The association between progression of atherosclerosis and the methylated amino acids asymmetric dimethylarginine and trimethyllysine

PLoS One. 2013 May 29;8(5):e64774. doi: 10.1371/journal.pone.0064774. Print 2013.

Abstract

Objective: We previously showed that treatment with folic acid (FA)/B12 was associated with more rapid progression of coronary artery disease (CAD). High doses of FA may induce methylation by increasing the availability of S-adenosyl-methionine (SAM). Asymmetric dimethylarginine (ADMA) and trimethyllysine (TML) are both produced through proteolytic release following post-translational SAM-dependent methylation of precursor amino acid. ADMA has previously been associated with CAD. We investigated if plasma levels of ADMA and TML were associated with progression of CAD as measured by quantitative coronary angiography (QCA).

Methods: 183 patients from the Western Norway B Vitamin Intervention Trial (WENBIT) undergoing percutaneous coronary intervention (PCI) were randomized to daily treatment with 0.8 mg FA/0.4 mg B12 with and without 40 mg B6, B6 alone or placebo. Coronary angiograms and plasma samples of ADMA and TML were obtained at both baseline and follow-up (median 10.5 months). The primary end-point was progression of CAD as measured by diameter stenosis (DS) evaluated by linear quantile mixed models.

Results: A total of 309 coronary lesions not treated with PCI were identified. At follow-up median (95% CI) DS increased by 18.35 (5.22-31.49) percentage points per µmol/L ADMA increase (p-value 0.006) and 2.47 (0.37-4.58) percentage points per µmol/L TML increase (p-value 0.021) in multivariate modeling. Treatment with FA/B12 (±B6) was not associated with ADMA or TML levels.

Conclusion: In patients with established CAD, baseline ADMA and TML was associated with angiographic progression of CAD. However, neither ADMA nor TML levels were altered by treatment with FA/B12 (±B6).

Trial registration: Controlled-Trials.com NCT00354081.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine / analogs & derivatives
  • Adenosine / metabolism
  • Aged
  • Arginine / analogs & derivatives*
  • Arginine / blood
  • Arginine / metabolism
  • Coronary Angiography
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / drug therapy*
  • Coronary Artery Disease / metabolism
  • Disease Progression
  • Ethionine / analogs & derivatives
  • Ethionine / metabolism
  • Female
  • Folic Acid / therapeutic use
  • Follow-Up Studies
  • Humans
  • Lysine / analogs & derivatives*
  • Lysine / blood
  • Lysine / metabolism
  • Male
  • Methylation
  • Middle Aged
  • Treatment Outcome
  • Vitamin B 12 / therapeutic use
  • Vitamin B 6 / therapeutic use
  • Vitamin B Complex / therapeutic use*

Substances

  • Vitamin B Complex
  • trimethyllysine
  • S-adenosylethionine
  • N,N-dimethylarginine
  • Vitamin B 6
  • Folic Acid
  • Arginine
  • Lysine
  • Adenosine
  • Vitamin B 12
  • Ethionine

Associated data

  • ClinicalTrials.gov/NCT00354081

Grants and funding

The study was funded by the Norwegian Foundation for Health and Rehabilitation, the Norwegian Heart and Lung Patient Organization, the Norwegian Ministry of Health and Care Services, the Western Norway Regional Health Authority, the Department of Heart Disease at Haukeland University Hospital, the Foundation to Promote Research Into Functional Vitamin B12 Deficiency, Bergen, Norway, and Alpharma Inc, Copenhagen, Denmark. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.