Published Online
on September 6, 2005

A more recent version of this article appeared on September 13, 2005

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Submitted on September 8, 2004
Revised on May 28, 2005
Accepted on June 6, 2005

Dimethylarginine Dimethylaminohydrolase Overexpression Suppresses Graft Coronary Artery Disease

Masashi Tanaka MD, Karsten Sydow MD, Feny Gunawan BA, Johannes Jacobi MD, Phil S. Tsao PhD, Robert C. Robbins MD, and John P. Cooke MD, PhD^*

From the Department of Cardiothoracic Surgery (M.T., F.G., R.C.R.) and the Department of Cardiovascular Medicine (K.S., J.J., P.S.T., J.P.C.), Stanford University Medical Center, Stanford, Calif.

^* To whom correspondence should be addressed. E-mail: john.cooke{at}stanford.edu.

Background--Graft coronary artery disease (GCAD) is the leading cause of death after the first year of heart transplantation. The reduced bioavailability of endothelium-derived nitric oxide (NO) may play a role in endothelial vasodilator dysfunction and the structural changes that are characteristic of GCAD. A potential contributor to endothelial pathobiology is asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor. We hypothesized that lowering ADMA concentrations by dimethylarginine dimethylaminohydrolase (DDAH) overexpression in the recipient might suppress GCAD and long-term immune responses in murine cardiac allografts.

Methods and Results--In one series, donor hearts of C-H-2^bm12KhEg (H-2^bm12) wild-type (WT) mice were heterotopically transplanted into C57BL/6 (H-2^b) transgenic mice overexpressing human DDAH-I or WT littermates and procured after 4 hours of reperfusion (WT and DDAH-I recipients, n=6 each). In a second series, donor hearts were transplanted into DDAH-I-transgenic or WT mice and procured 30 days after transplantation (n=7 each). In DDAH-I recipients, plasma ADMA concentrations were lower, in association with reduced myocardial generation of superoxide anion (WT versus DDAH-I, 465.7±79.8 versus 173.4±32.3 µmol · L^-1 · mg^-1 · h^-1; P=0.02), inflammatory cytokines, adhesion molecules, and chemokines. GCAD was markedly reduced in cardiac allografts of DDAH-I-transgenic recipients as assessed by luminal narrowing (WT versus DDAH, 79±2% versus 33±7%; P<0.01), intima-media ratio (WT versus DDAH, 1.1±0.1 versus 0.5±0.1; P<0.01), and the percentage of diseased vessels (WT versus DDAH, 100±0% versus 62±10%; P<0.01).

Conclusions--Overexpression of DDAH-I attenuated oxidative stress, inflammatory cytokines, and GCAD in murine cardiac allografts. The effect of DDAH overexpression may be mediated by its reduction of plasma and tissue ADMA concentrations.

Key words: nitric oxide synthase • coronary disease • reperfusion • arginine • transplantation

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