Procedure-related pulmonary hypertension in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection—Role of ethanol, hemolysis, asymmetric dimethylarginine, and the nitric oxide system

Abstract

Procedure-related pulmonary hypertension in patients undergoing PEI is multifactorial. Plasma concentrations of the NO precursor l-arginine are reduced by arginase released from lysed erythrocytes, a condition further exacerbated by the increased concentrations of symmetric dimethylarginine, which may compete with the cellular uptake of l-arginine. The result would be reduced synthesis of NO, the concentration of which would be further decreased extracellularly through free hemoglobin. Predictably, the result would be severe endothelial dysfunction and pulmonary hypertension in patients undergoing PEI. These mechanisms might also be relevant in other states of (sudden) hemolysis.

Unilateral nephrectomy causes an abrupt increase in inflammatory mediators and a simultaneous decrease in plasma ADMA: a study in living kidney donors

“…In line with that, Zoccali et al (35) found that after resolution of an acute inflammatory state secondary to infectious processes, L-arginine increased significantly by ϳ15%. Part of this can also be explained by the liberation of arginase, as has been described for other invasive procedures (17).…”

Dimethylarginines ADMA and SDMA: The Real Water-Soluble Small Toxins?

“…However, it also is possible that redistribution during and after HD, 22 ADMA increase by hemolysis, 23 and the effect of acute inflammation on ADMA levels 24 might influence the acute effect of dialysis on ADMA levels.…”

Physiological role of plasma and its components and the clinical implications of different methods of apheresis: A narrative review

“…Physiologically, increased viscosity induces vasodilation via NO release from endothelial cells 23 . However, in clinical settings associated with endothelial dysfunction, or acute hemolysis, the release of NO due to shear stress is reduced and increased viscosity may lead to increased resistance, as in sickle cell anemia which may lead to a painful vaso‐occlusive crisis 23,31,32 . Reduction of plasma viscosity associated with improved microcirculation was first observed in the treatment of familial hypercholesterolemia 33 .…”