Siroen MP, Wiest R, Richir MC, Teerlink T, Rauwerda JA, Drescher FT, Zorger N, Leeuwen PAV. Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients. World J Gastroenterol 2008; 14(47): 7214-7219 [PMID: 19084936 DOI: 10.3748/wjg.14.7214]
Corresponding Author of This Article
Paul AM van Leeuwen, MD, PhD, VU University Medical Center, Department of Surgery, PO Box 7057, Amsterdam 1007 MB, The Netherlands. pam.vleeuwen@vumc.nl
Article-Type of This Article
Rapid Communication
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 21, 2008; 14(47): 7214-7219 Published online Dec 21, 2008. doi: 10.3748/wjg.14.7214
Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients
Michiel PC Siroen, Reiner Wiest, Milan C Richir, Tom Teerlink, Jan A Rauwerda, Friedrich T Drescher, Niels Zorger, Paul AM van Leeuwen
Michiel PC Siroen, Milan C Richir, Jan A Rauwerda, Paul AM van Leeuwen, Department of Surgery, VU University Medical Center, Amsterdam 1007 MB, The Netherlands
Reiner Wiest, Friedrich T Drescher, Department of Internal Medicine, University Hospital, Regensburg D-93042, Germany
Tom Teerlink, Department of Clinical Chemistry, VU University Medical Center, Amsterdam 1007 MB, The Netherlands
Niels Zorger, Department of Radiology, University Hospital, Regensburg D-93042, Germany
Author contributions: Siroen MPC and Wiest R equally contributed in this work. Siroen MPC, Wiest R, and van Leeuwen PAM designed the research; Wiest R, Drescher FT, and Zorger N performed the research; Siroen MPC, Richir MC, and Teerlink T analysed data and determined amino acids; Siroen MPC, Wiest R, Richir MC, Teerlink T, Rauwerda JA, and van Leeuwen PAM wrote the manuscript.
Correspondence to: Paul AM van Leeuwen, MD, PhD, VU University Medical Center, Department of Surgery, PO Box 7057, Amsterdam 1007 MB, The Netherlands. pam.vleeuwen@vumc.nl
Telephone: +31-20-4443601 Fax: +31-20-4443620
Received: April 18, 2008 Revised: June 16, 2008 Accepted: June 22, 2008 Published online: December 21, 2008
Abstract
AIM: To analyze the change of dimethylarginine plasma levels in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt (TIPS).
METHODS: To determine arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and nitric oxide (NO) plasma levels, blood samples were collected from the superior cava, hepatic, and portal vein just before, directly after, and 3 mo after TIPS-placement.
RESULTS: A significant increase in the arginine/ADMA ratio after TIPS placement was shown. Moreover, TIPS placement enhanced renal function and thereby decreased systemic SDMA levels. In patients with renal dysfunction before TIPS placement, both the arginine/ADMA ratio and creatinine clearance rate increased significantly, while this was not the case in patients with normal renal function before TIPS placement. Hepatic function did not change significantly after TIPS placement and no significant decline in ADMA plasma levels was measured.
CONCLUSION: The increase of the arginine/ADMA ratio after TIPS placement suggests an increase in intracellular NO bioavailability. In addition, this study suggests that TIPS placement does not alter dimethylarginine dimethylaminohydrolase (DDAH) activity and confirms the major role of the liver as an ADMA clearing organ.
