The Open Biomarkers Journal

ISSN: 1875-3183 ― Volume 9, 2019

Altered Plasma Global Arginine Bioavailability Ratio in Early-stage Alzheimer’s Disease

José M. Martínez-Martos, María E. Pulido-Navas, María J. Ramírez-Expósito*
Department of Health Sciences, School of Health Sciences, University of Jaén, Jaén, Spain



L-arginine is an amino acid that can be metabolized to form several bioactive molecules including Nitric Oxide (NO). In the Central Nervous System (CNS), NO regulates various and important physiological functions. However, the involvement of L-arginine metabolism –and by extension of NO- in Alzheimer’s disease (AD) pathogenesis, has been suggested.


To determine the Global L-Arginine Bioavailability Ratio (GABR) and NO levels (as the sum of nitrates and nitrites, NOx) in the plasma of early-stage Alzheimer’s Disease (AD) patients in order to analyze if GABR can reflect an altered NO production, to confirm the importance of L-arginine metabolism in the development of the disease, and to evaluate the putative diagnostic/prognostic value of GABR.


GABR index is an indicator of the availability of L-arginine to form NO by nitric oxide synthases. It is calculated as the ratio between the levels of L-arginine and the sum of the levels of L-ornithine and L-citrulline. Plasma amino acids are measured by high-performance liquid chromatography coupled to fluorescence detection. Nitric oxide is measured in plasma as the sum of nitrates and nitrites (NOx).


No changes were found in L-arginine levels, whereas L-citrulline and L-ornithine levels were highly increased in AD patients. We also found that GABR decreased significantly by 47.8% in AD patients, whereas NOx levels increased significantly by 46.9%. Receiver Operator Characteristic (ROC) curve analysis for GABR showed a sensitivity of 78.1 and a specificity of 90.5.


Low plasma GABR levels in AD patients reflect that the L-arginine-NO pathway has turned towards NO in AD, probably being related to the nitroxidative stress involved in neurodegenerative diseases. Furthermore, increased NOx could also be involved in several altered physiological functions. Therefore, GABR is proposed as a putative useful biomarker of the disease.

Keywords: L-Arginine, L-Citrulline, L-Ornithine, Nitric Oxide, Non-Invasive Biomarkers, Receptor Operated Curves.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 8
First Page: 34
Last Page: 41
Publisher Id: TOBIOMJ-8-34
DOI: 10.2174/1875318301808010034

Article History:

Received Date: 20/9/2018
Revision Received Date: 13/11/2018
Acceptance Date: 23/12/2018
Electronic publication date: 31/12/2018
Collection year: 2018

Article Metrics:

CrossRef Citations:

Total Statistics:

Full-Text HTML Views: 763
Abstract HTML Views: 536
PDF Downloads: 194
ePub Downloads: 170
Total Views/Downloads: 1663

Unique Statistics:

Full-Text HTML Views: 396
Abstract HTML Views: 365
PDF Downloads: 119
ePub Downloads: 106
Total Views/Downloads: 986
Geographical View

© 2018 Martínez-Martos et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Health Sciences, School of Health Sciences, University of Jaén, Jaén, Spain; E-mails:,;


"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."

Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."

Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."

Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."

Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."

Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."

Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."

Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."

J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."

Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."

Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."

Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."

Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."

Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."

M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."

Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."

Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."

Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."

Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."

Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."

Jih Ru Hwu
(National Central University, Taiwan)

Browse Contents

Webmaster Contact:
Copyright © 2019 Bentham Open