ, Saint-Petersburg, Russian Federation
| | - Alexey A Kolobov
- Dept of Biochemistry, Saint-Petersburg State Univ, Saint-Petersburg, Russian Federation
| | - Anton V Demyanov
- Institute of highly pure biopreparations, Institute of highly pure biopreparations, Saint-Petersburg, Russian Federation
| | - Alexey A Soshnev
- Laboratory of Chromatin Biology and Epigenetics, Rockefeller Univ, New York, NY
| | - Chad Brocker
- Cntr for Cancer Rsch, National Institutes of Health, Bethesda, MD
| | - Nikolay Samusik
- Univ Cntr for Vascular Medicine, Stanford Univ, Stanford, CA
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Theresa Reetz
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Univ Erlangen-Nürnberg, Erlangen, Germany
| | | | - Frank Gonzalez
- Cntr for Cancer Rsch, National Institute of Health, Bethesda, MD
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
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Jarzebska N, Rodionov RN, Burdin D, Brilloff S, Todorov VT, Martens-Lobenhoffer J, Hofmann A, Morawietz H, Demyanov A, Hilgers K, Cordasic N, Jacobi J, Maas R, Chen Y, Bode-Böger SM, Hugo CP, Hohenstein B, Weiss N. Abstract 453: Transgenic Overexpression of Alanine-glyoxylate Aminotransferase 2 in Mice Lowers Asymmetric Dimethylarginine and Improves Vasomotor Function. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Elevation of the endogenous inhibitor of nitric oxide synthase asymmetric dimethylarginine (ADMA) has been shown to be associated with increased risk of cardiovascular diseases. There are two major pathways of ADMA catabolism: hydrolysis to citrulline by dimethylarginine dimethylaminohydrolases (DDAH) and transamination by alanine-glyoxylate aminotransferase 2 (AGXT2) with formation of asymmetric dimethylguanidino valeric acid (ADGV). The second pathway is poorly characterized. The goal of the current study was to test the hypothesis that transgenic overexpression of AGXT2 leads to lowering of systemic levels of ADMA and improvement of vasomotor function.
Methods and Results:
We generated transgenic mice (TG) with ubiquitous overexpression of
AGXT2
under control of the chicken beta actin (CAG) promoter. qPCR and Western Blot were used to confirm the ubiquitous expression of the transgene. There were no developmental or phenotypic changes in the TG animals. Biochemical data were generated using HPLC-MS/MS. ADMA plasma levels were decreased by 15% (p<0.05) in the TG mice, whereas ADGV plasma levels were 6 times higher in comparison with wild-types littermates (p<0.001). Lung and heart of TG animals exhibited 2 times lower tissue ADMA content in comparison with controls (p<0.05). TG mice demonstrated improved endothelium-dependent vasodilation (in response to acetylcholine) in aortic rings. The endothelium-independent relaxation (in response to sodium nitroprusside) was unchanged. There was no difference in mean arterial blood pressure measured by telemetry between the wild type and AGXT2 TG mice. In further experiments, we crossed the AGXT2 TG mice with DDAH1 KO mice and showed that upregulation of AGXT2 protects DDAH1 KO mice from elevation of plasma ADMA levels.
Conclusion:
In the current study we demonstrated that upregulation of AGXT2 leads to lowering of ADMA levels and improvement of endothelium-dependent relaxation
in vivo.
AGXT2 thereby may be a potential drug target for long-term reduction of systemic ADMA levels in cardiovascular pathologies. This is especially important, because all the efforts to develop pharmacological ADMA-lowering interventions by means of upregulation of DDAH have not been successful so far.
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Affiliation(s)
- Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dmitri Burdin
- Dept of General Physiology, Saint-Petersburg State Univ, Saint Petersburg, Russian Federation
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | | | | | - Anja Hofmann
- Institute of Endothelium and Cardiovascular Diseases, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Dept of Endothelium and Cardiovascular Diseases, Technische Universität Dresden, Dresden, Germany
| | - Anton Demyanov
- Institute of highly pure biopreparations, Institute of highly pure biopreparations, Saint-Petersburg, Russian Federation
| | - Karl Hilgers
- Institute of Hypertensiology, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Nada Cordasic
- Institute of Hypertensiology, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Johannes Jacobi
- Institute of Hypertensiology, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Renke Maas
- Institute of Clinical Pharmacology, Otto-von-Guericke Univ, Magdeburg, Germany
| | - YingJie Chen
- Cardiovscular Div, Univ of Minnesota, Minnesota, MN
| | | | - Christian P Hugo
- Dept of Nephrology, Technische Universität Dresden, Dresden, Germany
| | - Bernd Hohenstein
- Dept of Nephrology, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
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Schmidt JJ, Ramazan L, Bockemeyer C, Günter HH, Martens-Lobenhoffer J, Ganzenmüller T, Bode-Böger SM, Kielstein JT. Acute interstitial nephritis due to flecainide therapy in the 38(th) week of pregnancy. BMC Nephrol 2016; 17:28. [PMID: 26980436 PMCID: PMC4793513 DOI: 10.1186/s12882-016-0240-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute interstitial nephritis (AIN) represents a frequent cause of acute kidney injury. While many etiologies of AIN have been recognized, the majority (60-70 %) are due to allergic reactions or drug exposure. Many different classes of drugs and several agents within a class can cause drug induced AIN. Flecainide, a class Ic antiarrhythmic drug, had thus far not been associated with the occurrence of AIN. CASE PRESENTATION Here we describe a case of biopsy proven AIN after flecainide therapy in a pregnant patient. The 24-year old Caucasian woman was admitted to our university hospital for a planned c-section. She had been put on flecainide at a dose of 200 mg/d for supraventricular tachyarrhythmia of the fetus ten days earlier. The only fleaainide drug level was obtained 24 h after the last dose. At this time point the serum level was still in the therapeutic range (392 ng/mL). After hospital admission the patient underwent uneventful c-section and delivered a 3095 g baby girl with mild insufficiency of the tricuspid valve. In the hours following the c-section, a single dose of the non-steroidal anti-inflammatory drug (NSAID) ibuprofen (600 mg) as well as single dose of diclofenac (100 mg) was administered. Within 5 days after c-section her baseline creatinine of 30 μmol/L increased to 277 μmol/L. The serum creatinine continued to rise to 411 μmol/L on hospital day # 7. On renal ultrasound kidneys were enlarged and swollen. Urinary sediment at this point only revealed slight proteinuria (506 mg/g creatinine). A renal biopsy was performed showing acute interstitial nephritis. Within four days the renal function improved after discontinuation of flecainide and NSAIDs even without steroid therapy and the patient was discharged with a creatinine of 88 μmol/L after 13 days in the hospital. CONCLUSION This case suggests that flecainide, at least in combination with NSAIDs, can cause AIN.
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Affiliation(s)
- Julius J Schmidt
- Department of Nephrology and Hypertension Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Leyla Ramazan
- Department of Nephrology and Hypertension Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | | | - Hans-Heinrich Günter
- Department of Gynecology and Obstetrics, Medical School Hannover, Hannover, Germany
| | | | | | - Stefanie M Bode-Böger
- Institute for Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension Medical School Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. .,Medical Clinic V, Academic Teaching Hospital Braunschweig, Braunschweig, Germany.
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Rodionov RN, Martens-Lobenhoffer J, Brilloff S, Burdin DV, Jarzebska N, Demyanov AV, Hohenstein B, Weiss N, Bode-Böger SM. Acetylation of asymmetric and symmetric dimethylarginine: an undercharacterized pathway of metabolism of endogenous methylarginines. Nephrol Dial Transplant 2015; 31:57-63. [PMID: 26610597 DOI: 10.1093/ndt/gfv390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased levels of asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are associated with cardiovascular and renal diseases. We and others have shown that both ADMA and SDMA can be Nα-acetylated to form asymmetric and symmetric Nα-acetyldimethylarginine (Ac-ADMA and Ac-SDMA). The current study further investigated this undercharacterized metabolic pathway. METHODS ADMA and SDMA were infused in C57/BL6 mice for 3 days using osmotic minipumps. Half of the mice underwent bilateral nephrectomy 24 h before completion of the infusion. Plasma and tissue levels of Ac-ADMA and Ac-SDMA were detected by liquid chromatography-tandem mass spectrometry. RESULTS ADMA and SDMA infusion resulted in a 3.6-fold increase in plasma Ac-ADMA and a 21-fold increase in plasma Ac-SDMA levels, respectively. Plasma Ac-ADMA and Ac-SDMA levels were dramatically increased after bilateral nephrectomy. The highest baseline tissue concentrations of Ac-ADMA and Ac-SDMA in wild-type mice were detected in the liver, kidney, small intestine, pancreas and spleen. Incubation of the tissue lysates with ADMA and SDMA resulted in increased levels of the corresponding Nα-acetylated products only in the liver, kidney and small intestine. CONCLUSIONS Our results show that overload of ADMA or SDMA leads to an increase in plasma Ac-ADMA and Ac-SDMA levels. This observation is consistent with the hypothesis that Ac-ADMA and Ac-SDMA are formed directly from ADMA and SDMA in vivo. The increase in plasma Ac-ADMA and Ac-SDMA concentrations after bilateral nephrectomy suggests that both compounds are predominantly eliminated via the kidneys. We demonstrated that acetylation of ADMA and SDMA occurs primarily in the liver, kidney and small intestine.
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Affiliation(s)
- Roman N Rodionov
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | | | - Silke Brilloff
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Dmitry V Burdin
- Department of General Physiology, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Natalia Jarzebska
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Anton V Demyanov
- Institute of Highly Pure Biopreparations, Saint-Petersburg, Russia
| | - Bernd Hohenstein
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- University Center for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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Martens-Lobenhoffer J, Bode-Böger SM, Clement B. First detection and quantification of N(δ)-monomethylarginine, a structural isomer of N(G)-monomethylarginine, in humans using MS(3). Anal Biochem 2015; 493:14-20. [PMID: 26464121 DOI: 10.1016/j.ab.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/27/2022]
Abstract
The L-arginine metabolites methylated at the guanidino moiety, such as N(G)-monomethyl-L-arginine (LNMMA), asymmetric N(G),N(G)-dimethyl-L-arginine (ADMA), and symmetric N(G),N(G')-dimethyl-L-arginine (SDMA), are long known to be present in human plasma. Far less is known about the structural isomer of LNMMA, N(δ)-monomethyl-L-arginine (δ-MMA). In prior work, it has been detected in yeast proteins, but it has not been investigated in mammalian plasma or cells. In this work, we present a method for the simultaneous and unambiguous quantification of LNMMA and δ-MMA in human plasma that is capable of detecting δ-MMA separately from LNMMA. The method comprises a simple protein precipitation sample preparation, hydrophilic interaction liquid chromatography (HILIC) gradient elution on an unmodified silica column, and triple stage mass spectrometric detection. Stable isotope-labeled D6-SDMA was used as internal standard. The calibration ranges were 25-1000 nmol/L for LNMMA and 5-350 nmol/L for δ-MMA. The intra- and inter-batch precision determinations resulted in relative standard deviations of less than 12% for both compounds with accuracies of less than 6% deviation from the expected values. In a pilot study enrolling 10 healthy volunteers, mean concentrations of 48.0 ± 7.4 nmol/L for LNMMA and 27.4 ± 7.7 nmol/L for δ-MMA were found.
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Affiliation(s)
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Bernd Clement
- Pharmaceutical Institute, Christian Albrechts University, 24118 Kiel, Germany
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Kielstein H, Suntharalingam M, Perthel R, Song R, Schneider SM, Martens-Lobenhoffer J, Jäger K, Bode-Böger SM, Kielstein JT. Role of the endogenous nitric oxide inhibitor asymmetric dimethylarginine (ADMA) and brain-derived neurotrophic factor (BDNF) in depression and behavioural changes: clinical and preclinical data in chronic kidney disease. Nephrol Dial Transplant 2015; 30:1699-705. [PMID: 26175142 DOI: 10.1093/ndt/gfv253] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/21/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) exhibit a high prevalence of neuropsychiatric alterations, including depression and behavioural changes. CKD is also associated with decreased physical activity not fully explained by co-morbidities. In patients without CKD, the brain-derived neurotropic factor (BDNF) as well as the endogenous NOS inhibitor asymmetric dimethylarginine (ADMA) had been suspected to be involved in major depression. The aim of our study was to examine the role of ADMA and BDNF in the behaviour of haemodialysis patients (CKD5D) as well as in a rat model of 5/6 nephrectomy and chronic ADMA infusion alone. METHODS Eleven (5F/6M) CKD5D patients underwent Beck Depression Inventory (BDI) testing along with analysis of ADMA and BDNF. Male Sprague-Dawley rats were randomly assigned to four groups: (i) saline infusion; (ii) ADMA (250 µg/kg/day) infusion via osmotic mini pumps; (iii) 5/6 nephrectomy; (iv) untreated controls. After 28 days, the animals underwent behavioural tests measuring anxiety, locomotion and investigative behaviour. Animals were sacrificed, blood samples were drawn and analysed and hippocampal immunohistology for BDNF was performed. RESULTS In CKD5D patients, decreased BDNF levels correlated with higher scores of depression (Pearson r = -0.8156, P = 0.002). ADMA infusion led to a significant decrease of BDNF while the decrease of BDNF in 5/6 nephrectomy was not significant. However, an attenuated hippocampal BDNF expression could be detected in 5/6 nephrecomized animals. Decreased spontaneous locomotor activity was shown in ADMA-infused rats [15.9 (13.5-26.1) lines crossed/min] and 5/6 nephrectomy [14.6 (6.1-20.2) lines crossed/min] when compared with controls [32.5 (15.3-42.4) lines crossed/min]. Anxiety-like behaviour tested by hole investigation time was significantly more pronounced in 5/6 nephrectomy [24 (6-44) s] when compared with ADMA infusion [64 (28-93) s] and controls [33 (26-65) s]. CONCLUSIONS Progressive renal failure in rats is accompanied by a marked increase of ADMA and a decrease in BDNF. 5/6 nephrectomy leads to significantly decreased exploratory behaviour and locomotion. Both behaviours could be reproduced by ADMA infusion alone. Indicators of anxiety were more pronounced in ADMA-infused animals when compared with 5/6 nephrectomized rats. Furthermore, an inverse relationship of BDNF and BDI in 11 CKD5D patients was shown.
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Affiliation(s)
- Heike Kielstein
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mayuren Suntharalingam
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Ronny Perthel
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Rong Song
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Sabrina M Schneider
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Kristin Jäger
- Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefanie M Bode-Böger
- Institute for Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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Rodionov RN, Burdin DV, Martens-Lobenhoffer J, Brilloff S, Jarzebska N, Demyanov AV, Weiss N, Bode-Böger S. Abstract 162: Detection of N-alpha-acetyltransferase Activity Towards Endogenous Inhibitor of Nitric Oxide Synthase Asymmetric Dimethylarginine in the Liver and Kidneys. Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Endogenous inhibitor of nitric oxide synthase asymmetric dimethylarginine (ADMA) has been proposed as a risk factor and mediator of cardiovascular diseases. ADMA can undergo hydrolysis by dimethylarginine dimethylaminohydrolase or be processed through an alternative pathway by alanine:glyoxylate aminotransferase 2. We and other have also shown that ADMA can be N-acetylated to form asymmetrical Nα-acetyldimethylarginine (Ac-ADMA). The goal of the study was to characterize this novel pathway in vivo and identify the organs, which are responsible for the ADMA-acetylating activity.
Results:
We infused ADMA in mice for three days. Control mice received saline infusion. Half of the mice underwent bilateral nephrectomy 24 hours before completion of the infusion, the rest had a sham surgery. ADMA infusion resulted in a 3.5 fold rise in plasma Ac-ADMA levels in the sham-operated mice (1.35 ± 0.45 nmol/L vs. 4.77 ± 0.88 nmol/L). In nephrectomized mice plasma Ac-ADMA levels were markedly increased even after saline infusion (45.08 ± 9.25 nmol/L) and further raised 5-fold after ADMA infusion (229.65 ± 91.30 nmol/L). We assessed tissue distribution of Ac-ADMA in mice and found the highest levels in pancreas, small intestine, liver and kidney. We incubated the lysates of those organs with ADMA for 24 hours and estimated production of Ac-ADMA. Only liver and kidney lysates showed significant increase in Ac-ADMA levels upon addition of ADMA (from 0.03 ± 0.01 nmol/μg protein to 0.18 ± 0.06 nmol/μg protein and from 0.06 ± 0.01 nmol/μg protein to 0.11 ± 0.02 nmol/μg protein).
Conclusions:
We showed that overload of ADMA leads to increase in plasma Ac-ADMA levels. This observation is consistent with the hypothesis that Ac-ADMA is formed from ADMA in vivo. The striking rise in plasma Ac-ADMA concentrations after bilateral nephrectomy suggests that Ac-ADMA is predominantly eliminated via the kidneys. We demonstrated that liver and kidney are the organs, in which acetylation of ADMA takes place. The high levels of Ac-ADMA in pancreas and intestine may be due to accumulation of Ac-ADMA in those organs. In the next step we want to identify the enzyme responsible for acetylation of ADMA and explore the clinical implications of this novel pathway of ADMA metabolism.
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Affiliation(s)
- Roman N Rodionov
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Dmitrii V Burdin
- Dept of Physiology, Saint-Petersburg State Univ, St. Petersburg, Russian Federation
| | | | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Anton V Demyanov
- NA, Institute of Highly Pure Biopreparations, St. Petersburg, Russian Federation
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Stefanie Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke Univ, Magdeburg, Germany
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39
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Burdin DV, Kolobov AA, Demyanov AV, Soshnev AA, Broker CN, Samusik N, Brilloff S, Martens-Lobenhoffer J, Reetz T, Maas R, Bode-Böger SM, Gonzalez F, Weiss N, Rodionov RN. Abstract 551: Deficiency of Hepatic Nuclear Factor 4 Alpha Results in Impaired Metabolism of Endogenous Methylarginines and Beta-aminoisobutiric Acid - A Novel Mechanism of Cardiovascular Complications in Patients With Type 2 Diabetes? Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Alanine-glyoxylate aminotransferase 2 (AGXT2) is the only known enzyme capable of degradation of all three endogenous methylarginines, which serve as markers and potentially mediators of cardiovascular disease. Recent studies also suggest that AGXT2 and its alternative substrate beta-aminoisobutyric acid (BAIB) play important role in lipid metabolism. The predicted core promoter region of mammalian AGXT2 promoter contains a highly conserved putative binding site for hepatic nuclear factor 4 alpha (HNF4A). Patients with severe deficiency in HNF4a develop maturity onset diabetes of young 1. Furthermore, polymorphisms of HNF4A are associated with increased risk of diabetes type 2. The aim of this study was to test the hypothesis that HNF4A is a major regulator of AGXT2 expression and activity.
Methods and results:
We demonstrated direct binding of HNF4A to the Agxt2 promoter region in hepatic cell line Hepa 1-6 using chromatin immunoprecipitation assays. Then we showed that mutations of the predicted HNF4A binding site in the Agxt2 core promoter result in up to 80% decrease in the promoter activity as assessed by luciferase reporter assays (p<0.001). We used siRNA-mediated knockdown of HNF4A to determine whether this factor is required for basal Agxt2 expression in Hepa 1-6 cells. Knockdown of HNF4A led to almost 50% reduction in Agxt2 mRNA levels compared to controls (p<0.01). We took advantage of the previously characterized inducible liver-specific Hnf4a knockout (KO) mice to determine whether HNF4A regulates Agxt2 expression in vivo and showed a 90% (p<0.001) decrease in liver Agxt2 expression and a 85% (p<0.01) decrease in liver AGXT2 activity towards methylarginines in Hnf4a KO mice compared with the wild-type littermates. Finaly, on a functional level, Hnf4a KO mice had significant amounts of BAIB present in plasma, whereas BAIB was not detectable in the plasma of the wild-type littermates.
Conclusions:
In our study we identified HNF4A as the major regulator of Agxt2 gene expression. This finding suggests that diabetic patients with HNF4A deficiency might have a unique mechanism for development of cardiovascular complication via AGXT2-dependent impairment of lipid metabolism and methylarginines-mediated vascular dysfunction.
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Affiliation(s)
- Dmitrii V Burdin
- Dept of Physiology, St. Petersburg State Univ, St. Petersburg, Russian Federation
| | - Alexey A Kolobov
- Biochemistry, St. Petersburg State Univ, St. Petersburg, Russian Federation
| | - Anton V Demyanov
- Immunofarmacology, Institute of Highly Pure Biopreparations, St. Petersburg, Russian Federation
| | - Alexey A Soshnev
- Chromatin Biology and Epigenetics, The Rockefeller Univ, New York, NY
| | - Chad N Broker
- Cntr for Cancer Rsch, National Institutes of Health, Bethesda, MD
| | - Nikolay Samusik
- The Biomedical Cntr, Stanford Univ Sch of Medicine, Stanford, CA
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Theresa Reetz
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Univ Erlangen-Nürnberg, Erlangen, Germany
| | | | - Frank Gonzalez
- Cntr for Cancer Rsch, National Institutes of Health, Bethesda, MD
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
| | - Roman N Rodionov
- Univ Cntr for Vascular Medicine, Technische Universität Dresden, Dresden, Germany
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Rodionov RN, Burdin DV, Todorov V, Brilloff S, Jarzebska N, Martens-Lobenhoffer J, Hofmann A, Morawietz H, Demyanov AV, Maas R, Bode-Böger SM, Hugo CP, Hohenstein B, Weiss N. Abstract 373: Transgenic Overexpression of Alanine-glyoxylate Aminotransferase 2 Lowers Tissue Levels of Asymmetric Dimethylarginine and Improves Endothelial Function in Mouse Aortas. Arterioscler Thromb Vasc Biol 2015. [DOI: 10.1161/atvb.35.suppl_1.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase, which has been proposed to play a direct role in the pathogenesis of cardiovascular disease. There are two enzymatic pathways for degradation of ADMA: hydrolysis to citrulline by dimethylarginine dimethylaminohydrolase (DDAH) and transamination by alanine-glyoxylate aminotransferase 2 (AGXT2) with formation of asymmetric dimethylguanidino valeric acid (ADGV). The first pathway is well characterized, whereas the physiological role of AGXT2 is still poorly understood. The goal of our study was to test the hypothesis that transgenic overexpression of AGXT2 would lead to lowering of systemic levels of ADMA and improved vasomotor function.
Methods and results:
We generated transgenic mice (TG) with ubiquitous overexpression of AGXT2 under control of the chicken beta actin (CAG) promoter. Ubiquitous overexpression of the transgene was confirmed by qPCR and Western Blot. TG animals had normal weight and no observed developmental abnormalities. Biochemical data were generated using HPLC-MS/MS. ADMA plasma levels in AGXT2 TG animals were decreased by 15% (p<0.05), whereas ADGV levels were 6 times higher in TG animals in comparison with wild-types (p<0.001). Lung and heart of TG animals exhibited 2 times lower tissue ADMA content in comparison with controls (p<0.05). Isolated aortic rings were used to estimate endothelium-dependent and -independent relaxation in response to acetylcholine (Ach) and sodium nitroprusside (SNP), respectively. Aortas from AGXT2 TG mice demonstrated an increase in maximal response to ACh (p<0.05). There was a similar relaxation in response to SNP in both groups.
Conclusions:
Our findings show that upregulation of AGXT2 results in lower ADMA levels and improved endothelial-dependent relaxation in vivo. AGXT2 thereby may be a therapeutic target for long-term reduction of systemic ADMA levels and improvement of vascular function in vivo. This is especially important, because all the efforts to develop ADMA-lowering interventions by means of upregulation of DDAH have not been successful so far. Our data suggest that AGXT2 might be a promising drug target for cardiovascular pathologies associated with elevated ADMA levels.
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Affiliation(s)
- Roman N Rodionov
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Dmitrii V Burdin
- Dept of Physiology, Saint-Petersburg State Univ, St. Petersburg, Russian Federation
| | - Vladimir Todorov
- Div of Nephrology, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Silke Brilloff
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | | | - Anja Hofmann
- Div of Vascular Endothelium and Microcirculation, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Div of Vascular Endothelium and Microcirculation, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Anton V Demyanov
- NA, Institute of Highly Pure Biopreparations, St. Petersburg, Russian Federation
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Univ Erlangen-Nürnberg, Erlangen, Germany
| | | | - Christian P Hugo
- Div of Nephrology, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Bernd Hohenstein
- Div of Nephrology, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Norbert Weiss
- Univ Cntr for Vascular Medicine, Dept of Internal Medicine III, Technische Universität Dresden, Dresden, Germany
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Rodionov RN, Martens-Lobenhoffer J, Brilloff S, Hohenstein B, Jarzebska N, Jabs N, Kittel A, Maas R, Weiss N, Bode-Böger SM. Role of alanine:glyoxylate aminotransferase 2 in metabolism of asymmetric dimethylarginine in the settings of asymmetric dimethylarginine overload and bilateral nephrectomy. Nephrol Dial Transplant 2014; 29:2035-42. [PMID: 25002409 DOI: 10.1093/ndt/gfu236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asymmetric and symmetric dimethylarginines (ADMA and SDMA) predict complications and mortality in cardiovascular and renal diseases. Alanine:glyoxylate aminotransferase 2 (AGXT2) can metabolize both ADMA and SDMA; however, this metabolic pathway is still poorly understood. The goal of our study was to test the hypothesis that AGXT2 is compensatory upregulated in the settings of ADMA overload and bilateral nephrectomy. METHODS ADMA was infused for 3 days using osmotic minipumps in mice. Half of the mice underwent bilateral nephrectomy 24 h before the end of the infusion. RESULTS Infusion of ADMA caused a 3- to 4-fold increase in plasma and urine ADMA levels and a 2- to 3-fold increase in plasma and urine levels of the ADMA-specific metabolite of AGXT2 α-keto-δ-(N,N-dimethylguanidino)valeric acid (DMGV). Bilateral nephrectomy led to an ∼4-fold increase of plasma SDMA levels, but did not change plasma ADMA levels. Interestingly, plasma levels of DMGV were elevated 32-fold in the mice, which underwent bilateral nephrectomy. Neither bilateral nephrectomy nor ADMA infusion caused upregulation of AGXT2 expression or activity. CONCLUSIONS Our data demonstrate that short-term elevation of systemic levels of ADMA leads to a dramatic increase of DMGV formation without upregulation of AGXT2 expression or activity, which suggests that AGXT2-mediated pathway of ADMA metabolism is not saturated under normal conditions and may play a major role in the maintenance of ADMA homeostasis in the setting of local or systemic elevation of ADMA levels.
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Affiliation(s)
- Roman N Rodionov
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Silke Brilloff
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernd Hohenstein
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Natalia Jarzebska
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Normund Jabs
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anja Kittel
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Norbert Weiss
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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Neves FMDO, Leite TT, Meneses GC, Araujo De Souza NH, Martins AMC, Parahyba MC, Queiroz REB, Liborio A, Liu Y, Li Y, Li X, Chen L, Zulkarnaev A, Vatazin A, Nikolaj S, Stadler T, Raddatz A, Hubner W, Poppleton A, Fliser D, Klingele M, Castellano G, Intini A, Stasi A, Divella C, Pontrelli P, Gigante M, Zito A, Pertosa GB, Gesualdo L, Grandaliano G, Powell TC, Donnelly JP, Wang HE, Warnock DG, De Loor J, Hoste E, Herck I, Francois K, Decrop L, Clauwaert C, Bracke S, Vermeiren D, Demeyere K, Meyer E, Mitra P, Rahim MA, Gupta RD, Samdani TS, Rahman SA, Enam SF, Mursalin G, E-Khoda MM, Haque WMM, Iqbal S, Mansur MA, Guglielmetti G, Cena T, Musetti C, Quaglia M, Battista M, Radin E, Airoldi A, Izzo C, Stratta P, Haase-Fielitz A, Albert C, Westphal S, Hoffmann J, Mertens PR, Plass M, Westerman M, Bellomo R, Maisel A, Ronco C, Haase M, Wu PC, Wu VC, Prasad B, Wong B, St.Onge JR, Rungta R, Das P, Ray DS, Gupta S, De Gracia MDC, Osuna A, Quesada A, Manzano F, Montoro S, Jimenez MDM, Wangensteen R, Strunk AK, Schmidt J, Schmidt B, Bode-Boger S, Martens-Lobenhoffer J, Welte T, Kielstein JT, Wang AY, Bellomo R, Cass A, Myburgh J, Finfer S, Gatta D, Chadban S, Jardine M, Lo S, Barzi F, Gallagher M, Marn-Pernat A, Benedik M, Bren A, Buturovic-Ponikvar J, Gubensek J, Knap B, Premru V, Ponikvar R, Koba L, Teixeira M, Macedo E, Altunoren O, Balli M, Tasolar H, Eren N, Arpaci A, Caglayan CE, Yavuz YC, Sahin M, Gliga ML, Gliga PM, Frigy A, Bandea A, Magdas AM, Dogaru G, Mergulhao C, Pinheiro H, Vidal E, Sette L, Amorim G, Fernandes G, Valente L, Hornum M, Penninga L, Rasmussen A, Plagborg UB, Oturai P, Feldt-Rasmussen B, Hillingso JG, Klimenko A, Villevalde S, Kobalava Z, Arias Cabrales C, Rodriguez E, Bermejo S, Sierra A, Pascual J, Huang TM, Wu VC, Oh WC, Rigby M, Mafrici B, Sharman A, Harvey D, Welham S, Mahajan R, Gardner D, Devonald M, Wu VC, Lin MC, Wu PC, Wu CH, Nagaraja P, Clark A, Brisk R, Jennings V, Jones H, Hashmi M, Parker C, Mikhail A, Schraut J, Keller F, Mertens T, Duprel JB, Quercia AD, Cantaluppi V, Dellepiane S, Pacitti A, Biancone L, Chang KY, Park HS, Kim HW, Choi BS, Park CW, Yang CW, Jin DC, Quercia AD, Cantaluppi V, Dellepiane S, Medica D, Besso L, Gai M, Leonardi G, Guarena C, Biancone L, Obrencevic K, Jovanovic D, Petrovic M, Ignjatovic L, Tadic J, Mijuskovic M, Maksic D, Vavic N, Pilcevic D, Mistry HD, Bramham K, Seed PT, Lynham S, Ward MA, Poston L, Chappell LC. CLINICAL ACUTE KIDNEY INJURY 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Strunk AK, Schmidt JJ, Baroke E, Bode-Böger SM, Martens-Lobenhoffer J, Welte T, Kielstein JT. Single- and multiple-dose pharmacokinetics and total removal of colistin in a patient with acute kidney injury undergoing extended daily dialysis. J Antimicrob Chemother 2014; 69:2008-10. [PMID: 24651826 DOI: 10.1093/jac/dku075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Ann-Kathrin Strunk
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Julius J Schmidt
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Eva Baroke
- Department of Pulmonary Medicine, Medical School Hannover, Hannover, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Jens Martens-Lobenhoffer
- Institute of Clinical Pharmacology, Otto von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Tobias Welte
- Department of Pulmonary Medicine, Medical School Hannover, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
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Martens-Lobenhoffer J, Rodionov RN, Bode-Böger SM. Determination of asymmetric Nα-acetyldimethylarginine in humans: a phase II metabolite of asymmetric dimethylarginine. Anal Biochem 2014; 452:25-30. [PMID: 24560726 DOI: 10.1016/j.ab.2014.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/28/2014] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
Abstract
Asymmetric dimethylarginine (ADMA) is produced by protein methylation, a common mechanism of posttranslational protein modification. Elevated levels of ADMA lead to impaired endothelial nitric oxide production and subsequently to a range of cardiovascular and other diseases related to decreased nitric oxide production. Knowledge of the elimination pathways of ADMA and the possibility of influencing them is therefore of major clinical interest. One of these pathways is the N-acetylation and subsequent renal elimination of ADMA in the form of asymmetric Nα-acetyldimethylarginine (Ac-ADMA). In this work, we describe the first method to quantitatively determine Ac-ADMA in human plasma and urine. Ac-ADMA was separated by HPLC on a porous graphitic carbon column and selectively analyzed by tandem mass spectrometry. Ac-ADMA and the internal standard D7-Ac-ADMA were synthesized in-house. Precision and accuracy of the method were better than 5% in plasma and urine quality control samples. First results obtained with this method in samples of healthy volunteers showed plasma levels of 0.643±0.454 nmol/L and urine levels of 152.7±76.7 nmol/L or 13.0±8.9 nmol/mmol creatinine. The method is a suitable tool for investigating this currently mostly neglected ADMA elimination pathway.
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Affiliation(s)
| | - Roman N Rodionov
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, 39120 Magdeburg, Germany
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Martens-Lobenhoffer J, Bode-Böger SM. Mass spectrometric quantification of L-arginine and its pathway related substances in biofluids: the road to maturity. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 964:89-102. [PMID: 24210895 DOI: 10.1016/j.jchromb.2013.10.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/17/2013] [Accepted: 10/19/2013] [Indexed: 11/18/2022]
Abstract
The amino acid L-arginine together with its metabolites and related substances is in the center of many biologically important pathways, especially the urea cycle and the nitric oxide (NO) synthesis. Therefore, the concentrations of these substances in various biological fluids are of great interest as predictive markers for health and disease. Yet, they provide major analytical difficulties as they are very polar in nature and therefore not easily to be separated on standard reversed phase HPLC stationary phases. Furthermore, as endogenous substances, no analyte-free matrix is available, a fact that results in complicated calibration procedures. This review evaluates the analytical literature for the determination of L-arginine, symmetric dimethylarginine, asymmetric dimethylarginine, monomethylarginine, L-citrulline, L-ornithine, L-homoarginine, agmatine and dimethylguanidinovaleric acid in biological fluids. Papers are discussed, which were published since 2007 and describe methods applying capillary electrophoresis (CE), gas chromatography (GC), reversed phase HPLC or polar phase HPLC, coupled to mass spectrometric quantification. Nowadays, many carefully developed and validated methods for L-arginine and its related substances are available to the scientific community. The use of stable isotope labeled internal standards enables high precision and accuracy in mass spectrometry-based quantitative analysis.
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Affiliation(s)
| | - Stefanie M Bode-Böger
- Institute of Clinical Pharmacology, Otto-von-Guericke University, Magdeburg, Germany
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Tutarel O, Röntgen P, Bode-Böger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical Dimethylarginine Is a Better Biomarker for Systemic Ventricular Dysfunction in Adults after Atrial Repair for Transposition of the Great Arteries Than NT-proBNP. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tutarel O, Röntgen P, Bode-Böger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical dimethylarginine is superior to NT-proBNP for detecting systemic ventricular dysfunction in adults after atrial repair for transposition of the great arteries. Int J Cardiol 2013; 168:4415-6. [DOI: 10.1016/j.ijcard.2013.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/04/2013] [Indexed: 11/16/2022]
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Martens-Lobenhoffer J, Surdacki A, Bode-Böger SM. Fast and Precise Quantification of l-Homoarginine in Human Plasma by HILIC-Isotope Dilution-MS–MS. Chromatographia 2013. [DOI: 10.1007/s10337-013-2561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tutarel O, Roentgen P, Bode-Boeger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical dimethylarginine is superior to NT-proBNP for detecting systemic ventricular dysfunction in adults after atrial repair for transposition of the great arteries. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Worthmann H, Martens-Lobenhoffer J, Joumaah M, Li N, Lichtinghagen R, Hecker H, Kielstein JT, Ehrenreich H, Bode-Böger SM, Weissenborn K. Asymmetric dimethylarginine in response to recombinant tissue-type plasminogen activator and erythropoietin in acute stroke. Stroke 2013; 44:2128-33. [PMID: 23788583 DOI: 10.1161/strokeaha.113.001145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the German Multicenter Erythropoietin (EPO) Stroke Trial, patients not receiving thrombolysis most likely benefited from EPO on clinical recovery, whereas a combination of rtPA and EPO was associated with increased mortality. We investigated whether the combination of rtPA and EPO increased release of the endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA), and thereby potentially deteriorated ischemic stroke outcome, as suggested from experimental data. METHODS ADMA was determined in serum samples from 90 patients of the German Multicenter EPO Stroke Trial taken at days 1 (within 6 hours after symptom onset), 2, 3, 4, and 7 after stroke using high-performance liquid chromatography-tandem mass spectrometry. ADMA was analyzed for the different treatment groups (EPO, n=25; placebo, n=30; rtPA+placebo, n=18; EPO+rtPA, n=17). Clinical outcome was expressed as difference between National Institutes of Health Stroke Scale at baseline and 90 days. RESULTS ADMA levels significantly increased during the observation time in EPO, EPO+rtPA, and placebo groups (P<0.05). A treatment effect on ADMA levels was revealed by repeated measures ANOVA only in the rtPA+placebo group (P=0.027). Here, ADMA levels were decreased compared with the placebo group (P<0.05). Both the EPO and the rtPA+placebo groups in the Hannover subgroup of the EPO trial had better outcome than the placebo group (P<0.05). CONCLUSIONS Our data underscore the potential benefit of EPO in ischemic stroke. The hypothesis from experimental data, that EPO treatment increases ADMA in stroke patients, was disproved. Further studies are needed to clarify whether decreased ADMA might contribute to therapeutic rtPA effects.
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Affiliation(s)
- Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
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