Increased asymmetric dimethylarginine and endothelin 1 levels in secondary Raynaud's phenomenon: implications for vascular dysfunction and progression of disease.
OBJECTIVE
To compare microvascular and macrovascular functions in a cohort of patients with primary and secondary Raynaud's phenomenon (RP) who were matched for demographic, risk factor, and severity profiles.


METHODS
Forty patients with primary or secondary RP matched for vascular risk factors and severity scores underwent testing of endothelial function and cold pressor responsiveness of the brachial artery. Microvascular perfusion of the digital vasculature was assessed using laser Doppler fluxmetry in response to reactive hyperemia. Plasma was assayed for endothelin 1 (ET-1), asymmetric dimethylarginine (ADMA), intercellular adhesion molecule 1, vascular cell adhesion molecule 1 (VCAM-1), and monocyte chemoattractant protein 1 (MCP-1).


RESULTS
Patients with RP had abnormal vasoconstrictor responses to cold pressor tests (CPT) that were similar in primary and secondary RP. There were no differences in median flow-mediated and nitroglycerin-mediated dilation or CPT of the brachial artery in the 2 populations. Patients with secondary RP were characterized by abnormalities in microvascular responses to reactive hyperemia, with a reduction in area under the curve adjusted for baseline perfusion, but not in time to peak response or peak perfusion ratio. Plasma ET-1, ADMA, VCAM-1, and MCP-1 levels were significantly elevated in secondary RP compared with primary RP. There was a significant negative correlation between ET-1 and ADMA values and measures of microvascular perfusion but not macrovascular endothelial function.


CONCLUSIONS
Secondary RP is characterized by elevations in plasma ET-1 and ADMA levels that may contribute to alterations in cutaneous microvascular function.
Rajagopalan
Sanjay
S
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0273, USA. srajagop@umich.edu
Pfenninger
Dana
D
Kehrer
Christine
C
Chakrabarti
Anjan
A
Somers
Emily
E
Pavlic
Robert
R
Mukherjee
Debabrata
D
Brook
Robert
R
D'Alecy
Louis G
LG
Kaplan
Mariana J
MJ
D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives* / Q000378:metabolism*; D001916:Brachial Artery; D018932:Chemokine CCL2 / Q000097:blood; D003080:Cold Temperature; D018450:Disease Progression; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011928:Raynaud Disease / Q000097:blood* / Q000503:physiopathology*; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood; D014655:Vascular Resistance; D014661:Vasoconstriction
D018932:Chemokine CCL2; D019332:Endothelin-1; D019010:Vascular Cell Adhesion Molecule-1; C018524:N,N-dimethylarginine; D001120:Arginine