A significant increase in the arginine/ADMA ratio after TIPS placement was shown. Moreover, TIPS placement enhanced renal function and thereby decreased systemic levels of symmetric dimethylarginine (SDMA). In patients with renal dysfunction before TIPS placement, both 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.
A research article to be published on December 21, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Paul A.M. van Leeuwen from VU University Medical Center of Amsterdam analyzed the change of dimethylarginine plasma levels in cirrhotic patients receiving TIPS.
It showed an increase of the arginine/ADMA ratio after TIPS placement suggesting an increase in intracellular NO bioavailability which could have a positive effect on the microcirculation of important organs. In addition, this study suggests that TIPS placement does not alter dimethylarginine dimethylaminohydrolase (DDAH) activity and confirms the major role of the liver as ADMA clearing organ.
TIPS placement is associated with an increased arginine/ADMA ratio suggesting an increased NO bioavailability which could have a positive effect on the microcirculation of important organs.
In this study, the levels of ADMA, SDMA and arginine in caval/portal and hepatic vein as well as the NOx plasma levels in patients with cirrhosis were analyzed. Most of patients enrolled in this study suffered from alcohol-induced liver disease. The key finding of the manuscript is that arginine levels increase after TIPS-placement. The study is interesting and well performed.