Plasma adrenomedullin in cerebrovascular disease: a possible indicator of endothelial injury.
BACKGROUND
Cultured vascular endothelial and smooth muscle cells actively produce adrenomedullin, a novel vasodilator peptide discovered in human pheochromocytoma tissue. This present study was designed to determine whether the plasma level of adrenomedullin is a useful indicator for estimating the degree of endothelial injury in patients with atherosclerotic disease.


METHODS
We used a radioimmunoassay to measure plasma adrenomedullin concentrations in 51 patients with chronic cerebrovascular disease (34 infarctions and 17 haemorrhages) and in 10 subjects without symptomatic cerebrovascular disease. We also measured the plasma concentrations of thrombomodulin and endothelin as markers of endothelial injury. The patients were divided into three groups (A, B, and C) on the basis of the number of risk factors for atherosclerosis: hypertension, hyperlipidemia, smoking, low HDL-cholesterol, diabetes mellitus, and hyperuricaemia. Group A (68.7+/-2.7 years) consisted of patients with 0 or 1 risk factors; B (68.3+/-4.2 years) those with 2 risk factors; and C (69.2+/-3.6 years) those with 3 or more risk factors.


RESULTS
The plasma concentration of adrenomedullin in these patients showed a significant positive correlation with age (r=0.33, p<0.05), as well as with the plasma concentrations of thrombomodulin (r=0.54, p<0.001) and endothelin (r=0.53, p<0.001). Moreover, the plasma concentrations of adrenomedullin and thrombomodulin (p<0.005 and p<0.02, respectively) tended to be higher in Group B and to be significantly higher in Group C as compared to Group A. Plasma adrenomedullin concentrations did not, however, significantly differ between the infarction and haemorrhage patients.


CONCLUSIONS
These findings suggest that the plasma adrenomedullin concentrations reflect the degree of endothelial injury in patients with atherosclerotic disease.
Kuwasako
K
K
First Department of Internal Medicine, Miyazaki Medical College, Kiyotake, Japan.
Kida
O
O
Kitamura
K
K
Kato
J
J
Eto
T
T
D053607:Adrenomedullin; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D016232:Endothelins / Q000097:blood; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood; D010455:Peptides / Q000097:blood*; D012307:Risk Factors; D018180:Thrombomodulin / Q000097:blood; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000097:blood*
D015415:Biomarkers; D016232:Endothelins; D009419:Nerve Tissue Proteins; D010455:Peptides; D018180:Thrombomodulin; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor; D002784:Cholesterol