The role of asymmetric dimethyl arginine and nitric oxide in patients with chronic pancreatitis

Purpose: Endothelial dysfunction (ED) is a well-known pathological feature in the development of many diseases. The dysfunctional condition includes reduction in nitric oxide (NO) bioavailability. Chronic pancreatitis (CP) is a progressive and irreversible destruction of pancreas, and may lead to varying degrees of endocrine and exocrine dysfunction. NO released from endothelial cells is thought to be involved in the pathogenesis of CP; however, there is no study investigating the relationship between CP and ED. The purpose of this study was to investigate the levels of NO and methylarginines, including AMDMA, in patients with CP. Patients and Methods: A total of 44 patients with CP and 36 healthy volunteers were included in this study. Serum levels of ADMA, SDMA, NMMA, arginine, and citrulline were analyzed by LC-MS/MS and nitric oxide levels were analyzed using ELISA. Results: Serum SDMA levels were higher in patients with CP (0.55±0.02 μmol/L vs.0.47±0.02 μmol/L, p= 0.041), whereas NMMA levels were lower in patients with CP (0.052±0.003 μmol/L vs 0.068±0.003 μmol/L,p<0.001). There was a correlation between the C-reactive protein and SDMA levels (r= 0.443, p= 0.004). Conclusion: Elevated SDMA and reduced NMMA levels may be responsible for the increased pancreatic damage. Circulating SDMA may be a better marker of stage pancreatic detriment with respect to ADMA or NO in subjects with CP. Further research for possible associations among serum SDMA, ADMA, NO and other measures of pancreatitis may be beneficial in order to better understand the pathophysiology of CP and establish more effective treatment options.