Blood glutathione and cysteine changes in cardiovascular disease

Biomarkers of oxidative damage in human disease

Oxidative/nitrosative stress, a pervasive condition of increased amounts of reactive oxygen/nitrogen species, is now recognized to be a prominent feature of many acute and chronic diseases and even of the normal aging process. However, definitive evidence for this association has often been lacking because of recognized shortcomings with biomarkers and/or methods available to assess oxidative stress status in humans. Emphasis is now being placed on biomarkers of oxidative stress, which are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to therapeutic intervention. To be a predictor of disease, a biomarker must be validated. Validation criteria include intrinsic qualities such as specificity, sensitivity, degree of inter- and intraindividual variability, and knowledge of the confounding and modifying factors. In addition, characteristics of the sampling and analytical procedures are of relevance, including constraints and noninvasiveness of sampling, stability of potential biomarkers, and the simplicity, sensitivity, specificity, and speed of the analytical method. Here we discuss some of the more commonly used biomarkers of oxidative/nitrosative damage and include selected examples of human studies.

Disruption of thiol homeostasis in plasma of terminal renal failure patients

BACKGROUND

The aim of the present studies was to investigate the changes in concentrations of different forms of thiols in plasma of terminal renal failure patients before and after hemodialysis.

METHODS

Total concentrations of thiols, their free forms and the level of their mixed disulfides with proteins were determined with HPLC.

RESULTS

In terminal renal failure patients before dialysis, total concentrations of cysteine, homocysteine and cysteinylglycine and their free and protein-bound fractions increased while level of all such forms of glutathione dropped. A single dialysis session caused short-lasting return of concentrations of all forms of thiols to the level equal or close to the control group. The changes observed in non-dialyzed patients were similar to those observed in dialyzed patients before single dialysis procedure.

CONCLUSIONS

The obtained results showed severe disturbance of thiol homeostasis in plasma of terminal renal failure patients. The following changes have to be emphasized: (1) high level of free cysteine (cystine) fraction, (2) strong tendency of homocysteine to form mixed disulfides with proteins, (3) drop of glutathione level. These observations confirm a suggestion that atherogenic action of homocysteine can be a result of S-homocysteinylation and N-homocysteinylation reactions, whereas toxic action of cysteine can result from auto-oxidation reaction.

The effects of age and hyperhomocysteinemia on the redox forms of plasma thiols

We assayed the redox forms of cysteine (reduced [CSH], oxidized [CSSC], and bound to protein [CS-SP]), cysteinylglycine (CGSH; cysteinylgycine disulfide [CGSSGC] and cysteinylglycine-protein mixed disulfide [CGS-SP]), glutathione (GSH; glutathione disulfide [GSSG] and glutathione-protein mixed disulfide [GS-SP]), homocysteine (Hcy; homocystine [HcyS] and homocystine-protein mixed disulfides [bHcy]), and protein sulfhydryls in the plasma of healthy subjects (divided into 8 groups ranging in age from birth to 70 years) and patients with mild hyperhomocysteinemia associated with cardiovascular disease (heart-transplant patients) or vascular atherosclerosis, with or without renal failure. In healthy individuals, levels of disulfides and protein-mixed disulfides were more abundant than those of thiols, and those of protein-thiol mixed disulfides were higher than disulfides. Concentrations of CSH, GSH, and CGSH in the various groups had profiles characterized by a maximum over time. The concentration of Hcy was unchanged up to the age of 30 years, after which it increased. CSSC concentration increased gradually with age, whereas concentrations of the other disulfides were essentially unchanged. By contrast, the concentrations of all protein-thiol mixed disulfides, especially those with CSH, increased gradually with age. Ranks of distribution of the reduced forms changed with age (at birth, CSH > CGSH > GSH > Hcy; in 1- to 2-year-olds, CSH > GSH > CGSH > Hcy; and in 51- to 70-year-olds, CSH > CGSH = GSH > Hcy), whereas those of disulfides and protein-thiol mixed disulfides were substantially unchanged (in all age groups, CSSC > CGSSGC > GSSG = HcyS and CS-SP > CGS-SP > bHcy > GS-SP). In patients with pathologic conditions, plasma levels of disulfide forms CSSC, HcyS, CS-SP, and bHcy were significantly increased, whereas other redox forms of thiols were unchanged or showed variations opposite (increasing or decreasing) to control values. Maximal increases in disulfides and protein-thiol mixed disulfides were associated with renal failure. Our data suggest that increases in plasma bHcy concentrations in subjects with pathologic conditions were more likely the result of activation of thiol-disulfide exchange reactions between free reduced Hcy and CS-SP than of a direct action of reactive oxygen species.

An improved HPLC measurement for GSH and GSSG in human blood

The pathophysiological sequelae of oxidative/nitrosative stress are notoriously difficult to quantify. Despite these impediments, the medical significance of oxidative/nitrosative stress has become increasingly recognized to the point that it is now considered to be a component of virtually every disease. The level of oxidative stress can be quantified in blood by the measurement of the increase in glutathione disulfide (GSSG) and the decrease in the GSH/GSSG ratio, which has been shown to be altered in a variety of human diseases such as lung inflammation, amyotrophic lateral sclerosis, chronic renal failure, malignant disorders, and diabetes. Among the proposed methods for GSH/GSSG detection, the amino group derivatization with 2,4-dinitrofluorobenzene followed by HPLC separation has the advantage of allowing evaluation of both parameters within a single run contemporaneously. However, it has been shown that the application of this method on blood samples is not reproducible. In this report, we offer an explanation for these experimental limits and suggest some modifications that allow the application of this method to blood samples. The modified method has a low detection limit (0.5 microM, i.e., 1.4 pmoles) and a high reproducibility with a within-run imprecision of less than 2%. It could have a wide application as it is simple, virtually artifact-free, and not time-consuming, especially for large-scale screening studies.

The role of plasma thiol compounds and antioxidant vitamins in patients with cardiovascular diseases

BACKGROUND

Increased levels of homocysteine (Hcy) and cysteine (Cys) are associated with risk of cardiovascular diseases (CVD). These thiol compounds can generate various free radicals and so cause endothelial dysfunction. Antioxidant vitamins are effective scavengers of reactive oxygen species (ROS) and prevent endothelial dysfunction. In this study, we investigated the plasma homocysteine, cysteine, vitamins E, C and A, and beta-carotene (BC) levels in cardiovascular patients to compare with controls. We also investigated whether there is a correlation between the plasma thiol compounds and antioxidant vitamins.

METHODS

Blood samples were collected from 47 patients with cardiovascular disease (16 women and 31 men) and 21 healthy subjects (8 women and 13 men) in the overnight fasting state. Serum thiol compound and antioxidant vitamin levels were measured by high-pressure liquid chromatography (HPLC) methods.

RESULTS

The plasma homocysteine and cysteine levels were significantly higher in patients than those of controls. While vitamin C (VC), vitamin A (VA) and beta-carotene levels were significantly lower in patients than in controls, vitamin E (VE) levels did not change in both groups. There is a positive correlation between homocysteine and cysteine levels (r=0.622, p=0.000) in all study population. We found that the plasma level of homocysteine was significantly correlated in negative manner with vitamins E and A levels (r=-0.260, p=0.033 and r=-0.255, p=0.036, respectively) of all study population. Plasma cysteine levels were negatively correlated with only vitamin C levels (r=-0.320, p=0.008) in all study populations.

CONCLUSIONS

Our data suggest that Hcy and Cys are associated with cardiovascular disease and there is negative but weak correlation's between thiol compounds and antioxidant vitamins.

Analysis of glutathione: implication in redox and detoxification

BACKGROUND

Glutathione is a ubiquitous thiol-containing tripeptide, which plays a central role in cell biology. It is implicated in the cellular defence against xenobiotics and naturally occurring deleterious compounds, such as free radicals and hydroperoxides. Glutathione status is a highly sensitive indicator of cell functionality and viability. Its levels in human tissues normally range from 0.1 to 10 mM, being most concentrated in liver (up to 10 mM) and in the spleen, kidney, lens, erythrocytes and leukocytes. In humans, GSH depletion is linked to a number of disease states including cancer, neurodegenerative and cardiovascular diseases. The present review proposes an analysis of the current knowledge about the methodologies for measuring glutathione in human biological samples and their feasibility as routine methods in clinical chemistry. Furthermore, it elucidates the fundamental role of glutathione in pathophysiological conditions and its implication in redox and detoxification process.

TESTS AVAILABLE

Several methods have been optimised in order to identify and quantify glutathione forms in human biological samples. They include spectrophotometric, fluorometric and bioluminometric assays, often applied to HPLC analysis. Recently, a liquid chromatography-mass spectrometry technique for glutathione determination has been developed that, however, suffers from the lack of total automation and the high cost of the equipment.

CONCLUSION

Glutathione is a critical factor in protecting organisms against toxicity and disease. This review may turn useful for analysing the glutathione homeostasis, whose impairment represents an indicator of tissue oxidative status in human subjects.

Alteration in the redox state of plasma in heart-transplant patients with moderate hyperhomocysteinemia

Hyperhomocysteinemia has recently been suggested to contribute to the progression of the so-called chronic rejection or cardiac allograft vasculopathy (CAV) in heart-transplant patients in which the major determinant of the increase in homocysteine (Hcy) was the progressive decline of renal function. The exact mechanisms of tissue injury by Hcy is unknown, but some aspects of its toxicity have been related to its capacity for altering the redox state of plasma and forming protein adducts by intermediate lactone. To study the relationships between Hcy levels and variations in the redox state governed by thiols, plasma levels of Hcy, cysteine, glutathione, cysteinylglycine, and corresponding disulfides and protein-mixed disulfides were evaluated in subjects with moderate hyperhomocysteinemia represented by heart-transplant patients with (HTRF) and without (HT) renal failure, as well as patients with renal failure of different origin (RF), and compared with those of a control group (C) of normal subjects matched for age and sex. Plasma levels of Hcy and the corresponding protein mixed disulfides increased progressively in HTs, RFs, and HTRFs with respect to control. These changes were correlated with cysteine variations (as cystine and protein-mixed disulfides) but not with glutathione or cysteinylglycine that varied only as disulfides with a similar tendency. Moreover, an alteration in the plasma redox was evidenced by the decrease in thiol/disulfide ratios of cysteine, Hcy, and cysteinylglycine. In all groups, cysteine was directly correlated with Hcy but not with glutathione or cysteinylglycine, which in turn were correlated each other. Therefore levels of plasma cysteine were more linked to Hcy than to metabolism of glutathione. The clinical meaning of cysteine changes remains undefined and requires further study.

Plasma total cysteine, mortality, and cardiovascular disease hospitalizations: the Hordaland Homocysteine Study

BACKGROUND

We have previously reported a positive association between tHcy and mortality and cardiovascular disease (CVD) hospitalizations in the Hordaland Homocysteine Study cohort. Using the same data set, we assessed the relationship between plasma total cysteine (tCys) and mortality from all causes and from cardiovascular and noncardiovascular conditions, and the association between tCys and the risk of hospitalizations from CVD.

METHODS

We measured plasma tCys in blood samples from 12,595 men and women 40-42 years of age and from 4766 men and women 65-67 years of age, collected as part of the Hordaland Homocysteine Study in the year 1992-1993. Follow-up data on mortality were collected through 1999. Data on CVD hospitalizations were collected from hospital records up to May 31, 1998.

RESULTS

After a follow-up time of 6.6-7.6 years, there were a total of 610 deaths, of which 243 were cardiovascular deaths and 367 were noncardiovascular deaths. There was no association between tCys and all-cause, cardiovascular, or noncardiovascular mortality. When we used tCys values <247.6 micromol/L (lowest quartile) as the reference category, the adjusted mortality ratio (MR) for all-cause mortality at tCys concentrations of 247.6-270.79, 270.8-295.79, and > or =295.8 micromol/L (highest quartile) were 1.0, 0.9, and 1.0, respectively. The adjusted MRs for cardiovascular mortality were 1.0, 1.1, and 1.1, respectively. There were no associations between tCys and 1275 CVD hospitalizations, except that tCys was significantly associated with hospitalizations from coronary artery bypass grafting.

CONCLUSION

Plasma tCys is not associated with mortality or CVD hospitalizations.

Predictors of change in plasma total cysteine: longitudinal findings from the Hordaland homocysteine study

BACKGROUND

Total cysteine (tCys) in plasma has recently been linked to cardiovascular risk and is also associated with cardiovascular risk factors, including body mass index (BMI) and cholesterol. Changes and predictors of change in tCys concentrations over a mean follow-up time of 6.0 (5.2-7.2) years were assessed in this study.

METHODS

Baseline data from the Hordaland Homocysteine Study recorded in 1992-1993 included tCys, total homocysteine (tHcy), and various lifestyle and cardiovascular risk factors. In 1998-1999, the same measurements were repeated in 3,732 individuals born in 1950-1951 and 3,339 individuals born in 1925-1927. Most of the statistical analyses were done separately in the four age and sex groups.

RESULTS

The overall mean values of tCys were higher at follow-up [mean (SD), 296 (41) micro mol/L] than at baseline [278 (36.5) micro mol/L]; P <0.0001. The mean percentage of increase in tCys in the different age and sex groups ranged from 4.9% to 8.5%. There was a significant correlation between the tCys values measured on the two occasions (Spearman correlation coefficient, 0.55-0.59 in the different age and sex groups; P <0.0001). The change in tCys correlated with changes in BMI, cholesterol, and diastolic blood pressure in the younger age group, whereas only changes in BMI predicted changes in tCys in the older age group.

CONCLUSIONS

tCys increased in the 6 years between the two measurements. Factors related to the baseline tCys values, including BMI and the change in BMI, predicted the tCys changes over time.

Homocysteine is the only plasma thiol associated with carotid artery remodeling

Several authors have reported that moderate hyperhomocysteinemia is related to asymptomatic carotid arterial wall remodeling, but few data are available on other thiol compounds with potential vascular toxicity. We, therefore, investigated the relationships between major plasma thiol compounds (homocysteine, cysteine and glutathione) and the structural phenotype of the common carotid artery in a cohort of 123 subjects with no evidence of cardiovascular disease. Fasting levels of thiol compounds were measured by high-performance liquid chromatography, and arterial geometry was evaluated using high-resolution echotracking devices. In univariate regression analysis, plasma homocysteine and plasma cysteine concentrations were positively associated with carotid artery internal diameter (P=0.0001 and 0.002, respectively) and intima media thickness (P=0.003 and 0.004), but the plasma glutathione concentration was not. In multivariate analysis, plasma homocysteine was independently and positively associated with carotid artery internal diameter (P<0.005) and intima media thickness (P<0.05), but plasma cysteine was not. These data suggest that homocysteine is the only plasma thiol compound that may be considered as a risk factor for preclinical cardiovascular disease.

The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia

Cardiovascular disease is the leading cause of mortality in uremic patients. In large cross-sectional studies of dialysis patients, traditional cardiovascular risk factors such as hypertension and hypercholesterolemia have been found to have low predictive power, while markers of inflammation and malnutrition are highly correlated with cardiovascular mortality. However, the pathophysiology of the disease process that links uremia, inflammation, and malnutrition with increased cardiovascular complications is not well understood. We hereby propose the hypothesis that increased oxidative stress and its sequalae is a major contributor to increased atherosclerosis and cardiovascular morbidity and mortality found in uremia. This hypothesis is based on studies that conclusively demonstrate an increased oxidative burden in uremic patients, before and particularly after renal replacement therapies, as evidenced by higher concentrations of multiple biomarkers of oxidative stress. This hypothesis also provides a framework to explain the link that activated phagocytes provide between oxidative stress and inflammation (from infectious and non-infections causes) and the synergistic role that malnutrition (as reflected by low concentrations of albumin and/or antioxidants) contributes to the increased burden of cardiovascular disease in uremia. We further propose that retained uremic solutes such as beta-2 microglobulin, advanced glycosylated end products (AGE), cysteine, and homocysteine, which are substrates for oxidative injury, further contribute to the pro-atherogenic milieu of uremia. Dialytic therapy, which acts to reduce the concentration of oxidized substrates, improves the redox balance. However, processes related to dialytic therapy, such as the prolonged use of catheters for vascular access and the use of bioincompatible dialysis membranes, can contribute to a pro-inflammatory and pro-oxidative state and thus to a pro-atherogenic state. Anti-oxidative therapeutic strategies for patients with uremia are in their very early stages; nonetheless, early studies demonstrate the potential for significant efficacy in reducing cardiovascular complications.

Plasma sulfur amino acids in relation to cardiovascular disease, nutritional status, and diabetes mellitus in patients with chronic renal failure at start of dialysis therapy

Sulfur amino acids (sAAs) are potential candidates as risk factors for cardiovascular disease (CVD). However, we recently reported that chronic hemodialysis patients with CVD had a greater prevalence of malnutrition, hypoalbuminemia, and lower plasma total homocysteine (tHcy) levels than those without CVD. In this cross-sectional study, we examined the relationship of plasma sAAs to CVD and nutritional status in 151 patients with chronic renal failure (CRF) close to the start of regular dialysis treatment (33 +/- 7 days before the first dialysis treatment). Clinical signs of CVD were present in 32% of patients with CRF, 41% had malnutrition assessed by subjective global nutritional assessment (SGNA) score, and 26% had diabetes mellitus (DM). Plasma tHcy levels were high in 91% of patients, as were plasma total cysteine (tCys) levels, whereas plasma methionine (Met) and taurine (Tau) levels were normal. Patients with CRF who had CVD were older, more often malnourished, and had lower tHcy and serum albumin (s-albumin) levels and a greater frequency of DM than those without CVD. Plasma tCys, Met, and Tau levels did not differ between patients with CRF with and without CVD. The tCys-tHcy ratio was higher in patients with CVD and related to SGNA score and DM. Moreover, this ratio, but not tHcy or tCys level, correlated with age and triglyceride, total cholesterol, and apolipoprotein B levels. Malnutrition and hypoalbuminemia were associated with low plasma sAA levels (tHcy, Met, and Tau); tCys was related to s-albumin level, but not SGNA score. Among patients with diabetes, sAA levels did not differ between patients with and without CVD or between malnourished and well-nourished patients. In conclusion, patients with CRF at the start of dialysis treatment with CVD were more often diabetic, malnourished, and had lower s-albumin and tHcy levels and a higher tCys-tHcy ratio than patients with no CVD. tCys-tHcy ratio, but not tHcy or tCys levels per se, was related to cardiovascular risk factors, suggesting that cysteine may have a role in the development of CVD. Malnutrition, hypoalbuminemia, and DM in patients with CRF influence sAA levels, mainly plasma tHcy, which should be considered when evaluating hyperhomocysteinemia as a cardiovascular risk factor.

Combined cysteine and homocysteine quantitation in plasma by trap and release membrane introduction mass spectrometry

Recently, a new and efficient method for total homocysteine (tHcy) quantitation in plasma using trap and release membrane introduction mass spectrometry (T&R-MIMS) with a versatile removable direct introduction membrane probe (DIMP) was described [R. Haddad, M. A. Mendes, N. F. Hoehr and M. N. Eberlin, Analyst, 2001, 126, 1212]. Herein we report on the use of the DIMP-T&R-MIMS technique for total cysteine (tCys) quantitation; hence combined tCys and tHcy quantitation in plasma or serum can be achieved. The method employs Cys and Hcy derivatization with ethyl chloroformate (after disulfide bond reduction with dithiothreitol and protein precipitation with trichloroacetic acid), preconcentration in a capillary silicone membrane, and their thermal desorption to the gas phase inside the ion source region of a mass spectrometer, at a point exactly between the two ionization filaments. Thermal desorption uses the uniform heat radiation provided by the two ionization filaments. The analytes are then ionized by electron ionization and both Cys and Hcy are quantitated by mass spectrometry using selected ion monitoring. For tCys quantitation, good linearity and reproducibility was observed for concentrations ranging from 5 to 350 microM, recovery was near 95%, and the limit of detection (LOD) was of 2 microM. This LOD is well below the mean Cys concentration in plasma, and serum samples from a large group of healthy people showed a mean tCys concentration of 132 +/- 45 microM.

The Hordaland Homocysteine Studies

The Hordaland Homocysteine Study is a population-based screening of total plasma homocysteine (tHcy) in approximately 18,000 men and women aged 40-67 yr that took place in 1992-1993 in the county of Hordaland in Western Norway. In this cohort, tHcy was associated with several physiologic and life-style factors, including age and gender, blood pressure, serum cholesterol, smoking, alcohol and coffee consumption, physical activity, diet, and vitamin status. All associations with established cardiovascular risk factors were in the direction expected to confer increased risk. In a subset of 5,883 women aged 40-42 yr, tHcy was associated with previous pregnancy outcomes, including preeclampsia, placental abruption, and neural tube defects. This article reviews the published results from the Hordaland Homocysteine Study in the light of relevant literature. The Hordaland Homocysteine cohort will be used for future investigations of the stability of tHcy and vitamin status over time, and to investigate associations with mortality and morbidity including cancer incidence.

Blood Glutathione Disulfide: In Vivo Factor or in Vitro Artifact?

Background: The reported mean concentration of glutathione disulfide (GSSG) in human blood/erythrocytes varies widely (1 to &gt;500 μmol/L), as does that of reduced glutathione (GSH) to a lesser extent. We have identified and investigated possible pitfalls in measurement of both GSH and GSSG.

Methods: We measured GSH and GSSG using a spectrophotometer with a modification of the GSH recycling method; the same samples were also measured by reversed-phase HPLC after derivatization of thiols (dithiothreitol was used to reduce disulfides) with monobromobimane. The thiol-bimane adduct was measured by a fluorescence detector.

Results: Measured GSH/GSSG concentrations were affected by the following: (a) oxidation of thiols in acidified samples; (b) oxidation after restoring neutral-alkaline pH; (c) oxidation during acid deproteinization; (d) shift in the GSH/GSSG equilibrium because of irreversible blocking of free thiols; and (e) reaction of electrophiles with amino groups. In particular, oxidation during sample deproteinization with acid influenced and produced artifacts (30–150 μmol/L GSSG was produced by this procedure); this phenomenon was directly correlated with the presence of oxygenated hemoglobin, being minimized by both oxygen deprivation and incubation in an atmosphere of 5% carbon monoxide.

Conclusions: GSSG is present in healthy human blood at low concentrations (2–6 μmol/L), and most published data on GSSG may be affected by artifacts.

Plasma aminothiol oxidation in chronic hemodialysis patients

BACKGROUND

Plasma aminothiols, including homocysteine, cysteine, and glutathione, function as an important extracellular redox system. We examined the plasma aminothiol concentration and redox status in ten chronic hemodialysis patients compared to ten age-matched healthy subjects.

METHODS

Plasma levels of reduced, free oxidized, and protein-bound homocysteine, cysteine, cysteinylglycine, and glutathione were determined using high-pressure liquid chromatography (HPLC).

RESULTS

Total plasma homocysteine, cysteine, and cysteinylglycine levels were significantly elevated in hemodialysis patients before dialysis compared to healthy subjects. Total plasma concentration of cysteine and homocysteine significantly decreased after hemodialysis. The ratio of free oxidized to free reduced homocysteine, cysteine, cysteinylglycine, and glutathione were each significantly elevated before dialysis compared to healthy subjects, and decreased significantly by the end of dialysis. The free oxidized to reduced ratio of cysteine and homocysteine were also significantly correlated with total plasma concentrations.

CONCLUSIONS

Plasma aminothiols are excessively oxidized in uremia, while the hemodialysis procedure is restorative of redox status. Oxidized aminothiols are candidate uremic toxins.

Erythrocytic glutathione and plasma cysteine status of human immunodeficient patients

Both deficient and normal blood levels of glutathione (GSH) and cysteine (Cys) have been reported in HIV patients, a discrepancy that has been attributed to different methodologies. The goal of this study was to apply our analytical method to this problem. Blood samples from HIV patients and healthy subjects were collected, immediately stabilized, and quantified using high performance liquid chromatography with dual electrochemical detection. The results showed that the erythrocytic GSH levels were the same in healthy subjects and in HIV patients regardless of their CD4 lymphocyte level. Only those with the lowest CD4 level plus opportunistic infections had supranormal [corrected] GSH concentrations (P < 0.001). GSH plus glutathione disulfide (GSSG) levels also were normal in patients. However, the Cys contents were higher in patients than in controls (P < 0.05). These findings demonstrated that HIV patients have normal erythrocytic GSH concentrations and supranormal Cys levels.

Measurement of Homocysteine and Other Aminothiols in Plasma: Advantages of Using Tris(2-carboxyethyl)phosphine as Reductant Compared with Tri-n-butylphosphine

Background: Aminothiols have been implicated in the pathogenesis of arteriosclerosis, and reliable methods are needed to determine their concentrations in body fluids. We present a comparison of two analytical methods and focus on the reduction of low-molecular weight and protein-mixed disulfides of homocysteine, cysteine, cysteinyl-glycine, and glutathione.

Methods: The plasma total aminothiol profile was determined by HPLC with fluorescence detection after derivatization with ammonium 7-fluorobenzo-2-oxa-1,3-diazole-4-sulfonate. Disulfides and protein-bound aminothiols were reduced by either tri-n-butylphosphine (the TBP method) or tris(2-carboxyethyl)phosphine (the TCEP method); the effects of temperature, time of reduction, and concentration of reductants were evaluated.

Results: The intraassay imprecision (CV) was &lt;3% for all aminothiols using both methods. The interassay CVs for total cysteine (tCys), total cysteinyl-glycine (tCys-Gly), and total homocysteine (tHcy) were &lt;4% and &lt;8% for the TCEP and TBP methods, respectively, whereas for total glutathione (tGSH) the interassay CV was &gt;12% for both methods. Deming regression and Bland–Altman difference plots showed positive biases for total aminothiol concentrations determined by the TCEP method relative to the TBP method. The mean proportional biases were 65%, 27%, 6%, and 60% for tCys, tCys-Gly, tHcy, and tGSH, respectively. The calculated concentrations of total aminothiols by the TCEP method were less influenced by changes in temperature and concentration of reducing agent or by calibrator matrix.

Conclusions: The agreement between the TCEP and TBP methods was considerably lower for the determination of tCys, tCys-Gly, and tGSH than for tHcy. For total-aminothiol determination, the TCEP method yields better reproducibility and is more robust than the TBP method.

Plasma total cysteine as a risk factor for vascular disease: The European Concerted Action Project

BACKGROUND

Elevated plasma total homocysteine (tHcy) is a risk factor for cardiovascular disease. Although cysteine is structurally similar and metabolically linked to tHcy, its relation to the risk of cardiovascular disease has received little attention. We studied the relation between plasma total cysteine (tCys) levels and the risk of vascular disease in the coronary, cerebral, and peripheral vessels.

METHODS AND RESULTS

This case-control study included 750 patients with vascular disease and 800 age- and sex-matched control subjects recruited from 19 centers in 9 European countries. Conventional risk factors for cardiovascular disease were recorded. In addition, plasma levels of tCys, tHcy, folate, B(6), B(12), and creatinine were measured. Overall, a U-shaped relationship was observed between tCys and risk of vascular disease. With the middle range of 250 to 275 micromol/L tCys used as the reference category, the adjusted risk of vascular disease at low (</=225 micromol/L) tCys levels was 2.1 (95% CI 1.2 to 3.6), and the risk at high (>300 micromol/L) tCys levels was 1.6 (95% CI 1.1 to 2.3). Different shapes of the dose-response relationship were seen for the 3 vascular disease categories. The relation with peripheral vascular and cerebrovascular disease was U-shaped, whereas a weak positive relation was observed with coronary heart disease.

CONCLUSIONS

Our data show a significant U-shaped relationship between tCys and cardiovascular disease after adjustment for tHcy, creatinine, and other cardiovascular disease risk factors.

Impaired homocysteine metabolism and atherothrombotic disease

Based on recent retrospective, prospective, and experimental studies, mild to moderate elevation of fasting or postmethionine-load plasma homocysteine is accepted as an independent risk factor for cardiovascular disease and thrombosis in both men and women. Hyperhomocysteinemia results from an inhibition of the remethylation pathway or from an inhibition or a saturation of the transsulfuration pathway of homocysteine metabolism. The involvement of a high dietary intake of methionine-rich animal proteins has not yet been investigated and cannot be ruled out. However, folate deficiency, either associated or not associated with the thermolabile mutation of the N(5,10)-methylenetetrahydrofolate reductase, and vitamin B(6) deficiency, perhaps associated with cystathionine beta-synthase defects or with methionine excess, are believed to be major determinants of the increased risk of cardiovascular disease related to hyperhomocysteinemia. Recent experimental studies have suggested that moderately elevated homocysteine levels are a causal risk factor for atherothrombotic disease because they affect both the vascular wall structure and the blood coagulation system. The oxidant stress that results from impaired homocysteine metabolism, which modifies the intracellular redox status, might play a central role in the molecular mechanisms underlying moderate hyperhomocysteinemia-mediated vascular disorders. Because folate supplementation can efficiently reduce plasma homocysteine levels, both in the fasting state and after methionine loading, results from further prospective cohort studies and from on-going interventional trials will determine whether homocysteine-lowering therapies can contribute to the prevention and reduction of cardiovascular risk. Additionally, these studies will provide unequivocal arguments for the independent and causal relationship between hyperhomocysteinemia and atherothrombotic disease.