Arginine/Asymmetric Dimethylarginine Ratio in Colorectal Surgery

Neli Ragina, Gabrielle Davis, Michael Doorly, Kyle Cologne, Anthony J. Senagore


Background: Asymmetric dimethylarginine (ADMA) is a naturally occurring amino acid that inhibits the effects of nitric oxide synthetases, producing considerable effects on the vascular system. Recent studies have suggested that increased ADMA is a major contributor to endothelial dysfunction, resulting in significant effects on cardiovascular and renal function.

Methods: The study sample consisted of five male and 11 female patients scheduled for elective laparoscopic colorectal surgery; patients were between 41 and 77 years of age. Venous whole blood (8 - 10 mL) was collected from patients prior to colorectal surgery, as well as on postoperative day 1 and 2. Arginine, citrulline, ADMA, and symmetric dimethylarginine levels were measured in collected blood using liquid chromatography coupled to mass spectrometry.

Results: Data from the amino-acid blood analysis demonstrated that the levels of L-citrulline and L-arginine decreased on postoperative days 1, coinciding with an increase of ADMA levels. The overall result of these changes was a decrease in the arginine to ADMA ratio by 21% from the preoperative period to postoperative day 2 (P = 0.02).

Conclusions: The data collected through this study demonstrate a significant increase in systemic ADMA levels following major laparoscopic colorectal surgery.

J Clin Med Res. 2017;9(7):555-559


ADMA; Citrulline; Nitric oxide; Surgery

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