title: Asymmetric dimethylarginine causes hypertension and cardiac dysfunction in humans and is actively metabolized by dimethylarginine dimethylaminohydrolase.
abstract: OBJECTIVE
  Plasma levels of an endogenous nitric oxide (NO) synthase inhibitor, asymmetric dimethylarginine (ADMA), are elevated in chronic renal failure, hypertension, and chronic heart failure. In patients with renal failure, plasma ADMA levels are an independent correlate of left ventricular ejection fraction. However, the cardiovascular effects of a systemic increase in ADMA in humans are not known.
  
  
  RESULTS
  In a randomized, double-blind, placebo-controlled study in 12 healthy male volunteers, we compared the effects of intravenous low-dose ADMA and placebo on heart rate, blood pressure, cardiac output, and systemic vascular resistance at rest and during exercise. We also tested the hypothesis that ADMA is metabolized in humans in vivo by dimethylarginine dimethylaminohydrolase (DDAH) enzymes. Low-dose ADMA reduced heart rate by 9.2+/-1.4% from 58.9+/-2.0 bpm (P<0.001) and cardiac output by 14.8+/-1.2% from 4.4+/-0.3 L/min (P<0.001). ADMA also increased mean blood pressure by 6.0+/-1.2% from 88.6+/-3.4 mm Hg (P<0.005) and SVR by 23.7+/-2.1% from 1639.0+/-91.6 dyne. s. cm-5 (P<0.001). Handgrip exercise increased cardiac output in control subjects by 96.8+/-23.3%, but in subjects given ADMA, cardiac output increased by only 35.3+/-10.6% (P<0.05). DDAHs metabolize ADMA to citrulline and dimethylamine. Urinary dimethylamine to creatinine ratios significantly increased from 1.26+/-0.32 to 2.73+/-0.59 after ADMA injection (P<0.01). We estimate that humans generate approximately 300 micromol of ADMA per day, of which approximately 250 micromol is metabolized by DDAHs.
  
  
  CONCLUSIONS
  This study defines the cardiovascular effects of a systemic increase in ADMA in humans. These are similar to changes seen in diseases associated with ADMA accumulation. Finally, our data also indicate that ADMA is metabolized by DDAHs extensively in humans in vivo.
authors.affiliation: Centre for Clinical Pharmacology and Therapeutics, British Heart Foundation Laboratories, University College London, UK.
authors.forename: Vinod
authors.initials: V
authors.lastname: Achan
authors.forename: Michael
authors.initials: M
authors.lastname: Broadhead
authors.forename: Mohammed
authors.initials: M
authors.lastname: Malaki
authors.forename: Guy
authors.initials: G
authors.lastname: Whitley
authors.forename: James
authors.initials: J
authors.lastname: Leiper
authors.forename: Raymond
authors.initials: R
authors.lastname: MacAllister
authors.forename: Patrick
authors.initials: P
authors.lastname: Vallance
mesh_terms: D000328:Adult; D000581:Amidohydrolases / Q000378:metabolism*; D001120:Arginine / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000378:metabolism*; D007275:Injections, Intravenous; D008297:Male; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: C018524:N,N-dimethylarginine; D001120:Arginine; D000581:Amidohydrolases; C059999:dimethylargininase