Accessible Unlicensed Requires Authentication Published by De Gruyter March 12, 2009

Elevation of the glycoxidation product Nε-(carboxymethyl)lysine in patients presenting with acute myocardial infarction

Stefan Kralev, Elke Zimmerer, Martina Brueckmann, Siegfried Lang, Thorsten Kälsch, Anja Rippert, Jihong Lin, Martin Borggrefe, Hans-Peter Hammes and Tim Süselbeck


Background: An important role in the acceleration of vascular disease has been previously suggested for advanced glycation end products. Nε-(carboxymethyl)lysine (CML) is an advanced glycation end product formed on protein by combined non-enzymatic glycation and glycoxidation reactions. CML reacts with the receptor of advanced glycation end products inducing impairment of endothelium dependent relaxation and is a marker of oxidative stress.

Methods: A total of 40 patients with acute myocardial infarction (17 patients with ST-elevation myocardial infarction, 23 patients with non-ST-elevation myocardial infarction) and 40 patients with stable coronary artery disease were included consecutively in this study. During coronary angiography, peripheral venous blood sample was taken for measuring CML.

Results: Serum levels of CML were significantly increased in patients with acute myocardial infarction [17.9±10.7 vs. 6.6±3.1 arbitrary units (AU)/mg protein, p<0.001]. A cut-off value of CML>9.5 AU/mg protein was associated with an odds ratio of acute myocardial infarction of 39.7 [95% confidence interval (CI): 11.1–142, p<0.001], a sensitivity of 0.85 (95% CI: 0.70–0.94) and a specificity of 0.88 (95% CI: 0.73–0.96).

Conclusions: CML levels are significantly elevated in patients presenting with acute myocardial infarction. These results suggest the involvement of endothelial dysfunction (through receptor interaction) and oxidative stress in acute myocardial infarction.

Clin Chem Lab Med 2009;47:446–51.

Corresponding author: Stefan Kralev, MD, I. Department of Medicine, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany Phone: +49-621-3832512, Fax: +49-621-3832012,

Received: 2008-9-30
Accepted: 2009-1-9
Published Online: 2009-03-12
Published in Print: 2009-04-01

©2009 by Walter de Gruyter Berlin New York