Journal
NATURE MEDICINE
Volume 13, Issue 10, Pages 1176-1184Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/nm1637
Keywords
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Funding
- NCRR NIH HHS [M01 RR018390] Funding Source: Medline
- NHLBI NIH HHS [P01 HL077107, P01 HL076491, HL70621] Funding Source: Medline
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Post- translational modification and functional impairment of proteins through carbamylation is thought to promote vascular dysfunction during end- stage renal disease. Cyanate, a reactive species in equilibrium with urea, carbamylates protein lysine residues to form epsilon-carbamyllysine (homocitrulline), altering protein structure and function. We now report the discovery of an alternative and quantitatively dominant mechanism for cyanate formation and protein carbamylation at sites of inflammation and atherosclerotic plaque: myeloperoxidase-catalyzed oxidation of thiocyanate, an anion abundant in blood whose levels are elevated in smokers. We also show that myeloperoxidase-catalyzed lipoprotein carbamylation facilitates multiple pro- atherosclerotic activities, including conversion of low-density lipoprotein into a ligand for macrophage scavenger receptor A1 recognition, cholesterol accumulation and foam-cell formation. In two separate clinical studies ( combined n = 1,000 subjects), plasma levels of protein-bound homocitrulline independently predicted increased risk of coronary artery disease, future myocardial infarction, stroke and death. We propose that protein carbamylation is a mechanism linking inflammation, smoking, uremia and coronary artery disease pathogenesis.
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