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Wen Z, Feng X, Tong X, Peng C, Xu A, Fan H, Bi Y, Liu W, Li Z, Guo S, Jin F, Li R, Liu Y, Su S, Zhang X, Li X, He X, Liu A, Duan C. A Mendelian randomisation, propensity score matching study to investigate causal association between serum homocysteine and intracranial aneurysm. Stroke Vasc Neurol 2024; 9:202-211. [PMID: 37507145 PMCID: PMC11221312 DOI: 10.1136/svn-2023-002414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Recent observational studies have reported that serum total homocysteine (tHcy) is associated with intracranial aneurysms (IAs). However, the causal effect of tHcy on IAs is unknown. We leveraged large-scale genetic association and real-world data to investigate the causal effect of tHcy on IA formation. METHODS We performed a two-sample Mendelian randomisation (MR) using publicly available genome-wide association studies summary statistics to investigate the causal relationship between tHcy and IAs, following the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology-MR statement. Furthermore, a propensity score matching (PSM) analysis was conducted to evaluate the detailed effects of tHcy on risk of IA formation by utilizing real-world multicentre data, including 9902 patients with and without IAs (1:1 matched). Further interaction and subgroup analyses were performed to elucidate how tHcy affects risk of IA formation. RESULTS MR analyses indicated that genetically determined tHcy was causally associated with IA risk (OR, 1.38, 95% CI 1.07 to 1.79; p=0.018). This is consistent with the more conservative weighted median analysis (OR, 1.41, 95% CI 1.03 to 1.93; p=0.039). Further sensitivity analyses showed no evidence of horizontal pleiotropy or heterogeneity of single nucleotide polymorphisms in causal inference. According to the PSM study, we found that, compared with low tHcy (≤15 µmol/L), moderate tHcy (>15-30 µmol/L) (OR 2.13, 95% CI 1.93 to 2.36) and high tHcy (>30 µmol/L) (OR 3.66, 95% CI 2.71 to 4.95) were associated with a higher IA risk (p trend <0.001). Subgroup analyses demonstrated significant ORs of tHcy in each subgroup when stratified by traditional cardiovascular risk factors. Furthermore, there was also a synergistic effect of tHcy and hypertension on IA risk (p interaction <0.001; the relative excess risk due to interaction=1.65, 95% CI 1.29 to 2.01). CONCLUSION Both large-scale genetic evidence and multicentre real-world data support a causal association between tHcy and risk of IA formation. Serum tHcy may serve as a biomarker to identify high-risk individuals who would particularly benefit from folate supplementation.
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Affiliation(s)
- Zhuohua Wen
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Peng
- Department of Neurosurgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Anqi Xu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Haiyan Fan
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiming Bi
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wenchao Liu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenjun Li
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shenquan Guo
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fa Jin
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ran Li
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yanchao Liu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shixing Su
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Zhang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xifeng Li
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuying He
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanzhi Duan
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Mota Telles JP, Rosi Junior J, Yamaki VN, Rabelo NN, Teixeira MJ, Figueiredo EG. Homocysteine serum levels in patients with ruptured and unruptured intracranial aneurysms: a case-control study. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-6. [PMID: 38325387 PMCID: PMC10849822 DOI: 10.1055/s-0044-1779270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. OBJECTIVE To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. METHODS This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. RESULTS A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75µmol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5µmol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15µmol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30µmol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS≤1) (OR = 1.04; 95% CI = 0.94-1.16). CONCLUSION There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes.
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Affiliation(s)
- João Paulo Mota Telles
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
| | - Jefferson Rosi Junior
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Vitor Nagai Yamaki
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Nicollas Nunes Rabelo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Neurocirurgia, São Paulo SP, Brazil.
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Ma C, Zhang W, Mao L, Zhang G, Shen Y, Chang H, Xu X, Li Z, Lu H. Hyperhomocysteinemia and intracranial aneurysm: A mendelian randomization study. Front Neurol 2022; 13:948989. [PMID: 36247759 PMCID: PMC9554923 DOI: 10.3389/fneur.2022.948989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the link between genetic variants associated with plasma homocysteine levels and risk of intracranial aneurysm (IA) using two-sample Mendelian randomization. Methods We used single-nucleotide polymorphisms associated with human plasma homocysteine levels as instrumental variables for the primary analysis in a genome-wide association study of 44,147 subjects of European ancestry. Summary-level statistics were obtained for 79,429 individuals, including 7,495 IA cases and 71,934 controls. To enhance validity, five different Mendelian randomization methods (MR-Egger, weighted median, inverse variance weighted, simple mode, and weighted mode) were used for the analyses. Results The inverse variance weighted analysis method produced P-values of 0.398 for aneurysmal subarachnoid hemorrhage [odds ratio (OR): 1.104; 95% confidence interval (CI): 0.878–1.387], 0.246 for IA (OR: 1.124; 95% CI: 0.923–1.368), and 0.644 for unruptured IA (OR: 1.126; 95% CI: 0.682–1.858). The MR-Egger analysis showed no association between IAs and homocysteine, with all P > 0.05. Conclusion Using gene-related instrumental variables, the Mendelian randomization analyses demonstrated a lack of an association between plasma homocysteine levels and IAs or aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Chencheng Ma
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Weiwei Zhang
- Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Nanjing, China
| | - Lei Mao
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Guangjian Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Yuqi Shen
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Hanxiao Chang
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Xiupeng Xu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
| | - Zheng Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- *Correspondence: Zheng Li
| | - Hua Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Hua Lu
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Wei S, Yuan X, Li D, Guo X, Guan S, Xu Y. Homocysteine Levels Are Associated With the Rupture of Intracranial Aneurysms. Front Neurosci 2022; 16:945537. [PMID: 35911998 PMCID: PMC9330164 DOI: 10.3389/fnins.2022.945537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Homocysteine (Hcy) levels may be associated with the development of intracranial aneurysms (IAs). However, whether it increases the risk of rupture of IAs is unknown. This study aimed to determine the association between homocysteine levels and IA rupture. Methods We retrospectively reviewed patients with IAs and subarachnoid hemorrhage (SAH) at our hospital between January 2019 and May 2021. Clinical data, including Hcy levels and IA images, were assessed. The association between Hcy level and IA rupture was investigated using multivariate logistic regression analyses in patients with IAs and SAH. Results A total of 589 patients were included. 546 patients with IAs, including 331 UIA (Unruptured IA) and 215 RIA (Ruptured IA). The average age was 57.43 ± 10.86 years old, and 67.03% were women. Among them, all 215 RIAs lead to SAH. In addition, we also enrolled 43 non-aneurysmal subarachnoid hemorrhage (Na-SAH) patients. The average age was 54.12 ± 10.55 years old, and 53.48% were female. After adjusting for confounders in the multivariate model, Hcy levels were correlated with the rupture of IA (odds ratio [OR] 1.069; 95% confidence interval [CI] 1.025–1.114, p = 0.002) and a-SAH (OR 1.083; 95% CI 1.002–1.170, p = 0.046). Conclusion Hcy levels were associated with IA rupture. These findings provide novel insights into IAs rupture, and future studies are needed to confirm this relationship.
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Affiliation(s)
- Sen Wei
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Xin Yuan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Dongdong Li
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Xinbin Guo
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
| | - Sheng Guan
- Department of Neurointervention, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
- *Correspondence: Sheng Guan,
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University at Zhengzhou, Zhengzhou, China
- Yuming Xu,
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Zhang H, Yin D, Zhao Y, Li Y, Yao D, Sun D. Relationship between total plasma homocysteine and the risk of aneurysms - a meta-analysis. VASA 2020; 50:110-115. [PMID: 32933402 DOI: 10.1024/0301-1526/a000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Our meta-analysis focused on the relationship between homocysteine (Hcy) level and the incidence of aneurysms and looked at the relationship between smoking, hypertension and aneurysms. A systematic literature search of Pubmed, Web of Science, and Embase databases (up to March 31, 2020) resulted in the identification of 19 studies, including 2,629 aneurysm patients and 6,497 healthy participants. Combined analysis of the included studies showed that number of smoking, hypertension and hyperhomocysteinemia (HHcy) in aneurysm patients was higher than that in the control groups, and the total plasma Hcy level in aneurysm patients was also higher. These findings suggest that smoking, hypertension and HHcy may be risk factors for the development and progression of aneurysms. Although the heterogeneity of meta-analysis was significant, it was found that the heterogeneity might come from the difference between race and disease species through subgroup analysis. Large-scale randomized controlled studies of single species and single disease species are needed in the future to supplement the accuracy of the results.
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Affiliation(s)
- Hanji Zhang
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Dexin Yin
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Yue Zhao
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Yezhou Li
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
| | - Dejiang Yao
- Department of Chinese medicine, Third department of surgery, The Center Hospital of Enshi Tujia and Miao Autonomous Prefecture, Wuhan University, Enshi City, Hubei Province, China
| | - Dajun Sun
- Department of Vascular Surgery, China-Japan Union Hospital, Jilin University, Changchun City, Jilin Province, China
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Li D, Zhao Q, Huang X, Zhang C, Godfrey O, Zhang W. Association of genetic and epigenetic variants in one-carbon metabolism gene with folate treatment response in hyperhomocysteinaemia. Eur J Clin Nutr 2020; 74:1073-1083. [PMID: 32203239 DOI: 10.1038/s41430-020-0611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Folate supplementation treatment is the first-line therapy in hyperhomocysteinaemia (HHcy). Up to 40% of HHcy patients do not benefit from folate therapy. Genetic and epigenetic factors of one-carbon metabolism (1-CM) might be identified as a predictor of folate supplementation treatment response. In the present study, we attempt to identify whether genetic and epigenetic factors might predict folate treatment response. METHODS A total of 230 patients with HHcy were involved in this prospective cohort study. Differences between baseline concentrations and concentrations obtained at 90 days of treatment were calculated to evaluate the treatment response. General linear models and Pearson correlation was used to explore associations among single-nucleotide polymorphisms (SNPs), DNA methylation, and folate treatment response. Finally, mediation analysis was performed to investigate whether DNA methylation of MTRR mediates the association between SNPs and treatment response. RESULTS MTHFD rs1950902 and MTRR rs162036, rs1801394 was associated with the folate treatment response (P = 0.000, 0.048, and 0.043, respectively). CBS and CBS_2 DNA methylation was significantly associated with folate treatment response (P = 0.0009 and < 0.001). DNA methylation of MTHFR, MTR, and MTRR was also significantly associated with folate treatment response (P < 0.001). DNA methylation of MTRR and MTRR_1 mediated 40.71% and 40.47% of the effect of rs1801394 on folate treatment response, respectively. CONCLUSIONS Our results indicated that the 1-CM gene SNPs and DNA methylation was associated with folate treatment response and can be further evaluated relationship between SNPs and DNA methylation in 1-CM with treatment response in a larger sample.
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Affiliation(s)
- Dankang Li
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Qinglin Zhao
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Xiaowen Huang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Chengda Zhang
- Department of International Medicine, Beaumont Health System, Royal Oak, MI, 48073, USA
| | - Opolot Godfrey
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Weidong Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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Li D, Zhao Q, Zhang C, Huang X, Godfrey O, Zhang W. Associations of MTRR A66G polymorphism and promoter methylation with ischemic stroke in patients with hyperhomocysteinemia. J Gene Med 2020; 22:e3170. [DOI: 10.1002/jgm.3170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Dankang Li
- Department of Epidemiology, School of Public HealthZhengzhou University Zhengzhou Henan China
| | - Qinglin Zhao
- Department of Epidemiology, School of Public HealthZhengzhou University Zhengzhou Henan China
| | - Chengda Zhang
- Department of International Medicine, Beaumont Health System Royal Oak MI USA
| | - Xiaowen Huang
- Department of Epidemiology, School of Public HealthZhengzhou University Zhengzhou Henan China
| | - Opolot Godfrey
- Department of Epidemiology, School of Public HealthZhengzhou University Zhengzhou Henan China
| | - Weidong Zhang
- Department of Epidemiology, School of Public HealthZhengzhou University Zhengzhou Henan China
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