Serum Netrin-1 and Asymmetric Dimethylarginine as Biomarkers of Acute and Chronic Carbon Monoxide Poisoning

Document Type : Original Article


1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Benha University, Egypt

2 Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Benha University, Egypt


Diagnosis of carbon monoxide (CO) poisoning is done traditionally by detecting carboxyhemoglobin (COHb) level. However, the severity of clinical manifestations is unrelated to the absolute levels of COHb. Netrin-1 (Net-1) is a protein with anti-inflammatory and anti-apoptotic properties while asymmetric dimethylarginine (ADMA) is an oxidative stress indicator. This study aimed at assessing and comparing between Net-1, ADMA and COHb as biomarkers in CO poisoning. This cross-sectional clinical study was carried out on 30 acutely CO poisoned adults admitted to Benha Poisoning Control Unit, Benha University Hospitals; 30 chronic CO exposed workers at four different car service centres, plus 30 healthy controls. Results showed a positive correlation between serum levels of Net-1 and ADMA and the severity of acute CO poisoning both on admission, and after oxygen therapy. There was a positive correlation between COHb level and both serum levels of Net-1 and ADMA in chronic cases. In conclusion: COHb level can only support the initial diagnosis of acute CO poisoning. Both ADMA and Net-1 are better biomarkers in assessing the severity of acute CO poisoning, where ADMA is better than Net-1. In diagnosis of chronic CO poisoning, both ADMA and Net-1 are as dependable as COHb.