H Pécs, Hungary. Patients and Methods: Forty-seven hypertensive patients who underwent transcutaneous CO2 therapy were enrolled.
Thirty healthy individuals were recruited for the control group. Blood samples were taken one hour before, as well as one hour, 24 hours and 3 weeks after the first CO2 treatment. Controls did not undergo CO2 treatment.
Semmelweis Egyetem, II.
ACE inhibition seems to enhance the effect of CO2 treatment. CO2 passes freely through membranes and has a well-known vasodilation effect. Both in vitro and in vivo studies have demonstrated a rightward shift of the oxygen-hemoglobin O2-Hb dissociation curve after administration of CO2. These effects have been confirmed by Minamiyama and Yamamoto by using intra-vital microscopy video images to demonstrate subcutaneus vasodilation after CO2 administration 3.
In addition, CO2 has been shown to increase blood flow rate in the observed subcutaneus vessels 3.
Taking advantage of its easy use, low cost and high efficiency, CO2 treatment is used to cure several diseases notably, peripheral arterial and venous disorders e. The pathophysiological link between these conditions is the presence of excessive oxidative stress.
Investigating the relation between oxidative stress and CO2, Veselá and Wilhelm found CO2 to play a protective role in scavenging free radicals and suppressing oxidative metabolism 6. Increased plasma ADMA concentrations were shown in patients with classic cardiovascular risk factors e.
Its outstanding predictive value in cardiovascular risk assessment, already demonstrated by several authors, has been confirmed by a recent systematic review involving nearly 20, individuals. Willeit et al. Furthermore, strong correlations were found between ADMA levels and intima-media thickness and ADMA levels and aortic augmentation index, which are early markers of endothelial dysfunction 11 It also inhibits NO formation and induces vascular free radical production leading to increased oxidative stress Accordingly, ADMA is a useful tool for studying the NO system especially in conditions with inflammation and oxidative stress ADMA is produced intracellularly, as a result of methylated protein degradation, and metabolized mainly by dimethylarginine dimethylaminohydrolase enzyme DDAH.
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Expression and function of DDAH is impaired by several conditions, e. Furthermore, loss of efficiency of DDAH is directly proportional to the severity of oxidative stress In short, ADMA is considered as a marker and mediator of oxidative stress and an indicator of vascular well-being.
Patients and Methods Study design. Patients who had previously received CO2 therapy were excluded.
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Moreover, patients who had suffered from myocardial infarction, stroke or undergone open surgery less than a year before the study were also excluded. Additionally, individuals diagnosed with beta blockers and diabetes mechanism or kidney injury were also excluded. To monitor the changes of plasma ADMA concentrations, blood samples were obtained one hour before and 1 hour, 24 hours and 3 weeks after the first CO2 treatment, respectively.
The patients received three transcutaneous CO2 treatments per week for 3 weeks. CO2 gas was administered for 35 minutes in a plastic bag sealed at mid-thoracic level, as previously described by Fabry et al.
Clinical data medical history, age, weight, height, drugs, ejection fraction, beta blockers and diabetes mechanism data, etc. Healthy individuals were recruited for the control group. Only one sample was obtained from controls. Informed written consent was obtained from every patient. Sampling and measurement of ADMA.
After centrifugation 1, × g, 10 min plasma was collected and stored at —70˚C until analysis. The measuring range of the assay was 0. Statistical analysis.
Patients and Methods
Differences during the follow-up were investigated by paired-sample t-test. All p-values less than 0. Results We enrolled 47 patients and 30 controls.
Clinical characteristics of the subjects are shown in Table I. Baseline plasma ADMA concentrations were significantly higher in the patients compared to the controls 0.
Patients suffering from diabetes mellitus had significantly higher baseline plasma ADMA concentrations compared to non-diabetic patients 0. Twenty-four hours after the treatment, ADMA levels increased approximately to the baseline.
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Comparing ADMA concentrations measured 1 and 24 hours after the first CO2 treatment, a modest but statistically not significant increase was observed.