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Chmurzynska A, Seremak‐Mrozikiewicz A, Malinowska AM, Różycka A, Radziejewska A, KurzawiŃska G, Barlik M, Wolski H, Drews K. Associations between folate and choline intake, homocysteine metabolism, and genetic polymorphism of
MTHFR, BHMT
and
PEMT
in healthy pregnant Polish women. Nutr Diet 2019; 77:368-372. [DOI: 10.1111/1747-0080.12549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Agata Chmurzynska
- Institute of Human Nutrition and DieteticsPoznań University of Life Sciences Poznań Poland
| | - Agnieszka Seremak‐Mrozikiewicz
- Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
- Laboratory of Molecular Biology, Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
| | - Anna M. Malinowska
- Institute of Human Nutrition and DieteticsPoznań University of Life Sciences Poznań Poland
| | - Agata Różycka
- Department of Biochemistry and Molecular BiologyPoznań University of Medical Sciences Poznań Poland
| | - Anna Radziejewska
- Institute of Human Nutrition and DieteticsPoznań University of Life Sciences Poznań Poland
| | - Grażyna KurzawiŃska
- Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
- Laboratory of Molecular Biology, Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
| | - Magdalena Barlik
- Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
- Laboratory of Molecular Biology, Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
| | - Hubert Wolski
- Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
- Division of Gynecology and ObstetricsPodhale Multidisciplinary Hospital Nowy Targ Poland
| | - Krzysztof Drews
- Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
- Laboratory of Molecular Biology, Division of Perinatology and Women's DiseasesPoznań University of Medical Sciences Poznań Poland
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Teixeira JA, Steluti J, Gorgulho BM, Carioca AAF, Alencar GP, Fisberg RM, Marchioni DM. Prudent dietary pattern influences homocysteine level more than folate, vitamin B12, and docosahexaenoic acid: a structural equation model approach. Eur J Nutr 2019; 59:81-91. [DOI: 10.1007/s00394-018-1886-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
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3
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C677T and A1298C polymorphisms of Methylenetetrahydrofolate reductase (MTHFR) gene: Effect and risk to develop chronic myeloid leukemia: A study on Syrian patients. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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4
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Role of homocysteine in end-stage renal disease. Clin Biochem 2012; 45:1286-94. [PMID: 22683753 DOI: 10.1016/j.clinbiochem.2012.05.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 04/26/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022]
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5
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Huang T, Tucker KL, Lee YC, Crott JW, Parnell LD, Shen J, Smith CE, Ordovas JM, Li D, Lai CQ. Methylenetetrahydrofolate reductase variants associated with hypertension and cardiovascular disease interact with dietary polyunsaturated fatty acids to modulate plasma homocysteine in puerto rican adults. J Nutr 2011; 141:654-9. [PMID: 21270364 PMCID: PMC3056580 DOI: 10.3945/jn.110.134353] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although methylenetetrahydrofolate reductase (MTHFR) genetic variants are associated with plasma homocysteine (Hcy) and cardiovascular disease (CVD), little is known whether dietary fatty acid intake modulates these associations. The goal was to examine the interaction of MTHFR variants with dietary fatty acids influencing plasma Hcy in 995 Boston Puerto Rican adults. We found that plasma Hcy concentration was negatively correlated with (n-3) PUFA intake (r = -0.117; P = 0.022), and the ratio of (n-3):(n-6) PUFA in the diet (r = -0.122; P = 0.009). Further, 2 functional MTHFR variants, 1298A>C and 677C>T, which are not in linkage disequilibrium in this population, were significantly associated with hypertension (OR = 1.72, P = 0.024, and OR = 1.60, P = 0.002, respectively). In addition, the 1298A>C variant was significantly associated with CVD (OR = 3.32; P = 0.030). Importantly, this variant exhibited significant interactions with intakes of total and (n-6) PUFA and the (n-3):(n-6) PUFA ratio of the diet. The plasma Hcy concentration of carriers of risk allele 1298C was greater than that of noncarriers only when participants had consumed a high-PUFA diet (>7.8% energy) but was not greater when they had low intake of PUFA (≤7.8% energy). In addition, participants with combined genotypes of both SNP (677 TT with 1298 AC or CC) who consumed high levels of (n-3) PUFA (>0.66% energy) had lower plasma Hcy compared with those who had the same genotype and consumed low levels of (n-3) PUFA (≤0.66% energy). Our study suggests that dietary PUFA intake modulates the effect of 2 MTHFR variants on plasma Hcy in Boston Puerto Rican adults.
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Affiliation(s)
- Tao Huang
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, 310029 China,Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111,APCNS Centre of Nutrition and Food Safety, Hangzhou, China
| | | | - Yu-Chi Lee
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Jimmy W. Crott
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Laurence D. Parnell
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Jian Shen
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Caren E. Smith
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Jose M. Ordovas
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111
| | - Duo Li
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, 310029 China,APCNS Centre of Nutrition and Food Safety, Hangzhou, China,To whom correspondence should be addressed. E-mail: ,
| | - Chao-Qiang Lai
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111,To whom correspondence should be addressed. E-mail: ,
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6
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The factors that affect plasma homocysteine levels, pulse wave velocity and their relationship with cardiovascular disease indicators in peritoneal dialysis patients. Int Urol Nephrol 2009; 42:211-8. [DOI: 10.1007/s11255-009-9625-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 07/22/2009] [Indexed: 11/26/2022]
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7
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Domenici FA, Vannucchi MTI, Simões-Ambrósio LMC, Vannucchi H. Hyperhomocysteinemia and polymorphisms of the methylenetetrahydrofolate gene in hemodialysis and peritoneal dialysis patients. Mol Nutr Food Res 2007; 51:1430-6. [DOI: 10.1002/mnfr.200700114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Poduri A, Mukherjee D, Sud K, Kohli HS, Sakhuja V, Khullar M. MTHFR A1298C polymorphism is associated with cardiovascular risk in end stage renal disease in North Indians. Mol Cell Biochem 2007; 308:43-50. [PMID: 17899317 DOI: 10.1007/s11010-007-9610-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 09/13/2007] [Indexed: 11/28/2022]
Abstract
The methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism has been shown to be associated with cardiovascular disease and in patients with end-stage renal disease (ESRD). However, the relationship between MTHFR polymorphisms and cardiovascular disease (CVD) in patients on hemodialysis has not been examined. The aim of this study was to assess the association of polymorphisms of MTHFR gene with homocysteine (Hcy) and intimal medial thickness (IMT) in patients on hemodialysis. We performed case-control study involving107 patients with ESRD and 103 healthy controls. Plasma Hcy was measured in all the subjects and these subjects were genotyped for three MTHFR polymorphisms (C677T, A1298C, and G1793A). We observed significantly higher Hcy levels in patients as compared to controls. The frequency of MTHFR 1298CC genotype was significantly higher in ESRD patients than in controls (21.4% vs. 2.9%); the frequency of the MTHFR C677T genotypes did not differ between groups (26.1% vs. 17.4%). Compound heterozygous MTHFR 677CT/1298AC genotypes showed maximum association with the risk of ESRD (OR: 12.8; 5%CI: 1.64-10.01, P < 0.05). Concurrent occurrence of MTHFR 677CC wild genotype with either 1298CC or 1793GA significantly increased the risk of disease (OR: 7.20; 95%CI: 2.06-2.51, P < 0.001 and OR: 7.60; 95%CI: 1.68-34.35; P < 0.05, respectively). MTHFR 1298CC genotype was associated with higher Hcy levels. IMT was also significantly higher in patients with the 1298CC genotype (P < 0.05). Thus, A1298C polymorphism of MTHFR gene appears to be associated with the severity of carotid atherosclerosis and co-occurrence of MTHFR polymorphisms may be a risk factor for CVD in patients on hemodialysis.
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Affiliation(s)
- Aruna Poduri
- Department of Experimental Medicine & Biotechnology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh 160012, India
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9
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Mallamaci F, Bonanno G, Seminara G, Rapisarda F, Fatuzzo P, Candela V, Scudo P, Spoto B, Testa A, Tripepi G, Tech S, Zoccali C. Hyperhomocysteinemia and arteriovenous fistula thrombosis in hemodialysis patients. Am J Kidney Dis 2005; 45:702-7. [PMID: 15806473 DOI: 10.1053/j.ajkd.2005.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To date, the relationship between vascular access (VA) failure and plasma total homocysteine level has been investigated only in mixed dialysis populations (ie, patients with a native arteriovenous [AV] fistula or arterial graft), whereas almost no data exist for hemodialysis patients with a native AV fistula. METHODS In this prospective cohort study, we examined the relationship between plasma total homocysteine level and the methylenetetrahydrofolate reductase (MTHFR) gene and VA-related incident morbidity in a cohort of 205 hemodialysis patients, all with a native AV fistula. RESULTS During follow-up, 78 patients experienced 1 or more VA thrombotic episodes. Patients with incident VA thrombosis had a significantly greater plasma total homocysteine level compared with patients without this event (P = 0.046). In Kaplan-Meier survival analysis, the hazard ratio for VA thrombosis increased in parallel with homocysteine level, such that patients in the third homocysteine level tertile had a relative risk for this outcome 1.72 times (95% CI, 1.21 to 2.24) greater than in those in the first tertile (log-rank test, 6.81; P = 0.009). In a multiple Cox regression model, plasma total homocysteine level was confirmed to be an independent predictor of AV fistula outcome. Plasma total homocysteine level was significantly greater (P < 0.001) in patients with the TT genotype of the MTHFR gene than in those with the CT or CC genotype. CONCLUSION VA thrombosis in dialysis patients is associated with hyperhomocysteinemia. Intervention studies are needed to clarify whether decreasing plasma homocysteine concentrations may prevent VA failure in hemodialysis patients.
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Affiliation(s)
- Francesca Mallamaci
- Division of Nephrology, Consiglio Nazionale della Ricerche-Istituto di Bio-Medicina, Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy
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10
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Karagas MR, Park S, Nelson HH, Andrew AS, Mott L, Schned A, Kelsey KT. Methylenetetrahydrofolate reductase (MTHFR) variants and bladder cancer: A population-based case-control study. Int J Hyg Environ Health 2005; 208:321-7. [PMID: 16217917 DOI: 10.1016/j.ijheh.2005.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Functional variants in the methylenetetrahydrofolate reductase (MTHFR) gene, including the 677C>T and 1298A>C polymorphisms, have been associated with a moderately reduced risk of several cancers, including colorectal cancers. While recent studies have investigated the role of these polymorphisms on bladder cancer susceptibility, results have been mixed. To clarify the role of MTHFR polymorphisms on bladder cancer risk, we genotyped MTHFR 677C > T and MTHFR 1298A > C in a population-based study of bladder cancer of 352 patients and 551 controls from New Hampshire, USA. The allelic frequency was 35.6% for MTHFR 677C>T and 40.4% for MTHFR 1298A > C among controls. We found no evidence of a main gene effect for either polymorphism (adjusted OR for MTHFR 677C>T variants versus the reference genotype = 1.1; 95% CI, 0.8-1.4 and adjusted OR for MTHFR 1298A>C variants versus the reference genotype = 1.0; 95% CI, 0.7-1.4). Odds ratios did not appear to differ by smoking status or gender. We observed differences in the risk estimates for the MTHFR polymorphisms by arsenic exposure, but they were not statistically significant (P = 0.67 for MTHFR 677C > T and P = 0.12 for MTHFR 1298A>C). Thus, our findings do not support the presence of a main gene effect. The possibility that MTHFR polymorphism affects susceptibility to environmental exposures warrants further consideration.
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Affiliation(s)
- Margaret R Karagas
- Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
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11
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Robien K, Ulrich CM, Bigler J, Yasui Y, Gooley T, Bruemmer B, Potter JD, Radich JP. Methylenetetrahydrofolate reductase genotype affects risk of relapse after hematopoietic cell transplantation for chronic myelogenous leukemia. Clin Cancer Res 2005; 10:7592-8. [PMID: 15569990 DOI: 10.1158/1078-0432.ccr-04-1057] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Methylenetetrahydrofolate reductase (MTHFR) directs intracellular folate toward homocysteine metabolism and away from nucleotide synthesis. Two common MTHFR polymorphisms, C677T and A1298C, are associated with reduced enzyme activity. We evaluated the association of these polymorphisms with risk of relapse and bcr-abl mRNA transcript detection among 336 Caucasian patients who underwent allogeneic hematopoietic cell transplantation for chronic myelogenous leukemia. EXPERIMENTAL DESIGN Data on the transplant course and folate-related exposures were abstracted from medical records. MTHFR C677T and A1298C genotypes were determined using polymerase chain reaction/restriction fragment length polymorphism and TaqMan assays. Qualitative bcr-abl mRNA testing was conducted using a two-step reverse transcription-polymerase chain reaction assay. Cox regression analysis was used to assess the association between MTHFR genotypes and time to relapse and bcr-abl mRNA detection. RESULTS A statistically significant decreased risk of relapse was observed in patients with the variant A1298C genotype [1298AC, hazard ratio (HR)=0.48 and 95% confidence interval (CI)=0.26-0.88; 1298CC, HR=0.28 and 95% CI=0.09-0.84; P-trend <0.01). For the joint C677T/A1298C genotype, variant genotypes were associated with a decreased risk of relapse when compared with the wild-type 677CC/1298AA genotype. This risk was lowest for the 677CC/1298CC genotype (HR, 0.23; 95% CI, 0.08-0.72). MTHFR genotypes were not associated with bcr-abl transcript detection. CONCLUSIONS These findings suggest that individuals with the 677CC/1298AA genotype are at higher risk of relapse after hematopoietic cell transplantation and that the balance of intracellular folate metabolites available for nucleotide synthesis (regulated by the relative activity of the MTHFR enzyme) may affect the progression from bcr-abl positivity to clinical relapse.
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MESH Headings
- Adolescent
- Adult
- Aged
- Cohort Studies
- Female
- Folic Acid/metabolism
- Fusion Proteins, bcr-abl/metabolism
- Genotype
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Methylenetetrahydrofolate Reductase (NADPH2)/genetics
- Middle Aged
- Polymorphism, Genetic
- Proportional Hazards Models
- Protein Binding
- RNA, Messenger/metabolism
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Risk
- Time Factors
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Affiliation(s)
- Kim Robien
- Cancer Prevention Program, Public Health Sciences Division and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
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Winkelmayer WC, Sunder-Plassmann G, Huber A, Födinger M. Patterns of co-occurrence of three single nucleotide polymorphisms of the 5,10-methylenetetrahydrofolate reductase gene in kidney transplant recipients. Eur J Clin Invest 2004; 34:613-8. [PMID: 15379760 DOI: 10.1111/j.1365-2362.2004.01394.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, a new mutation of the 5,10-methylenetetrahydrofolate reductase (MTHFR) encoding gene was first described (1793G > A). Only few reports have studied the prevalence of this polymorphism, especially in combination with other MTHFR mutations (677C > T, 1298A > C). METHODS We cross-sectionally identified the novel MTHFR 1793G > A polymorphism in 730 kidney transplant recipients. MTHFR 677C > T and 1298A > C were also assessed and the frequency of each was described individually as well as in cross-tabulation with the other MTHFR genotypes. The expected number of patients for each MTHFR genotype combination was calculated and contrasted with the observed numbers. Fisher's exact test was used for statistical inference. RESULTS The allelic frequency of MTHFR 1793G > A was 0.052. Seventy-two patients (9.9%) were heterozygous and two patients (0.3%) were homozygous. From the cross-tabulations, we identified 53 patients (expected: 33.6) with the MTHFR 1298AC/1793GA genotype and 17 patients (expected: 6.7) with the MTHFR 1298CC/1793GA genotype. Furthermore, we found two patients with double homozygosity for MTHFR 1793G > A and MTHFR 1298A > C (MTHFR 1793AA/1298CC genotype). The frequencies of these genotype combinations were substantially larger than could be expected (P < 0.001). CONCLUSIONS These findings suggest a selection or survival advantage for individuals with combined MTHFR 1793G > A and MTHFR 1298A > C genotypes, possibly owing to a mutually stabilizing effect on MTHFR enzyme activity.
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Affiliation(s)
- W C Winkelmayer
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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13
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Chang JM, Chen HC, Hwang SJ, Tsai JC, Lai YH. Does Amino Acid–Based Peritoneal Dialysate Change Homocysteine Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients? Perit Dial Int 2003. [DOI: 10.1177/089686080302302s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveWe examined whether amino acid–based peritoneal dialysate that contains 85 mg/dL L-methionine affects homocysteine (Hcy) metabolism.DesignThe study enrolled 17 adult CAPD patients (11 men, 6 women) who had been receiving CAPD for at least 6 months and who had low serum albumin levels (<3.7 g/dL). Diet was not specifically changed. All of the study patients received daily 4-exchange CAPD treatment, and they used Nutrineal (Baxter Healthcare, Deerfield, IL, U.S.A.) as one of their daily exchanges (first or second exchange). Blood samples were collected every 2 weeks, and Hcy was measured.ResultsAfter use of Nutrineal, serum albumin was unchanged, but blood urea nitrogen (BUN) and total protein were increased. Before the study began, 1 patient had a very high Hcy level (256 μmol/L); his data were excluded from the analysis. In the remaining 16 patients, baseline Hcy was 24.4 ± 7.0 μmol/L. Levels of Hcy progressively increased with the use of Nutrineal: 28.1 ± 6.2 μmol/L in week 2, 28.4 ± 7.1 μmol/L in week 4, 29.1 ± 7.6 μmol/L in week 6, 29.3 ± 9.0 μmol/L in week 8, 27.5±9.7 μmol/L in week 10, and 30.3 ± 8.2 μmol/L in week 12.ConclusionsNutrineal might help to replenish daily protein loss, but it also increased formation of Hcy and, therefore, the potential risk of cardiovascular illness. Further studies will be needed to examine the effect of folic acid and vitamin B12supplementation in the rescue of that Hcy increase, and also a possible correlation with methylenetetrahydrofolate reductase gene polymorphism.
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Affiliation(s)
- Jer-Ming Chang
- Department of Nephrology, Kaohsiung Medical University, and Department of Internal Medicine, Hsiao–Kang Municipal Hospital, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Department of Nephrology, Kaohsiung Medical University, and Department of Internal Medicine, Hsiao–Kang Municipal Hospital, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Department of Nephrology, Kaohsiung Medical University, and Department of Internal Medicine, Hsiao–Kang Municipal Hospital, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Department of Nephrology, Kaohsiung Medical University, and Department of Internal Medicine, Hsiao–Kang Municipal Hospital, Kaohsiung, Taiwan
| | - Yung-Hsiung Lai
- Department of Nephrology, Kaohsiung Medical University, and Department of Internal Medicine, Hsiao–Kang Municipal Hospital, Kaohsiung, Taiwan
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Laurés AS, Gomez E, Alvarez V, Coto E, Baltar J, Alvarez-Grande J. Influence of anticalcineurinic therapy in plasma homocysteine levels of renal transplant recipients: a prospective study. Transplant Proc 2003; 35:1739-41. [PMID: 12962777 DOI: 10.1016/s0041-1345(03)00627-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hyperhomocysteinemia is an independent factor for cardiovascular disease. Renal function and folate level are important determinants of total plasma homocysteine levels. The influence of anticalcineurin drugs on homocysteine levels is controversial. The aims of the study were: (1) to analyze changes in homocysteine levels after the first year of 73 renal transplants and (2) to determine the influence of immunosuppressive anticalcineurin drug therapy on fasting homocysteine concentrations. We examined homocysteine, serum creatinine, folate, and vitamin B12 concentrations immediately after transplant, at 6 months, and after 12 months from renal transplant. Also, MTHFRC677T polymorphism was investigated. Tacrolimus was administered in 28 patients and cyclosporine in 45. Homocysteine levels decreased from 28.41+/-13.71 micromol/L to 18.59+/-8.31 micromol/L after 6 months and to 17.13+/-7.06 micromol/L after 1 year. No relationship was found between homocysteine and folate levels. When anticalcineurin drugs were considered, the homocysteine levels in patients treated with tacrolimus was lower than that in patients treated with cyclosporine at month 6 after transplant (16+/-7.4 micromol/L vs 20.1+/-8.5 micromol/L, P=.03) and after 1 year (15+/-7.6 micromol/L vs 18.4+/-6.4 micromol/L, P=.04). Serum creatinine levels followed the same evolution: they were lower in patients treated with tacrolimus at 6 months (1.35+/-0.36 mg/dL vs 1.57+/-0.45 mg/dL, P=.03) and to a lesser extent at 1 year after renal transplant (1.38+/-0.35 mg/dL vs 1.54+/-0.45 mg/dL, P=.09). The homocysteine value closely related with serum creatinine in both groups. In conclusion, 1 year posttransplant, the homocysteine level was lower among patients treated with tacrolimus, the cohort that also showed the lower serum creatinine concentrations.
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Affiliation(s)
- A S Laurés
- Nephrology Service, Hospital Universitario Central de Asturias, Oviedo, Spain
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15
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Födinger M, Dierkes J, Skoupy S, Röhrer C, Hagen W, Puttinger H, Hauser AC, Vychytil A, Sunder-Plassmann G. Effect of glutamate carboxypeptidase II and reduced folate carrier polymorphisms on folate and total homocysteine concentrations in dialysis patients. J Am Soc Nephrol 2003; 14:1314-9. [PMID: 12707400 DOI: 10.1097/01.asn.0000064949.67401.d3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This study was designed to examine the effect of two single nucleotide polymorphisms in the reduced folate carrier 1 (RFC1 80G>A) and the glutamate carboxypeptidase 2 (GCP2 1561C>T) gene on total homocysteine (tHcy) plasma level and folate status in 120 chronic dialysis patients. Red blood cell folate concentration was higher in patients with the GCP2 CT or TT genotype (ANOVA, P = 0.04). Among patient groups with different RFC1 genotypes, red blood cell folate level was not significantly different. A multivariate analysis confirmed that the GCP2 1561C>T genotype (P = 0.011) had a significant influence on the red blood cell folate concentration. Overall, serum folate, creatinine, and the GCP2 polymorphism explained nearly 50% of the variance of red blood cell folate. A linear multivariate regression analysis showed that red blood cell folate (P < 0.001), creatinine (P < 0.001), and the 5,10-methylenetetrahydrofolate reductase (MTHFR) 677T allele (P = 0.013) are independent predictors of tHcy plasma level explaining 49% of the variance of tHcy plasma concentration. GCP2 1561C>T and RFC1 80G>A showed no effect on tHcy and folate plasma level. In conclusion, GCP2 1561C>T, but not RFC1 80G>A, is a predictor of red blood cell folate level in chronic dialysis patients. Both polymorphisms have no major effect on tHcy plasma concentration in end-stage renal disease patients.
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Affiliation(s)
- Manuela Födinger
- Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Logar CM, Herzog CA, Beddhu S. Diagnosis and therapy of coronary artery disease in renal failure, end-stage renal disease, and renal transplant populations. Am J Med Sci 2003; 325:214-27. [PMID: 12695727 DOI: 10.1097/00000441-200304000-00008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Even though cardiovascular disease is the leading cause of death in patients with CRF and end-stage renal disease (ESRD), ill-conceived notions have led to therapeutic nihilism as the predominant strategy in the management of cardiovascular disease in these populations. The recent data clearly support the application of proven interventions in the general population, such as angiotensin-converting enzyme inhibitors and statins to patients with CRF and ESRD. The advances in coronary stents and intracoronary irradiation have decreased the restenosis rates in renal failure patients. Coronary artery bypass with internal mammary graft might be the procedure of choice for coronary revascularization in these patients. The role of screening for asymptomatic coronary disease is established as a pretransplant procedure, but it is unclear whether this will be applicable to all patients with ESRD. Future studies need to focus on unraveling the mechanisms by which uremia leads to increased cardiovascular events to design optimal therapies targeted toward these mechanisms and improve cardiovascular outcomes.
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Affiliation(s)
- Christine M Logar
- Renal Section, Salt Lake VA Healthcare System, Department of Medicine, University of Utah School of Medicine, Salt Lake City, USA
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Abstract
Growing evidence has been gathered over the last 15 years regarding the role of nontraditional or uremia-related risk factors in the pathogenesis of atherosclerosis in subjects with renal failure. Among those factors, dyslipidemia, inflammation, hyperhomocysteinemia, and oxidant stress have been extensively studied. However, the clinical significance of many of these factors remains controversial in light of reported studies. In this article, the existing evidence regarding the role of uremia-related risk factors in the pathogenesis of atherosclerosis is reviewed, with special emphasis on prevalence, cardiac risk, and management in patients with chronic kidney disease (CKD). Consensus treatment recommendations are provided for risk factors for which there is evidence to support preventive or therapeutic interventions.
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Affiliation(s)
- François Madore
- Renal Division, Department of Medicine, Hôpital du Sacré-Coeur, University of Montreal, Quebec, Canada.
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18
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Skoupy S, Födinger M, Veitl M, Perschl A, Puttinger H, Röhrer C, Schindler K, Vychytil A, Hörl WH, Sunder-Plassmann G. Riboflavin is a determinant of total homocysteine plasma concentrations in end-stage renal disease patients. J Am Soc Nephrol 2002; 13:1331-7. [PMID: 11961021 DOI: 10.1097/01.asn.0000013299.11876.f6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The effect of thiamine (vitamin B(1)) or riboflavin (vitamin B(2)) availability on fasting total homocysteine (tHcy) plasma levels in end-stage renal disease patients is unknown. A cross-sectional study was performed in a population of non-vitamin supplemented patients maintained on continuous ambulatory peritoneal dialysis. Red blood cell availability of thiamine (alpha-ETK) and of riboflavin (alpha-EGR), along with other predictors of tHcy plasma levels, was considered in the analysis. There was a linear association of alpha-EGR with tHcy plasma concentrations (P = 0.009), which was not observed for alpha-ETK. Among red blood cell vitamins, alpha-EGR was the only predictor of tHcy levels (P = 0.035), whereas alpha-ETK, red blood cell pyridoxal-5-phosphate supply (alpha-EGOT) and red blood cell folate levels had no effect. The risk for having a high tHcy plasma levels within the fourth quartile (plasma tHcy >38.3 micromol/L) was increased by an alpha-EGR > median (odds ratio, 4.706; 95% confidence interval, 1.124 to 19.704; P = 0.026). By way of contrast, alpha-ETK had no effect in these analyses. Independent predictors of tHcy plasma levels were serum albumin, alpha-EGR, red blood cell folate, and certain MTHFR genotypes. A logistic regression analysis showed that the MTHFR genotype is a predictor for having a tHcy plasma concentration within the fourth quartile. In summary, riboflavin availability, as measured by alpha-EGR, is a determinant of fasting tHcy plasma levels in peritoneal dialysis patients. This finding may have implications for tHcy lowering therapy in individuals with end-stage renal disease.
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Affiliation(s)
- Sonja Skoupy
- Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Vienna, Austria
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19
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Feix A, Fritsche-Polanz R, Kletzmayr J, Vychytil A, Hörl WH, Sunder-Plassmann G, Födinger M. Increased prevalence of combined MTR and MTHFR genotypes among individuals with severely elevated total homocysteine plasma levels. Am J Kidney Dis 2001; 38:956-64. [PMID: 11684547 DOI: 10.1053/ajkd.2001.28581] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of the methionine synthase (MTR) 2756A-->G polymorphism among individuals with severely elevated total homocysteine (tHcy) plasma levels is unknown. Therefore, 1,716 subjects, including 415 hemodialysis patients, 179 peritoneal dialysis patients, 733 kidney graft recipients, and 389 healthy subjects, were investigated. The distribution of MTR 2756A-->G, as well as 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C-->T/1298A-->C, genotypes among study participants with extremely high tHcy plasma levels (>90th percentile) was compared with the genotype distribution of subjects with very low tHcy plasma levels (<10th percentile). The prevalence of MTR 2756AG and GG genotypes alone did not differ between individuals with extremely high or extremely low tHcy levels (P = 0.7402; odds ratio [OR], 1.076; 95% confidence interval [CI], 0.697 to 1.662). Conversely, combined MTR and MTHFR genotypes (MTR 2756AG and 2756GG and MTHFR 677TT/1298AA and 677CT/1298AC) were found more often in the highest (n = 34) compared with the lowest plasma tHcy decile (n = 19; P = 0.0252; OR, 1.983; 95% CI, 1.079 to 3.643). The number of patients with the wild-type MTR and MTHFR genotype was three times greater in the lowest compared with the highest decile (17 versus 6 patients, respectively; P = 0.0155; OR, 0.330; 95% CI, 0.126 to 0.861). In summary, our study shows that the 2756A-->G transition of MTR in combination with MTHFR 677TT/1298AA and 677CT/1298AC can be associated with extremely high tHcy plasma levels.
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Affiliation(s)
- A Feix
- Department of Medicine III, Division of Nephrology and Dialysis, Division of Endocrinology and Metabolism, University of Vienna, Austria.
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