Total homocysteine and cardiovascular disease

Fasting total homocysteine (tHcy) concentration and mortality in older Mexican Americans

OBJECTIVES

This study examines the association between tHcy on cardiovascular and noncardiovascular mortality.

DESIGN

Longitudinal study of 1,633 Mexican Americans age>60 years recruited in 1998.

SETTING

Sacramento, California.

MEASUREMENTS

Cox proportional models were used to estimate the effects of tHcy on mortality rate in the total sample and in a subgroup of subjects without a history of cardiovascular disease at baseline.

RESULTS

About half of the cohort was born in Mexico. Among Mexican-born participants, high tHcy (>11.0 micromol/L) was associated with a higher rate of cardiovascular mortality compared to those with low tHcy concentration

CONCLUSIONS

The effect of tHcy on cardiovascular mortality is nearly 40% stronger among the immigrant group. tHcy might be an early marker of subclinical vascular pathology amongst the Mexican-born group, despite their apparently healthy profile at baseline.

Collapse

Key Words

• homocysteine
• cardiovascular mortality
• mexican americans
• nutritional biomarkers
• elderly

Collapse

MESH Headings

• Aged
• Aged, 80 and over
• Biomarkers/blood
• California/epidemiology
• Cardiovascular Diseases/ethnology
• Cardiovascular Diseases/mortality
• Female
• Homocysteine/blood
• Humans
• Longitudinal Studies
• Male
• Mexican Americans
• Mexico/ethnology
• Middle Aged
• Proportional Hazards Models

Collapse

Grants

• 1R24HD047861 NICHD NIH HHS
• P60 DK20572 NIDDK NIH HHS
• R01 DK060753 NIDDK NIH HHS
• AG12975 NIA NIH HHS
• R24 HD047861 NICHD NIH HHS
• DK60753 NIDDK NIH HHS
• R01 DK060753-03 NIDDK NIH HHS
• R03 AG033751 NIA NIH HHS
• R01 AG012975 NIA NIH HHS
• P60 DK020572-30 NIDDK NIH HHS
• P30 DK092926 NIDDK NIH HHS
• R01 AG012975-11 NIA NIH HHS
• P60 DK020572 NIDDK NIH HHS
• RWJ04823 PHS HHS

Collapse

Affiliation(s)

V Colon Lopez Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI, USA.
M N Haan
A E Aiello
D Ghosh

Collapse

Intravenous N-acetylcysteine with saline hydration improves renal function and ameliorates plasma total homocysteine in patients undergoing cardiac angiography

Proinflammatory cytokines and hyperhomocysteinemia are associated with clinically relevant restenosis in coronary artery disease. N-acetylcysteine (NAC) can decrease proinflammatory cytokines and plasma homocystine as well as reduce contrast-induced nephropathy. The aim of this study, therefore, was to compare normal saline hydration with and without intravenous NAC in terms of changes in renal function, proinflammatory cytokines, inflammatory markers, and plasma total homocysteine during coronary angiography. Forty-six patients who underwent coronary angiography and/or stent implantation for unstable angina were enrolled and assigned to NAC or NS treatment groups based on normal saline hydration with or without intravenous NAC, respectively. The NS group had lower serum creatinine (Cre: p = 0.02) and plasma total homocysteine (tHcy; p < 0.001) and increased glomerular filtration rate (GFR; p = 0.003) after angiography. In the NAC group, the serum blood urea nitrogen (BUN; p = 0.001), Cre (p < 0.001), and plasma tHcy (p < 0.001) were lower, and the GFR (P = 0.013) was increased after angiography. There were no statistically significant differences in serum high-sensitivity C reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha), or interleukin-10 (IL-10) before and after angiography in the NS and NAC groups. Intergroup comparison revealed that plasma tHcy level was lower for the NAC-treated patients (p = 0.002), with lower plasma tHcy level before and after treatment in this group (p < 0.001). Normal saline hydration can improve renal function and decrease plasma tHcy after coronary angiography with or without NAC; however, the combination of the two decreases plasma tHcy more than normal saline hydration alone.

Riboswitches that sense S-adenosylhomocysteine and activate genes involved in coenzyme recycling

We have identified a highly conserved RNA motif that occurs upstream of genes involved in S-adenosyl-L-methionine (SAM) recycling in many Gram-positive and Gram-negative species of bacteria. The phylogenetic distribution and the conserved structural features of representatives of this motif are indicative of riboswitch function. Riboswitches are widespread metabolite-sensing gene control elements that are typically found in the 5' untranslated regions (UTRs) of bacterial mRNAs. We experimentally verified that examples of this RNA motif specifically recognize S-adenosylhomocysteine (SAH) in protein-free in vitro assays, and confirmed that these RNAs strongly discriminate against SAM and other closely related analogs. A representative SAH motif was found to activate expression of a downstream gene in vivo when the metabolite is bound. These observations confirm that SAH motif RNAs are distinct ligand-binding aptamers for a riboswitch class that selectively binds SAH and controls genes essential for recycling expended SAM coenzymes.

Homocysteine effects on cellular glutathione peroxidase (GPx-1) activity under in vitro conditions

Hyperhomocysteinemia is associated with a lot of diseases including cardiovascular diseases and neural tube defect, but it has not been clarified exactly which mechanism is responsible for occurence disease. Here, homocysteine (Hcy) and cysteine (Cys), which are thiol containing amino acids, were examined for their effect on glutathione peroxidase (GPx) activity. It was observed that the GPx-1 activity was inhibited under severe hyperhomocysteinemia (50-500 microM Hcy) conditions, especially at low glutathione concentrations but that cysteine increased GPx-1 activity at low glutathione concentrations and inhibition clearly appeared at 500 microM Cys concentration.

In vitro utilization of ferromagnetic nanoparticles in hemodialysis therapy

The in vitro utilization of biocompatible ferromagnetic nanoparticles (BFNs) in hemodialysis (HD), routinely used today for the treatment of end stage renal disease (ESRD), is introduced in this work. The proposed strategy is termed magnetically assisted hemodialysis (MAHD) and it aims to become a more efficient development of conventional HD. The method is based on the production of biocompatible ferromagnetic nanoparticles-targeted binding substances conjugates (BFNs-TBSs Cs) constructed of BFNs and specifically designed TBSs that should have high affinity and binding capacity for target toxic substances (TTSs) which must be removed from the ESRD patient subjected to HD. Antibodies or even specific proteins could serve as the TBS of the desired BFNs-TBSs Cs. The BFNs-TBSs Cs should be administered to the patient timely prior to the MAHD session so as to bind with the desired TTSs during their free circulation in the vascular network. Eventually, the complete BFNs-TBSs-TTSs structure can be selectively removed during the MAHD session by means of an external inhomogeneous magnetic field that is applied either at the dialyzer or at other collection point(s) along the blood circulation line of the dialysis machine. The advantages of MAHD over conventional HD regarding the patient's comfort and overall health status are discussed in detail among practical issues. To examine this proposition we employed Fe(3)O(4) and bovine serum albumin (BSA) as the BFN and the TBS constituents respectively, since they are both highly biocompatible. By means of x-ray diffraction, atomic force microscopy, circular dichroism spectropolarimetry, UV-vis spectrophotometry, SQUID magnetometry, and nuclear magnetic resonance we evaluated (i) the structural/morphological characteristics, (ii) the magnetic retraction efficiency, and most importantly (iii) the toxin binding affinity and capacity of both bare Fe(3)O(4) BFNs and Fe(3)O(4)-BSA Cs by performing in vitro experiments on specific TTSs. Homocysteine and p-cresol were chosen as representative TTSs and were investigated in great detail. The results obtained prove the in vitro applicability of the proposed MAHD method. Corrections were made to this article on 6 November 2007 (see figure 10 caption and lines 10 and 11 of page 11). The corrected electronic version is identical to the print version.

Molecular targeting of proteins by L-homocysteine: mechanistic implications for vascular disease

Hyperhomocysteinemia is an independent risk factor for cardiovascular disease, complications of pregnancy, cognitive impairment, and osteoporosis. That elevated homocysteine leads to vascular dysfunction may be the linking factor between these apparently unrelated pathologies. Although a growing body of evidence suggests that homocysteine plays a causal role in atherogenesis, specific mechanisms to explain the underlying pathogenesis have remained elusive. This review focuses on chemistry unique to the homocysteine molecule to explain its inherent cytotoxicity. Thus, the high pKa of the sulfhydryl group (pKa, 10.0) of homocysteine underlies its ability to form stable disulfide bonds with protein cysteine residues, and in the process, alters or impairs the function of the protein. Studies in this laboratory have identified albumin, fibronectin, transthyretin, and metallothionein as targets for homocysteinylation. In the case of albumin, the mechanism of targeting has been elucidated. Homocysteinylation of the cysteine residues of fibronectin impairs its ability to bind to fibrin. Homocysteinylation of the cysteine residues of metallothionein disrupts zinc binding by the protein and abrogates inherent superoxide dismutase activity. Thus, S-homocysteinylation of protein cysteine residues may explain mechanistically the cytotoxicity of elevated L-homocysteine.

High-throughput capillary electrophoresis method for plasma cysteinylglycine measurement: evidences for a clinical application

Increased levels in plasma homocysteine and cysteine, and more recently, decreased levels in cysteinylglycine have been indicated as a risk factor for vascular diseases. Most assays focused their attention only on homocysteine determination and when also other thiols were measured, analytical times drastically increased. By modifying our previous method for thiols detection, we set up a rapid capillary electrophoresis method for the selective quantification of plasma cysteinylglycine, cutting the analysis time of about 50%. Samples were treated with tri-n-butylphosphine as reducing agent, proteins were precipitated with trichloroacetic acid and released thiols were successively derivatized by the selective thiol laser-induced fluorescence-labeling agent 5-iodoacetamidofluorescein and separated by capillary electrophoresis. A baseline separation between peaks was obtained in about 2 min using 3 mmol/L sodium phosphate/2.5 mmol/L boric acid as electrolyte solution with 75 mmol/L N-methyl-D-glucamine at pH 11.25 in a 47 cm long capillary with a cartridge temperature of 45 degrees C. The method application was checked by measuring plasma Cys-Gly levels in a group of patients affected by retinal vein occlusion (RVO), an important cause of visual loss in the elderly. The low levels of Cys-Gly found in the RVO patients suggest that these small thiols may have importance in the disease development.

Homocysteine-lowering therapy does not affect inflammatory markers of atherosclerosis in patients with stable coronary artery disease

OBJECTIVES

A high level of total homocysteine (tHcy) is a risk marker for cardiovascular disease (CVD), and is related to inflammation. We wanted to test the effect of homocysteine-lowering B-vitamin therapy, as used in the Western Norway B-vitamin Intervention Trial (WENBIT), on inflammatory markers associated with atherosclerosis.

DESIGN

Single centre, prospective double-blind clinical interventional study, randomised in a 2 x 2 factorial design.

SUBJECTS AND METHODS

Ninety patients (21 female) with suspected coronary artery disease (CAD), aged 38-80 years, were blindly randomised into one of four groups of daily oral treatment with (A) folic acid (0.8 mg)/vitamin B12 (0.4 mg)/vitamin B6 (40 mg), (B) folic acid/vitamin B12, (C) vitamin B6 alone or (D) placebo. Blood samples were collected before and after 6 months of treatment.

RESULTS

Before intervention, median levels of the analytes were: tHcy 11.0 micromol L(-1), neopterin 8.1 nmol L(-1), soluble CD40 ligand (sCD40L) 3.9 ng mL(-1), interleukin (IL)-6 1.9 pg mL(-1), C-reactive protein (CRP) 1.9 mg L(-1) and low-density lipoprotein (LDL) cholesterol 3.3 mmol L(-1). tHcy was significantly associated with neopterin (r = 0.49, P < 0.001) and with IL-6 (r = 0.29, P = 0.01), but not with CRP or sCD40L. Neither treatment with folic acid/B12 nor with B6 induced significant changes in any of these inflammatory biomarkers (P >or= 0.14). In patients receiving folic acid/B12 (groups A and B), tHcy was reduced with 33% (P < 0.001).

CONCLUSIONS

In patients with stable CAD, homocysteine-lowering therapy with B-vitamins does not affect levels of inflammatory markers associated with atherogenesis. Failure to reverse inflammatory processes, may partly explain the negative results in clinical secondary B-vitamin intervention trials.

[Metabolic syndrome in childhood]

The World Health Organization has described obesity as the world epidemic of the twentieth century, ranking as the main problem in public health. In Spain, the enKid study, undertaken in a population aged between 2 and 24 years, shows prevalences of 13.9 % for obesity and 12.4 % for overweight. Longitudinal studies suggest that childhood obesity after the age of 3 years correlates with a greater risk of obesity in adulthood, with an increase in morbility and mortality due to the persistence of associated metabolic disorders. Among these disorders is the metabolic syndrome, defined as the association of several risk factors that herald arteriosclerotic cardiovascular disease and type 2 diabetes in adulthood, with insulin resistance playing a major role in its pathophysiology. Despite its importance, there is still no universally accepted pediatric definition of this syndrome, hampering exact knowledge of its scope, although the prevalence observed in numerous studies performed in obese pediatric patients ranges from 20-30 %.

Association of Increased Levels of Homocysteine and Peripheral Arterial Disease in a Japanese-Brazilian Population

OBJECTIVES

Our aim was to evaluate the possible association between homocysteine levels and peripheral arterial disease (PAD) in a population-based study of Japanese-Brazilians.

MATERIALS AND METHODS

This cross-sectional study was derived from a population-based survey on the prevalence of diabetes and associated diseases conducted in Japanese-Brazilians. A total of 1330 male and female subjects aged>or=30 years were submitted to clinical examination and laboratory procedures including homocysteine measurement. The ankle-brachial index (ABI) was calculated; subjects with ABI values <0.9 were diagnosed with PAD. The evaluable population included 1008 subjects. Logistic regression was used taking PAD as the dependent variable.

RESULTS

Mean age of the population was 56.5 years and overall prevalence of PAD was 20%. A worse cardiovascular profile was found in male patients, including significantly higher homocysteine levels (11.9+/-1.8 vs. 9.1+/-1.1micromol/L, p<0.001). Men with PAD had higher prevalence rates of hyperhomocysteinemia compared to women (22.7% vs 7.6%). Univariate analysis showed an odds ratio of hyperhomocysteinemia for PAD of 1.51 [1.02-2.25] in men and 1.69 [1.06-2.68] in women. After adjustment for other cardiovascular risk factors, higher levels of homocysteine were only significantly related to PAD in men.

CONCLUSION

In a Japanese-Brazilian population, elevated levels of homocysteine are associated with PAD in men. Prospective studies are necessary to confirm this finding.

Plasma homocysteine is elevated in elderly patients with memory complaints and vascular disease

BACKGROUND

There is an association between elevated plasma total homocysteine (tHcy) and vascular disease in elderly patients suffering from organic and non-organic mental disease. The main objective of the present study was to investigate the relationship between plasma tHcy concentration and vascular disease in elderly patients with memory complaints.

METHODS

In 108 patients with memory complaints the concentration of plasma tHcy was related to the presence of vascular disease. Furthermore, different determinants of plasma tHcy concentration were measured.

RESULTS

Patients with confirmed memory complaints (CMC, n = 86) which fulfilled the criteria of mild cognitive impairment were divided into two categories, with and without vascular disease. The CMC group without vascular disease showed similar biochemical and brain imaging findings to patients with subjective memory complaints (SMC, n = 22). The group of CMC patients with vascular disease had higher age, higher plasma tHcy, lower serum folate and lower renal function than patients without vascular disease.

CONCLUSION

The finding of two subgroups of patients with CMC supports the notion that mild cognitive impairment is a heterogenous clinical entity with multiple aetiological factors. The elevated plasma tHcy in the group of CMC patients with vascular disease is likely to be associated with vascular disease.

Hostility and serum homocysteine as cardiovascular risk factors in Korean patients with coronary artery disease

AIMS

The aim of this study is to determine the relationships between hostility and serum homocysteine in Korean patients with coronary artery disease and to identify their effects on the occurrence of coronary artery disease.

BACKGROUND

Recently, hostility as a psychosocial factor and serum homocysteine as a biochemical risk factor are gradually accepted as independent risk factors of coronary artery disease but research on the relationship between hostility and homocysteine is rare.

DESIGN

This is a descriptive and correlative study conducted in the single teaching hospital located in South Korea.

METHODS

Eighty-four patients with coronary artery disease participated. Semi-structured interviews were used to measure the level of hostility and the characteristics of participants. Hostility was measured by the Cynical Hostility Scale and fasting blood samples from venous vein was used to measure serum homocysteine level.

RESULTS

Mean scores for hostility of men were higher than women. The difference was statistically significant (p = 0.001). The serum homocysteine level (11.51 SD 5.43 micromol/l) in patients with coronary artery disease was higher than the normal reference value. Findings of this study indicate that serum homocysteine increased in a statistically consistent pattern with the level of hostility (F = 8.37, p < 0.01).

CONCLUSIONS

This result suggests that high level of hostility may increase cardiovascular risk by elevated serum homocysteine concentration.

RELEVANCE TO CLINICAL PRACTICE

The development and applications of nursing interventions for hostility can contribute to reducing the prevalence and mortality rate of coronary artery disease.

Homocysteine Concentrations and Molecular Analysis in Patients with Congenital Heart Defects

BACKGROUND

Congenital heart defects are the result of incomplete heart development and, like many diseases, have been associated with high homocysteine concentration.

METHODS

We evaluated homocysteine, folic acid and vitamin B(12) concentrations, and the mutations 677C>T and 1298A>C in MTHFR, 844ins68 in CBS and 2756A>G in MTR genes in 58 patients with congenital heart defects, 38 control subjects, and mothers of 49 patients and 26 controls.

RESULTS

Control and patients presented normal range concentrations for homocysteine (7.66 +/- 3.16 microM and 6.95 +/- 3.12 microM, respectively), folic acid (8.31 +/- 3.00 ng/mL and 11.84 +/- 10.74 ng/mL) and vitamin B(12,) (613.56 +/- 307.57 pg/mL and 623.37 +/- 303.12 pg/mL), which did not differ among groups. For the mothers studied, homocysteine and vitamin B(12) concentrations also did not differ between groups. However, folic acid concentrations of mothers showed significant difference, the highest values being in the group of patients. No difference was found in allele frequencies among all groups studied.

CONCLUSIONS

In the studied groups, high homocysteine seems not to be correlated with congenital heart defects, as well as folic acid and vitamin B(12). The mutations studied, in isolation, were not related to congenital heart defects, but high concentration of maternal homocysteine is associated with the presence of three or four mutated alleles.

Functional COMT Val158Met polymorphism, risk of acute coronary events and serum homocysteine: the Kuopio ischaemic heart disease risk factor study

Background

The role of circulating levels of total homocysteine tHcy in the development of coronary heart disease (CHD) is still under debate. One reason for conflicting results between previous studies on homocysteine and heart diseases could be consequence of different interactions between homocysteine and genes in different study populations. Many genetic factors play a role in folate-homocysteine metabolism, like functional polymorphism (Val108Met) in the Catechol-O-methyltransferase (COMT) gene.

Methodology and Findings

Our aim was to examine the role of COMT Val158Met polymorphism and interaction of this polymorphism with serum tHcy and folate concentration on the risk of acute coronary and events in middle-aged men from eastern Finland. A population-based prospective cohort of 792 men aged 46–64 years was examined as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. During an average follow-up of 9.3 years, there were 69 acute coronary events in men with no previous history of CHD. When comparing the COMT low activity genotype with the others, we found an age and examination year adjusted hazard rate ratio (HRR) of 1.73 (95% confidence interval (CI), 1.07–2.79), and an age, examination year, serum LDL and HDL cholesterol, and triglyceride concentration, systolic blood pressure and smoking adjusted HRR of 1.77 (95% CI, 1.05–2.77). Although serum tHcy concentration was not statistically significantly associated with acute coronary events (HRR for the highest third versus others 1.52, 95% CI, 0.93–2.49), subjects with both high serum tHcy and the COMT low activity genotype had an additionally increased adjusted risk of HRR 2.94 (95% CI 1.50–5.76) as compared with other men.

Conclusions

This prospective cohort study suggests that the functional COMT Val158Met polymorphism is associated with increased risk of acute coronary events and it may interact with high serum tHcy levels.

Serum sex hormone and plasma homocysteine levels in middle-aged and elderly men

OBJECTIVE

To investigate whether circulating levels of testosterone (total, bioavailable), estradiol (total, bioavailable), and DHEA sulfate (DHEAS) are associated with fasting plasma homocysteine (tHcy) levels in middle-aged and elderly men.

DESIGN

A population-based sample of 400 independently living men between 40 and 80 years of age in a cross-sectional study.

METHODS

Total testosterone, sex hormone binding globulin (SHBG), and total estradiol were measured by RIA methods and bioavailable testosterone and estradiol were calculated. DHEAS was measured using an immunometric technique. Fasting homocysteine was measured by fluorescence polarization immunoassay. Anthropometric characteristics were also measured and two standardized questionnaires completed, including life-style factors and diet. Linear regression analysis adjusted for age, body mass index (BMI), creatinine clearance, and mean visceral fat was used to assess the association of endogenous sex hormones and fasting plasma homocysteine levels.

RESULTS

After adjustment for age, BMI, creatinine clearance, and mean visceral fat no statistically significant association was observed between testosterone (total, bioavailable), DHEAS, and estradiol (total, bioavailable)levels with natural log tHcy (beta = -2 x 10(-3); 95% confidence intervals (CI) -9 x 10(-3); 5 x 10(-3)), (beta = -4 x 10(-3); 95% CI -18 x 10(-3); 9 x 10(-3)), (beta = 3 x 10(-3); 95% CI -6 x 10(-3); 12 x 10(-3)), (beta = -9.3 x 10(-5); 95% CI -1 x 10(-3); 1 x 10(-3)), and (beta = 0.00; 95% CI -3 x 10(-3); 2 x 10(-3)) respectively. Additional adjustment for smoking, alcohol intake, daily physical activity, diabetes mellitus, and hypertension did not change these findings.

CONCLUSION

The results of our study do not support a direct role for circulating sex hormone levels in the regulation of fasting plasma tHcy concentrations in middle-aged and elderly men.

A simple, convenient method to synthesize cobalamins: synthesis of homocysteinylcobalamin, N-acetylcysteinylcobalamin, 2-N-acetylamino-2-carbomethoxyethanethiolatocobalamin, sulfitocobalamin and nitrocobalamin

Glutathionylcobalamin, nitrocobalamin and sulfitocobalamin are important cobalamin metabolites isolable from human tissues. Herein we demonstrate that a procedure used to synthesize and isolate gamma-glutamylcysteinylcobalamin and glutathionylcobalamin in aqueous solution in high yield and purity can be used to synthesize other novel, biologically relevant thiolatocobalamins, including d,l-homocysteinylcobalamin, N-acetyl-l-cysteinylcobalamin (Na(+) salt) and 2-N-acetylamino-2-carbomethoxy-l-ethanethiolatocobalamin, as well as other non-alkylcobalamins, such as sulfitocobalamin (Na(+) salt) and nitrocobalamin. This uncomplicated, general procedure will assist researchers in identifying unknown cobalamin metabolites isolated from biological samples, and researchers interested in studying the uptake and intracellular cobalamin processing mechanisms utilizing non-alkylcobalamin derivatives that are not yet commercially available. The X-ray structure and XAS spectrum of N-acetyl-l-cysteinylcobalamin are also presented.

Dietary intake of B-vitamins in mothers born a child with a congenital heart defect

BACKGROUND

Periconceptional use of multivitamins reduces the risk of a child with a congenital heart defect (CHD). Data on the impact of maternal diet, however, are lacking.

AIM OF THE STUDY

We investigated the association between the maternal dietary intake of B-vitamins and having a child with a CHD.

METHODS

A case-control study was performed in 192 mothers of a child with a CHD and 216 mothers of a healthy child. Mothers filled out food frequency questionnaires covering the current dietary intake, and general questionnaires at 17 months after the index-pregnancy. Maternal blood samples were taken to determine B-vitamin and plasma total homocysteine (tHcy) concentrations as nutritional biomarkers. Pregnant and lactating mothers and those with another diet compared with the preconceptional period were excluded for analysis. Case-mothers and controls were compared using the Mann-Whitney U test and logistic regression.

RESULTS

The dietary intake of macronutrients and B-vitamins was comparable between both groups, but all mothers had a substantially lower median folate intake (cases 161 microg, controls 175 microg) than the Dutch recommended dietary allowance of 300 microg. Within the case-group, the intake of proteins and vitamin B(6) and the concentrations of serum vitamin B(12) and folate were significantly lower in hyperhomocysteinemics (tHcy > or = 14.5 micromol/l) than in normohomocysteinemics. The maternal educational level was positively associated with B-vitamin intake, except for vitamin B(12) in controls. Low educated case-mothers showed a significantly lower median vitamin B(12) intake than controls (2.8 microg and 3.8 microg, P = 0.01). The CHD risk doubled if vitamin B(12) intake in these mothers reduced by 50% (OR 2.0; 95% CI: 1.1-3.5).

CONCLUSIONS

A diet low in vitamin B(12) is associated with an increased risk of a child with a CHD, especially in low educated women. A disbalance in the maternal intake of proteins and low folate intake may play a role as well, but needs further investigation. As hyperhomocysteinemia is a strong risk factor for adult cardiovascular disease, these data may imply that the hyperhomocysteinemic mothers and their children should be targeted for nutritional interventions.

Increased Ventricular Ectopic Activity in Relation to C-Reactive Protein, and NT-Pro-Brain Natriuretic Peptide in Subjects With No Apparent Heart Disease

BACKGROUND

Subjects with frequent ventricular premature complexes (VPC) and no apparent heart disease make a heterogenic group with regard to prognosis. Some biomarkers have recently proved useful in risk stratification in different heart diseases. We examined prognostic impact of NT-Pro-brain natriuretic peptide (NT-Pro BNP), and C-reactive protein (CRP) in relation to frequent VPC in subjects with no apparent heart disease.

METHODS

Six hundred seventy-eight healthy subjects between 55 and 75 years of age with no history of cardiovascular disease were included in the study. All were tested with fasting laboratory testing and 48-hour ambulatory ECG monitoring. Frequent VPC was defined as VPC > or =30/hour.

RESULTS

In 56 subjects (8%) with frequent VPC the prognosis was much poorer compared to those without frequent VPC (Hazard ratio and 95% CI: 2.3;1.2-4.4, P = 0.01), after adjustment for conventional risk factors. In subjects with frequent VPC increased levels of CRP (above 2.5 microg/mL) was the only factor among the tested biomarkers, which was associated with a poor prognosis. Taking subjects without frequent VPC as reference, the hazard ratio and 95% CI for subjects with frequent VPC and increased CRP was 3.6;1.8-7.1, P = 0.0004, and for those with frequent VPC and normal CRP 0.8;0.2-3.5, P = 0.83, after correction for conventional risk factors.

CONCLUSIONS

Among middle-aged and elderly subjects with no apparent heart disease and frequent VPCs, a CRP value > or =2.5 microg/mL is associated with a significantly higher risk of death and acute myocardial infarction. These subjects deserve primary prevention measures and further work up for structural heart disease.

Total plasma homocysteine values among elderly subjects: findings from the Maracaibo Aging Study

OBJECTIVES

The present study generated baseline data for total homocysteine (tHcy) in elderly Caribbeans of Hispanic ancestry, residing in Venezuela, their country of origin.

DESIGN AND METHODS

2106 participants in the Maracaibo Aging Study (MAS), older than 55 years, underwent standardized clinical and laboratory assessments, including measurement of plasma tHcy levels, folate, and vitamin B12 in fasting samples.

RESULTS

tHcy concentration in the healthy, normative group ranged from 4.1 to 31.8 micromol/L, with a median of 11.5+/-4.7 micromol/L. tHcy level increased with age, was significantly higher in men than in women, and exhibited inverse correlations with folate and vitamin B12.

CONCLUSIONS

tHcy levels of the MAS participants were generally higher than levels previously reported for community-dwelling elderly populations from other countries. The normative centile curves for tHcy can be used in disease risk analysis for this population, and possibly for other Hispanic populations residing in the Caribbean.

Cerebrovascular disease in highly active antiretroviral therapy-treated individuals: incidence and risk factors

The occurrence of cerebrovascular events in patients infected by human immunodeficiency virus (HIV) has been traditionally associated with opportunistic infections and tumors, and/or advanced stages of immunosuppression. The current use in the clinical practice of antiretroviral treatment (ART) has been associated with a dramatic reduction of HIV-related mortality. Due to the increase of median age of HIV-infected subjects and to the ART-induced lipid abnormalities, an increasing incidence of vascular complications has been reported in this population. The potential contribution of these novel mechanisms should be considered and added to the classic vascular risk factors in the HIV-infected population and the cardiac abnormalities frequently observed in these patients. Large-scale epidemiological studies are needed to better define the incidence of cerebrovascular events in HIV-infected patients and the factors associated with their occurrence.

Polymorphism C776G in the transcobalamin II gene and homocysteine, folate and vitamin B12 concentrations. Association with MTHFR C677T and A1298C and MTRR A66G polymorphisms in healthy children

One of the etiologies of hyperhomocysteinemia is decreased vitamin B(12). Genetic variation in the transcobalamin II gene, the transporter of vitamin B(12) to the cells, may produce altered homocysteine levels. We determined transcobalamin II C776G polymorphism, homocysteine, folate and vitamin B(12) levels and analyzed the interactive effect with the methylenetetrahydrofolate reductase C677T and A1298C and methionine synthase reductase A66G polymorphisms in 207 healthy Brazilian children. The prevalence of GG genotype of transcobalamin II C776G polymorphism in this Brazilian population, a highly miscigeneous population was 12.5% and the statistical analysis showed that this population is in Hardy-Weinberg equilibrium, it could be considered representative of the general population. We observed a significant increase in homocysteine in the 776GG vs. 776CC genotype, corroborating the influence of age as a determinant of homocysteine in relation to this polymorphism. When we analyzed vitamin B(12) and its relationship with the C776G polymorphism, we found no significant differences. Only 776CG/66AA or 776GG/66AG genotypes presented a significant increase in homocysteine when compared with other groups. In the multivariate analysis, transcobalamin II C776G (CC/CG vs. GG), methylenetetrahydrofolate reductase C677T (CC/CT vs. TT), folate, gender and age presented statistical significance in relation to the homocysteine. These can be considered independent risk factors for hyperhomocysteinemia in this children group. Our results, if confirmed in other populations, highlight the necessity for investigation of the transcobalamin II C776G polymorphism in the research for hyperhomocysteinemia risk factors.

Testing the homocysteine hypothesis in end-stage renal disease: Problems and a possible solution

The homocysteine hypothesis states that circulating homocysteine is a vascular toxin in concentrations that occur in the general population and in renal failure. This hypothesis is currently being tested in the Kidney and End State Renal Disease Study (HOST), but data have emerged since the HOST began that suggest its results will be inconclusive. The crucial treatment component in the HOST is folic acid, but its effect is likely to be lost because the American food supply is now fortified with folic acid. A second concern is that the very high doses of folic acid and pyridoxine being used in the HOST may confound the results. Finally, confounding due to 'reverse epidemiology' was not considered when the HOST was designed. Parenteral vitamin B(12) is a highly promising therapy for homocysteine reduction in end-stage renal disease that merits careful investigation. Clinical trials using it to test the homocysteine hypothesis will avoid the problems inherent in the HOST.

Inhibition of betaine-homocysteine S-methyltransferase causes hyperhomocysteinemia in mice

Inhibitors and methyl donor substrates for betaine-homocysteine S-methyltransferase (BHMT) were used to study the role of this enzyme in the regulation of plasma total homocysteine (tHcy). Mice were administered an i.p. injection of S-(delta-carboxybutyl)-dl-homocysteine (CBHcy; 1 mg), a specific and potent inhibitor of BHMT, and tHcy and hepatic BHMT protein and activity levels were monitored over a 24-h period. Compared with saline-injected control mice, at 2 h postinjection, the CBHcy-treated mice had 87% lower BHMT activity and a 2.7-fold increase (11.1 vs. 3.0 micromol/L) in tHcy, effects that lasted nearly 8 h but returned to normal by 24 h. The level of BHMT protein remained constant over the 24-h period. After 6 CBHcy (1 mg) injections (one every 12 h), the mice had 7-fold higher tHcy, a 65% reduction in the liver S-adenosylmethionine:S-adenosylhomocysteine ratio, and a marked upregulation of BHMT protein expression. At 2 h after injection of the sulfoxide derivative of CBHcy (10 mg) into mice, there was a modest reduction in BHMT activity and a 90% increase in tHcy. When given an injection of Met (3 mg) or Met plus CBHcy (1 mg), post-Met load tHcy levels were 2.2-fold higher (128 vs. 40 micromol/L) at 2 h postinjection in the mice given CBHcy. Like betaine, dimethylsulfoniopropionate was an effective tHcy-lowering agent when given with a Met load. These studies are the first to show that transient inhibition of BHMT in vivo causes transient hyperhomocysteinemia, and that dimethylsulfoniopropionate can reduce a post-Met load rise in tHcy.

ACUTE DILATORY AND NEGATIVE INOTROPIC EFFECTS OF HOMOCYSTEINE ARE INHIBITED BY AN ADENOSINE BLOCKER

1. Previous studies have shown that homocysteine elicits acute negative inotropic and coronary vasodilatory effects in rat hearts. In addition, this earlier work suggested that the inotropic action is mediated via an endothelium-derived agent that is neither nitric oxide (NO) nor a cyclooxygenase product, while the coronary actions were found to be antagonized by the NOS inhibitor l-NNA. Current experiments, which utilized coronary-perfused rat hearts, were designed to determine if muscarinic or adenosine receptors are involved in these acute actions of homocysteine. 2. Left ventricular developed pressure was used as a measure of systolic function in electrically paced, Langendorff-perfused heart with coronary pressure being used to monitor coronary vascular tone. Acute effects of homocysteine (10-300 micromol/L) were examined in the presence and absence of 1 yen 10(-6) mol atropine or 7 yen 10(-5) mol 8-(p-sulfophenyl) theophylline (SPT), a non-selective adenosine receptor antagonist. 3. Atropine had no effect on either the inotropic or vascular actions of homocysteine. In contrast, SPT partially antagonized both actions of the amino acid with the antagonism of the vasodilation being much greater than its inhibition of the negative inotropic effect. Experiments with adenosine demonstrated that the selected dose of SPT elicited marked rightward shifts in the dose-response curves for both the inotropic and vascular actions. 4. Current results suggest that adenosine plays a role in both the negative inotropic and vasodilatory actions of homocysteine. However, the relatively minor antagonistic action of SPT on the inotropic effect of homocysteine suggests that additional endothelium-derived mediators underlie its effects on contractility.

High dietary methionine intake increases the risk of acute coronary events in middle-aged men

BACKGROUND AND AIM

Homocysteine, a methionine metabolite, is suggested to be a risk factor for cardiovascular diseases (CVD). To date, the effects of dietary intake of methionine, the key amino acid in homocysteine metabolism, on CVD have not been studied. Our aim was to examine the effects of dietary methionine intake on the risk of acute coronary events.

METHODS AND RESULTS

We examined the effects of dietary methionine intake, assessed with 4-d food record, on acute coronary events in a prospective cohort study consisting of 1981 coronary disease free men from eastern Finland, aged 42-60 years at baseline in 1984-89, in the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. During an average follow-up time of 14.0 years, 292 subjects experienced an acute coronary event. In a Cox proportional hazards model adjusting for age, examination years, BMI, urinary nicotine metabolites and protein intake (excluding methionine) the relative risks of acute coronary event in the three highest quarters of dietary methionine intake were 1.31 (95% CI: 0.92, 1.86), 1.31 (95% CI: 0.88, 1.96) and 2.08 (95% CI: 1.31, 3.29) as compared with the lowest quarter. Further adjustments did not change the results. However, opposite association was observed with total protein intake, which tended to decrease the risk.

CONCLUSIONS

The main finding of this study is that long-term, moderately high dietary methionine intake may increase the risk of acute coronary events in middle-aged Finnish men free of prior CHD. More prospective research is needed to confirm the role of dietary methionine in the development of CVD, and whether its effects are independent of homocysteine.

Acute intranigral homocysteine administration produces stereotypic behavioral changes and striatal dopamine depletion in Sprague–Dawley rats

Homocysteine has been considered a major risk factor for cardiovascular diseases, and patients with hyperhomocystinemia exhibit neurological and psychological abnormalities. Elevated level of this molecule in the blood of Parkinson's disease patients receiving long-term l-DOPA therapy prompted us to investigate whether homocysteine is neurotoxic to the nigrostriatal dopaminergic system in Sprague-Dawley rats. Animals infused unilaterally with different doses of homocysteine (0.25-1 micromol in 1 microl) intranigrally exhibited significant and dose-dependent decrease in dopamine levels in the ipsilateral striatum as assayed employing an HPLC coupled with electrochemical detector, 19 days post-infusion. While 3,4-dihydroxyphenylacetic acid level in the striatum showed a dose-dependent decrease, homovanillic acid was found to be inhibited only for the highest dose. Amphetamine administration in these animals on the 14th day caused stereotypic turning behavior ipsilateral to the side of infusion. Apomorphine challenge on the 16th day elicited stereotypic contralateral circling behavior. Neurotransmitter levels in the serotonergic perikarya or terminals were unaltered 19 days following intraraphe infusion of homocysteine, which suggested the specificity of its action to dopaminergic neurons. These results indicate nigrostriatal lesions similar to that observed following intranigral infusion of the dopaminergic neurotoxin, 6-hydroxydopamine and suggest its closeness to the parkinsonian animal model. Furthermore, these findings provide evidence for the neurotoxic nature of homocysteine to dopaminergic neurons and suggest that elevated level of this molecule in parkinsonian patients may be conducive to accelerate the progression of the disease.

The polyphenol quercetin strongly increases homocysteine production in a human hepatoma (Hep G2) cell line

OBJECTIVE

The metabolism of homocysteine is influenced by several dietary factors, including folate, cobalamin and possibly also the intake of polyhydroxylated phenolic compounds (polyphenols), which were shown to increase plasma homocysteine (tHcy) concentration. In order to reveal the cause of the increased plasma tHcy, we have therefore investigated the effects of a polyphenol in cell cultures from human cell lines.

DESIGN AND METHODS

We have studied the influence of the polyphenol quercetin (Quer) on intra- and extracellular homocysteine concentrations in HeLa and hepatoma cell cultures.

RESULTS

The main finding is an increased concentration of extracellular homocysteine in the presence of Quer in hepatoma cell cultures, whereas there were no significant changes of homocysteine concentration in HeLa cell cultures. There was no effect on cellular growth, as judged by cell protein. The presence of adenosyl-dialdehyde, an inhibitor of adenosyl-homocysteine hydrolase, abolished the increased extracellular concentration of homocysteine observed in hepatoma cell cultures in the presence of Quer.

CONCLUSION

The antioxidative agent Quer strongly increased the extracellular concentration of homocysteine in hepatoma cell cultures probably due to increased cellular methylation. In the human body, the same phenomenon might lead to increased plasma tHcy. Since elevated plasma tHcy is associated with premature vascular disease, high long-lasting dietary intake of polyphenols might be harmful. The interaction between Quer and homocysteine turnover may therefore warrant a re-evaluation of polyphenols as relatively harmless antioxidative food supplements or therapeutic antioxidative agents.

Diet and psoriasis: experimental data and clinical evidence

Psoriasis is considered as a T-cell-mediated inflammatory skin disease which is characterized by hyperproliferation and poor differentiation of epidermal keratinocytes. While susceptibility to psoriasis is inherited, the disease is influenced by environmental factors such as infections and stress. Diet has been suggested to play a role in the aetiology and pathogenesis of psoriasis. Fasting periods, low-energy diets and vegetarian diets improved psoriasis symptoms in some studies, and diets rich in n-3 polyunsaturated fatty acids from fish oil also showed beneficial effects. All these diets modify the polyunsaturated fatty acid metabolism and influence the eicosanoid profile, so that inflammatory processes are suppressed. Some patients with psoriasis show an elevated sensitivity to gluten. In patients with IgA and/or IgG antigliadin antibodies the symptoms have been shown to improve on a gluten-free diet. The active form of vitamin D, 1,25-dihydroxyvitamin D(3), exhibits antiproliferative and immunoregulatory effects via the vitamin D receptor, and thus is successfully used in the topical treatment of psoriasis. In this review, dietary factors which play a role in psoriasis are assessed and their potential benefit is evaluated. Furthermore, the risk of drug-nutrient interactions in psoriasis therapy is discussed.

Molecular analysis of homocystinuria in Brazilian patients

BACKGROUND

Cystathionine beta-synthase (CBS) deficiency is the most common cause of homocystinuria. However, no data are available concerning the molecular basis of this disease in Brazilian populations.

METHODS

We studied 14 Brazilian patients from 11 unrelated families using a combined screening approach, involving restriction analysis, single-strand conformational polymorphism (SSCP) scanning, and sequencing.

RESULTS

All patients presented homocysteine levels higher than 200 mumol/l before the beginning of treatment. The most common CBS gene mutations, p.G307S (c.919G > A) and p.I278T (c.833T > C), were evaluated and the allele c.919A was not found. One allele with the c.844 ins68 (4.5%) in the CBS gene was found. Three families (6 patients) presented the allele c.833 C (13.6%), without the insertion in the heterozygous state. SSCP scanning and sequencing showed 3 alleles p.T191M (13.64%) in 2 families. One allele with a novel mutation was found in exon 4 (c.168T > A) of the CBS gene (4.5%). We also analyzed c.677C > T and c.1298A > C polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene and the 2756A > G polymorphism in the methionine synthase (MTR) gene. The frequencies of mutated alleles were: 50% c.677T and 18.2% c.1298C for MTHFR, and 27.3% c.2756G for MTR.

CONCLUSION

In spite of the high level of racial mixing in the country, Brazilian homocystinuric patients did not present a high prevalence of the most common mutations described in the literature.

Peritoneal clearance of homocysteine with icodextrin or standard glucose solution exchange

BACKGROUND

The aim of the study was to assess plasma homocysteine concentration in peritoneal dialysis patients, and to compare the effect of different peritoneal solutions (glucose-based and icodextrin-based) on peritoneal clearance of homocysteine.

METHODS

The study group comprised 10 chronic peritoneal dialysis patients; the control group comprised 15 healthy, age-matched non-obese subjects with normal renal function. Patients with vitamin B(12) or folate deficiency were excluded. In all subjects, plasma homocysteine and dialysis adequacy parameters were assessed at baseline. The clearance study was carried out with 2.27% glucose and 7.5% icodextrin solutions (12-h dwell time).

RESULTS

Mean dialysate concentration of homocysteine was similar for both glucose and icodextrin solutions (8.3 +/- 3.2 and 8.4 +/- 1.9 micromol/L, respectively), but homocysteine clearance was significantly higher for icodextrin than glucose solution (1.82 +/- 0.57 vs 1.39 +/- 0.53 mL/min per 1.73 m(2)P = 0.01). Net ultrafiltration after icodextrin solution was also higher than after glucose solution (599 +/- 136 mL vs 134 +/- 337 mL, P < 0.01). A correlation between total plasma level of homocysteine and its peritoneal clearance was found (r = 0.69; P = 0.03).

CONCLUSION

It appears that peritoneal elimination of homocysteine depends primarily on its plasma concentration. Icodextrin-based solution for peritoneal dialysis seems to be more efficient in homocysteine elimination than a standard glucose-based solution.

Evaluation of a new enzymatic method for homocysteine measurement

BACKGROUND AND OBJECTIVES

The increased need in clinical chemistry laboratories for methods of homocysteine determination, in correlation with cardiovascular diseases and nutritional deficient status, has led to the development of different analytical methods; fluorescent immunoenzymatic assays and, recently, new fully automated spectrophotometric methods are commercially available. In this paper, we compared data obtained from a new enzymatic method for homocysteine assay (Carolina Liquid Chemistries), with data obtained from a HPLC reference method and an immunoenzymatic method (Abbott AxSYM immunoassay).

RESULTS

The enzymatic method shows a good correlation with both the HPLC (Y = -1.3 + 1.02X; R2 = 0.93) and the immunoenzymatic method (Y = 0.7 + 1.02X; R2 = 0.92), although a bias enhancement was present in some samples. However, the enzymatic method shows a superior analytical feasibility because it needs only common laboratory instruments (UV-visible spectrophotometer) and can be easily adapted to large automatic clinical chemistry analyzers. Moreover, it lowers the laboratory cost of the analysis in comparison to both HPLC and immunoenzymatic methods.

CONCLUSIONS

The enzymatic Carolina Liquid Chemistries method for homocysteine assay shows acceptable analytical performance and undoubtedly possesses technical and cost advantages.

Elimination of high amounts of extracellular homocysteine in human cell lines

BACKGROUND

Many clinical and epidemiological studies show that mild hyperhomocysteinemia is associated with premature vascular disease. Information about the metabolism of homocysteine is therefore essential for an understanding of its role in atherogenesis, thereby enabling a modulation of that risk.

METHODS

In the present study factors influencing the elimination of exogenously added homocysteine in HeLa and hepatoma cell cultures have been investigated with and without inhibition of the transmethylation pathway by adenosine-dialdehyde.

RESULTS

Agents with antioxidative effect (copper chelator and thiols) increased the metabolic removal of extracellular homocysteine in HeLa cell cultures, whereas in hepatoma cell cultures only the thiol N-acetylcysteine increased the elimination. The oxidative agent (copper ions) and cyst(e)ine transport inhibitors decreased the removal in both HeLa and hepatoma cell cultures. The inhibition of the transmethylation pathway by adenosine-dialdehyde increased the removal of exogenously added homocysteine and the addition of the different redox agents and cyst(e)ine transport inhibitors did not specifically influence this increase.

CONCLUSION

The elevated removal of exogenously added homocysteine in the presence of adenosine-dialdehyde might be attributed to limited availability of intracellular homocysteine, which leads to a larger amount of extracellular homocysteine being internalized.

Plasma homocysteine concentration and blood pressure in healthy Iranian adults: the Tehran Homocysteine Survey (2003–2004)

Hypertension is a modifiable risk factor for cardiovascular disease, but its aetiology has not been fully elucidated. Recently, attention has been focused on the direct relations of plasma homocysteine (Hcy) to blood pressure (BP). The purpose of this study was to determine the relationship of Hcy with BP and other cardiovascular disease risk factors. This population-based study was a part of the Cardiovascular Risk Factors Survey and has been designed and conducted based on the methodology of the MONICA/WHO Project. A total of 1214 people aged 25-64 years were recruited using cluster sampling and assessed regarding standardized methods. BP was measured in seated position after a 10-min rest period. Blood samples were gathered and analysed according to standard methods. Variables were assessed in 1191 participants (416 men; 775 women). Mean age was higher in hypertensives compared to normotensives (P < 0.001). Mean Hcy was higher in hypertensives, but significant only in men (P < 0.031). Concurrent effects of Hcy, folate and vitamin B12 on hypertension indicated that Hcy acts as a risk factor and folate and vitamin B12 as protective factors; however, after adjustment, just vitamin B12 remained as a protective factor. Although we detected a simple correlation of Hcy with BP in Iranian adults, this relationship was no longer significant after applying an adjustment. In light of our observations, it is likely that the increased Hcy levels reported in hypertensive persons are concomitant rather than a precursor of hypertension.

Trends in dietary intake of folate, vitamins B6, and B12 among Japanese adults in two rural communities from 1974 through 2001

BACKGROUND: The 5th edition of the Japanese food composition table enables us to evaluate intakes of folate and vitamins B₆ and B₁₂, which are associated with risk of chronic diseases.

METHODS: We investigated long-term trends in dietary intake of those nutrients in two rural communities; Ikawa from 1974 through 2000, and Kyowa from 1982 through 2001. The 24-hour recall method was adopted. Intake of green tea interviewed from 1994 was used to examine food sources for these nutrients in the latest period, but not to evaluate long-term trends. Reduced intakes of nutrients due to cooking were not taken into account.

RESULTS: Age-adjusted mean folate intake increased by 30% in Ikawa between the 1970’s and 1980’s, and then leveled off to the latest survey, while that in Kyowa did not change throughout the survey periods. The increased folate intake was primarily due to green/yellow vegetables. Mean vitamin B₆ intake did not change except that it increased for Ikawa women in the 1980’s and decreased for Kyowa men in the latest period. No secular trend was found for mean vitamin B₁₂ intake. The largest source for folate intake was total vegetables (38-58% of total intake) and the second largest source was alcohol/beverages including green tea (11-24%). Fish/shellfish was the largest source for vitamins B₆ (16-23%) and B₁₂ (77-84%).

CONCLUSIONS: Dietary intakes of folate, vitamins B₆ and B₁₂ showed no notable long-term trend, except for an increased folate intake between the 1970’s and 1980’s due to an increased intake of green/yellow vegetables.

Physiological variation in plasma total homocysteine concentrations in rats

Hyperhomocysteinemia was initially related to cardiovascular diseases; but homocysteine (Hcy) metabolism disturbances have more recently associated with a wide range of pathophysiological conditions including age-related diseases, disrupted circadian rhythms and gynaecological disorders. Since in many cases we do not know to what extent animal models are physiologically similar to human ones, this study aimed to track spontaneous variations in rat plasma Hcy concentrations during different physiological processes such as life cycle, 24 hours and estrous cycle. Plasma total Hcy concentrations were accessed by HPLC. Plasma Hcy concentration varied with age and newborns had the lowest values (2.94 +/- 0.47 micromol/L). Rats aged 10 days presented concentration similar to 3 month old animals (6.87 +/- 0.67 and 8.29 +/- 1.55 micromol/L respectively). Values decreased to 6.42 +/- 1.65 micromol/L at 6 months and 4.87 +/- 0.81 micromol/L at 28 months. Concerning circadian variations in Hcy concentration cosinor analysis showed acrophase in young rats at 1:09 pm, but no plasma Hcy circadian variations in aged rats. Female rats showed changes in Hcy concentration during the estrous cycle with higher values during the diestrous I (10.61 +/- 1.81 micromol/L) compared with the estrous (8.47 +/- 1.86 micromol/L) and diestrous II (7.68 +/- 1.58 micromol/L) phases. In conclusion, plasma Hcy concentration varied spontaneously with ontogenic development and during the estrous cycle and presented a circadian rhythm variation in young rats.

Protective effects of Danshensu from the aqueous extract of Salvia miltiorrhiza (Danshen) against homocysteine-induced endothelial dysfunction

Homocysteine (Hcy) is a by-product of methionine metabolism. An imbalance of Hcy in the body may lead to hyperhomocysteinemia, a condition with elevated Hcy concentration in blood that may be one of the risk factors responsible for the development of several vascular diseases (thromboembolism, atherosclerosis, stroke, vascular diseases and dementia). Radix Salvia miltiorrhiza (Danshen), a well-known Chinese medicinal herb that can activate and improve blood microcirculation, is noticeable for its beneficial effect in treating cardiovascular diseases. The present study is to demonstrate the protective effect of Danshen extract against the homocysteine-induced adverse effect on human umbilical vein endothelial cell (HUVEC). Homocysteine (5 mM) not only decreased the cell viability but also caused the disruption of capillary-like structure formation in vitro. The protective effect of Danshen aqueous extract and its active compounds on endothelial cell function were demonstrated through an in vitro tube formation assay, which mimics the new blood vessel formation. To identify the active components in the aqueous extract of Danshen, the content was characterized by instrumental analysis using high performance liquid chromatography with diode array detector (DAD) and electrospray tandem mass spectrometry (ESI-MS/MS). Interestingly, Danshen extract and its pure compounds showed different effectiveness in protecting HUVEC against Hcy-induced injury according to the following descending order: Danshen aqueous extract, 3-(3,4-dihydroxy-phenyl)-2-hydroxy-propionic acid (Danshensu), protocatechuic acid, catechin and protocatechualdehyde. We believed that such findings might provide evidence in understanding the beneficial effects of Danshen on the cardiovascular system.

Cobalamin: a critical vitamin in the elderly

Vitamin B(12) deficiency is a common problem in elderly subjects. If a serum cobalamin level of about 150 pmol/L (200 pg/mL) is considered normal, 10-15% of the elderly are deficient. Today, however, a threshold of 220-258 pmol/L (300-350 pg/mL) is recognized as desirable in the elderly, or else sensitive markers like the blood concentration of homocysteine or methylmalonic acid (MMA) are used. Then the prevalence of cobalamin deficiency rises to up to 43%. In the elderly, this high prevalence of poor cobalamin status is predominantly caused by atrophic gastritis type B. Atrophic gastritis results in declining gastric acid and pepsinogen secretion, and hence decreasing intestinal absorption of the cobalamin protein complexes from food. About 20-50% of the elderly are affected. Furthermore, the reduced acid secretion leads to an alkalinization of the small intestine, which may result in bacterial overgrowth and thus to a further decrease of the bioavailability of the vitamin. In addition, some drugs such as proton pump inhibitors or H2 receptor antagonists inhibit the intestinal absorption of vitamin B(12). An already moderately reduced vitamin B(12) level is associated with vascular disease and neurocognitive disorders such as depression and impaired cognitive performance. Furthermore, a poor vitamin B(12) status is assumed to be involved in the development and progression of dementia (e.g., Alzheimer's dementia). This is especially observable if the folic acid status is reduced as well. Due to the insecure supply, the cobalamin status of elderly persons (>/=60 years) should be regularly controlled and a general supplementation with vitamin B(12) (>50 microg/day) should be considered.

Extracellular concentration of homocysteine in human cell lines is influenced by specific inhibitors of cyst(e)ine transport

Despite the growing evidence that plasma homocysteine is a cardiovascular risk factor, the mechanism behind the vascular injuries is still unknown. Studies of the cellular uptake systems for homocysteine are scarce, but membrane transporters of cyst(e)ine seem to be involved. In the present study the cellular uptake of extracellular homocysteine in HeLa and hepatoma cell lines is investigated by using several different transport inhibitors for cellular uptake of cyst(e)ine. It is shown that systems A and Xc- are the main transport systems for homocysteine uptake in HeLa cells. It is also confirmed that the magnitude of homocysteine uptake in hepatoma cells is lower than in HeLa cells. However, in the presence of high amounts of extracellular homocysteine both cell types exhibited a high elimination of homocysteine, which was inhibited by the presence of inhibitors of systems A or Xc-. It is possible that there is normally a high turnover of homocysteine in cell cultures, which is not detected by occasional determinations of homocysteine concentrations. The complex pattern of homocysteine production, release, uptake and distribution between different cells in the body is important to examine further in order to possibly be able to modulate the elimination of homocysteine from circulation and thereby lower the risk of cardiovascular disease.

Methylenetetrahydrofolate reductase polymorphism (C677T), hyperhomocysteinemia, and risk of ischemic cardiovascular disease and venous thromboembolism: prospective and case-control studies from the Copenhagen City Heart Study

Hyperhomocysteinemia is associated with ischemic cardiovascular disease (ICD) and venous thromboembolism (VTE). We tested the hypothesis that methylenetetrahydrofolate reductase (MTHFR) C677T homozygosity with hyperhomocysteinemia is associated with ICD and VTE. First, 9238 randomly selected whites from the general population were followed for 23 years. Second, 2125 whites with ischemic heart disease and 836 whites with ischemic cerebrovascular disease were compared with 7568 controls from the general population. Plasma homocysteine was elevated 25% in homozygotes versus noncarriers (P &lt; .001) and 19% in ICD/VTE cases versus controls (P &lt; .001). In prospective studies adjusted hazard ratios for ICD and VTE for homozygotes versus noncarriers did not differ from 1.0. Furthermore, MTHFR C677T homozygosity was not associated with increased risk of ICD or VTE in subgroups after stratification for sex, age, cholesterol, high-density lipoprotein cholesterol, lipoprotein(a), fibrinogen, triglycerides, body mass index, smoking, diabetes mellitus, hypertension, and factor V Leiden genotype. Finally, in case-control studies odds ratios for ischemic heart disease and ischemic cerebrovascular disease in homozygotes versus noncarriers did not differ from 1.0. In conclusion, MTHFR C677T homozygosity with hyperhomocysteinemia is not associated with ICD or VTE; however, ICD/VTE is associated with hyperhomocysteinemia. Therefore, ICD and VTE may cause hyperhomocysteinemia, rather than vice versa.

Homocysteine effect on protein degradation rates

OBJECTIVES

To show the effect of homocysteine (Hcy) on the degradation rates of proteins.

DESIGN AND METHODS

Degradation rates of short-lived proteins in neutrophils were measured in in vivo human model of elevated plasma Hcy and lower vitamin status and in animal model of Hcy added in vitro to rat neutrophils.

RESULTS

In the human study, we found significant coefficients of correlation between plasma total homocysteine (tHcy) and the degradation rates of 21 protein fractions. In the animal model, Hcy significantly increased degradation rates of 57 protein fractions.

CONCLUSIONS

The increase in protein degradation rates, induced by Hcy, may provide a clue to our understanding of the mechanism of Hcy detrimental effects. Hcy may amplify the specific effect of cellular solutes on protein conformation, thereby monitor protein degradation rates to control enzyme activity. Consequently, the cell may lose its ability to maintain an efficient control of some crucial metabolic pathways, possibly leading to atherogenesis.