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Marqueurs du métabolisme du fer et dérivés de la L-arginine dans la cardiopathie ischémique : mise en évidence, intérêt de leur évaluation et rôle du stress oxydant en phase aiguë d’infarctus du myocarde

Abstract : Myocardial infarction (MI) is mostly caused by complications of atherosclerosis, whose the development would be initiated by a dysfunction of the vascular endothelium, characterized by an inflammatory condition and oxidative stress.In this pathogenesis, iron interacts at different levels and also has a major role in the development of endothelial dysfunction. Hepcidin and erythroferrone (discovered earlier as the myonectin/CTRP 15) participate in a major way in regulating certain stages of iron metabolism.Asymmetric dimethylarginine (ADMA), a marker of endothelial dysfunction is associated with most cardiovascular risk factors. Symmetrical dimethyl-arginine (SDMA), its stereoisomer, has an exclusively renal elimination and is considered as a powerful renal function marker.We aimed to study, in patients with acute MI, the meaning of the "traditional" status iron parameters, two proteins involved in the regulation of iron, hepcidin and myonectin, as well as the two L-arginine derivatives, ADMA and SDMA. In our first prospective study, we observe that, in patients with acute MI, the values of SDMA, and only weakly ADMA, are associated with admission blood glucose, beyond traditional dimethylarginine determinants and may therefore have biological activity beyond renal function.Our second work suggests that patients with heart failure in the acute phase of MI present more frequently anemia and a certain degree of iron deficiency. New iron metabolism regulators biomarkers, hepcidin and myonectin showed a trend toward an increase in the serum levels in these patients characterized by an increase in CRP.Thus, our work suggests the links between these new regulators of iron metabolism in acute MI with functional consequences of cardiovascular diseases, particularly in terms of anemia and heart failure.
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Aurélie Gudjoncik. Marqueurs du métabolisme du fer et dérivés de la L-arginine dans la cardiopathie ischémique : mise en évidence, intérêt de leur évaluation et rôle du stress oxydant en phase aiguë d’infarctus du myocarde. Médecine humaine et pathologie. Université de Bourgogne, 2015. Français. ⟨NNT : 2015DIJOMU04⟩. ⟨tel-01781772⟩

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