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Dhar I, Svingen GF, Bjørnestad EØ, Ulvik A, Saeed S, Nygård OK. B-vitamin treatment modifies the mortality risk associated with calcium channel blockers in patients with suspected stable angina pectoris: A prospective cohort study. Am J Clin Nutr 2023:S0002-9165(23)48891-0. [PMID: 37121550 PMCID: PMC10375456 DOI: 10.1016/j.ajcnut.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Calcium channel blockers (CCBs) are used for the treatment of cardiovascular disease (CVD), including angina pectoris, and hypertension; however, the effect on survival remains uncertain. CCBs impair fibrinolysis and have been linked to elevated plasma homocysteine (Hcy), a CVD risk marker. OBJECTIVE We explored the association between CCB use and mortality in a large prospective cohort of patients with suspected stable angina pectoris (SAP), and potential effect modifications by Hcy-lowering B-vitamin treatment (folic acid, B12 and/or B6) as 61.8% of the patients participated in a randomized placebo-controlled B-vitamin intervention trial. METHODS Patient baseline continuous characteristics according to CCB treatment were tested by linear regression. Hazard ratios (HRs) for mortality associated with CCB treatment, also according to B-vitamin intervention, were examined using Cox regression analysis. The multivariable model included cardiovascular risk factors, medical histories, and use of CVD medications. RESULTS A total of 3991 patients (71.5 % men) were included, of whom 907 were prescribed CCBs at discharge. During 10.3 years of median follow-up, 20.6% died and 8.9% from cardiovascular- and 11.6% from non-cardiovascular causes. Patients treated with CCBs had higher plasma Hcy, fibrinogen levels and erythrocyte sedimentation rate (all P<0.001). Further, CCB use was positively associated with mortality, also after multivariable adjustments (HRs [95% CIs]: 1.34 [1.15-1.57], 1.35 [1.08-1.70] and 1.33 [1.09-1.64] for total, CVD and non-CVD death, respectively). Numerically stronger associations were observed among patients not treated with B-vitamins (HR [95% CI]: 1.54 [1.25-1.88], 1.69 [1.25-2.30] and 1.41 [1.06- 1.86] for total, CVD and non-CVD death, respectively), whereas, no association was seen in patients treated with B-vitamins (HR [95% CI]: 1.15 [0.91-1.46], 1.09 [0.76-1.57] and 1.20 [0.88-1.65]). CONCLUSIONS In patients with suspected SAP, CCB treatment was associated with increased mortality risk primarily among patients not treated with B-vitamins. CLINICAL TRIAL REGISTRATION-URL https://clinicaltrials.gov/ct2/show/NCT00354081?term=NCT00354081&draw=2&rank=1. Clinical Trial Registration-Unique identifier (NCT number): NCT00354081.
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Affiliation(s)
- Indu Dhar
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Norway.
| | - Gard Ft Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Espen Ø Bjørnestad
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ottar K Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Singh Y, Samuel VP, Dahiya S, Gupta G, Gillhotra R, Mishra A, Singh M, SreeHarsha N, Gubbiyappa SK, Tambuwala MM, Chellappan DK, Dua K. Combinational effect of angiotensin receptor blocker and folic acid therapy on uric acid and creatinine level in hyperhomocysteinemia‐associated hypertension. Biotechnol Appl Biochem 2019; 66:715-719. [DOI: 10.1002/bab.1799] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/18/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Yogendra Singh
- Department of Pharmaceutical Sciences Mahatma Gandhi College of Pharmaceutical Sciences Sitapura Jaipur India
| | - Vijaya Paul Samuel
- Department of Anatomy RAK College of Medicine RAK Medical and Health Sciences, University Ras Al Khaimah UAE
| | - Sunita Dahiya
- Department of Pharmaceutical Sciences School of Pharmacy University of Puerto Rico, Medical Sciences Campus San Juan Puerto Rico USA
| | - Gaurav Gupta
- School of Pharmacy Suresh Gyan Vihar University Jagatpura Jaipur India
| | - Ritu Gillhotra
- School of Pharmacy Suresh Gyan Vihar University Jagatpura Jaipur India
| | - Anurag Mishra
- School of Pharmacy Suresh Gyan Vihar University Jagatpura Jaipur India
| | - Mahaveer Singh
- School of Pharmaceutical Sciences Jaipur National University Jagatpura Jaipur India
| | - Nagaraja SreeHarsha
- Department of Pharmaceutical Sciences College of Clinical Pharmacy King Faisal University Al‐Ahsa Saudi Arabia
| | | | - Murtaza M. Tambuwala
- School of Pharmacy & Pharmaceutical Sciences Ulster University Coleraine Northern Ireland UK
| | | | - Kamal Dua
- Discipline of Pharmacy Graduate School of Health University of Technology Sydney Sydney NSW Australia
- Priority Research Centre for Healthy Lungs School of Biomedical Sciences and Pharmacy The University of Newcastle Callaghan Australia
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Abstract
BACKGROUND Elevated plasma homocysteine concentrations have been associated with both cognitive impairment and dementia. However, it is unclear whether some cognitive domains are more affected than others, or if this relationship is independent of B12 and folate levels, which can also affect cognition. We examined the relationship between plasma homocysteine and cognitive decline in an older hypertensive population. METHODS 182 older people (mean age 80 years) with hypertension and without dementia, were studied at one center participating in the Study on COgnition and Prognosis in the Elderly (SCOPE). Annual cognitive assessments were performed using a computerized assessment battery and executive function tests, over a 3-5 year period (mean 44 months). Individual rates of decline on five cognitive domains were calculated for each patient. End of study plasma homocysteine, folate and B12 concentrations were measured. The relationship between homocysteine levels and cognitive decline was studied using multivariate regression models, and by comparing high versus low homocysteine quartile groups. RESULTS Higher homocysteine showed an independent association with greater cognitive decline in three domains: speed of cognition (β = -27.33, p = 0.001), episodic memory (β = -1.25, p = 0.02) and executive function (β = -0.05, p = 0.04). The association with executive function was no longer significant after inclusion of folate in the regression model (β = -0.032, p = 0.22). Change in working memory and attention were not associated with plasma homocysteine, folate or B12. High homocysteine was associated with greater decline with a Cohen's d effect size of approximately 0.7 compared to low homocysteine. CONCLUSIONS In a population of older hypertensive patients, higher plasma homocysteine was associated with cognitive decline.
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Hansel B, Girerd X, Bonnefont-Rousselot D, Bittar R, Chantepie S, Orsoni A, Bruckert E, Chapman MJ, Kontush A. Blood Pressure-Lowering Response to Amlodipine as a Determinant of the Antioxidative Activity of Small, Dense HDL3. Am J Cardiovasc Drugs 2011; 11:317-25. [DOI: 10.2165/11592280-000000000-00000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kumar N, Kant R, Maurya PK. Concentration-dependent effect of (-) epicatechin in hypertensive patients. Phytother Res 2011; 24:1433-6. [PMID: 20127878 DOI: 10.1002/ptr.3119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Non-vitamin polyphenolic compounds are ubiquitous in food plants and therefore potentially present in human plasma in a diet-dependent concentration. The aim of this study was to evaluate the concentration-dependent effect of (-) epicatechin, a polyphenol present in green tea with antioxidant activity, on various biomarkers of oxidative stress. The current study examined the in vitro concentration-dependent (10(-4) M to 10(-7) M) effects of (-) epicatechin on biomarkers of oxidative stress viz. malondialdehyde (MDA), reduced glutathione (GSH), membrane sulfhydryl (-SH) group and protein carbonyl content in hypertensive patients and normal ones. This effect seems to be due to ability of (-) epicatechin to reduce MDA and protein carbonyl content while increase in GSH and membrane -SH group in hypertensive patients. It can be concluded that (-) epicatechin exerts an antioxidant action inside the cell, responsible for the observed modulation of cellular response to oxidative challenges.
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Affiliation(s)
- Navneet Kumar
- Doon PG Paramedical College & Hospital, Dehradun UK, India
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Ntaios G, Savopoulos C, Chatzopoulos S, Mikhailidis D, Hatzitolios A. Iatrogenic hyperhomocysteinemia in patients with metabolic syndrome: A systematic review and metaanalysis. Atherosclerosis 2011; 214:11-9. [DOI: 10.1016/j.atherosclerosis.2010.08.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 06/04/2010] [Accepted: 08/02/2010] [Indexed: 11/28/2022]
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Muda P, Kampus P, Teesalu R, Zilmer K, Ristimäe T, Fischer K, Zilmer M. Effects of amlodipine and candesartan on oxidized LDL level in patients with mild to moderate essential hypertension. Blood Press 2009; 15:313-8. [PMID: 17380850 DOI: 10.1080/08037050601037844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the effects of amlodipine and candesartan on oxidized low-density lipoprotein (OxLDL), conjugated dienes (CD) and baseline diene conjugation in circulating low-density lipoproteins (LDL-BDC) level during antihypertensive treatment. METHODS Forty-nine patients with untreated mild to moderate essential hypertension were recruited in a randomized double-blind study to receive a daily dose either of 8 mg candesartan or 5 mg amlodipine for 16 weeks. Blood pressure, OxLDL, CD, LDL-BDC, triglycerides (TG), total cholesterol and lipoprotein cholesterol were measured at baseline, at week 2 and at week 16. RESULTS During treatment, in addition to a significant decrease in systolic and diastolic blood pressure, high level of OxLDL decreased significantly reaching practically upper kit reference values. Both treatment groups were similar with regard to the studied parameters at all time points. At the same time serum TG, lipoprotein and total cholesterol levels as well as LDL-BDC did not change and CD levels did not exceed endemic normal. Decrease in both systolic and diastolic blood pressure was associated with decrease in LDL-BDC/LDL. CONCLUSIONS Besides their antihypertensive effects, both candesartan and amlodipine are efficient drugs for reducing OxLDL level, being neutral with regard to serum lipids.
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Affiliation(s)
- Piibe Muda
- Department of Cardiology, University of Tartu, L.Puusepa 8, Tartu 51014, Estonia.
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Puddu P, Puddu GM, Cravero E, Rosati M, Muscari A. The molecular sources of reactive oxygen species in hypertension. Blood Press 2008; 17:70-7. [PMID: 18568695 DOI: 10.1080/08037050802029954] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In both animal models and humans, increased blood pressure has been associated with oxidative stress in the vasculature, i.e. an excessive endothelial production of reactive oxygen species (ROS), which may be both a cause and an effect of hypertension. In addition to NADPH oxidase, the best characterized source of ROS, several other enzymes may contribute to ROS generation, including nitric oxide synthase, lipoxygenases, cyclo-oxygenases, xanthine oxidase and cytochrome P450 enzymes. It has been suggested that also mitochondria could be considered a major source of ROS: in situations of metabolic perturbation, increased mitochondrial ROS generation might trigger endothelial dysfunction, possibly contributing to the development of hypertension. However, the use of antioxidants in the clinical setting induced only limited effects on human hypertension or cardiovascular endpoints. More clinical studies are needed to fully elucidate this so called "oxidative paradox" of hypertension.
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Affiliation(s)
- Paolo Puddu
- Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna and S Orsola-Malpighi Hospital, Bologna, Italy
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Wang D, Strandgaard S, Iversen J, Wilcox CS. Asymmetric dimethylarginine, oxidative stress, and vascular nitric oxide synthase in essential hypertension. Am J Physiol Regul Integr Comp Physiol 2008; 296:R195-200. [PMID: 18685064 DOI: 10.1152/ajpregu.90506.2008] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We reported impaired endothelium-derived relaxation factor/nitric oxide (EDRF/NO) responses and constitutive nitric oxide synthase (cNOS) activity in subcutaneous vessels dissected from patients with essential hypertension (n = 9) compared with normal controls (n = 10). We now test the hypothesis that the patients in this study have increased circulating levels of the cNOS inhibitor, asymmetric dimethylarginine (ADMA), or the lipid peroxidation product of linoleic acid, 13-hydroxyoctadecadienoic acid (HODE), which is a marker of reactive oxygen species. Patients had significantly (P < 0.001) elevated (means +/- SD) plasma levels of ADMA (P(ADMA), 766 +/- 217 vs. 393 +/- 57 nmol/l) and symmetric dimethylarginine (P(SDMA): 644 +/- 140 vs. 399 +/- 70 nmol/l) but similar levels of L-arginine accompanied by significantly (P < 0.015) increased rates of renal ADMA excretion (21 +/- 9 vs. 14 +/- 5 nmol/mumol creatinine) and decreased rates of renal ADMA clearance (18 +/- 3 vs. 28 +/- 5 ml/min). They had significantly increased plasma levels of HODE (P(HODE): 309 +/- 30 vs. 226 +/- 24 nmol/l) and renal HODE excretion (433 +/- 93 vs. 299 +/- 67 nmol/micromol creatinine). For the combined group of normal and hypertensive subjects, the individual values for plasma levels of ADMA and HODE were both significantly (P < 0.001) and inversely correlated with microvascular EDRF/NO and positively correlated with mean blood pressure. In conclusion, elevated levels of ADMA and oxidative stress in a group of hypertensive patients could contribute to the associated microvascular endothelial dysfunction and elevated blood pressure.
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Affiliation(s)
- Dan Wang
- Georgetown University Hypertension, Kidney and Vascular Disorders Center, Division of Nephrology and Hypertension, Georgetown University, Washington, DC 20007 USA
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Rodrigo R, Prat H, Passalacqua W, Araya J, Guichard C, Bächler JP. Relationship between oxidative stress and essential hypertension. Hypertens Res 2008; 30:1159-67. [PMID: 18344620 DOI: 10.1291/hypres.30.1159] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study investigated the association of blood pressure with blood oxidative stress-related parameters in normotensive and hypertensive subjects. A cross-sectional design was applied to 31 hypertensive patients and 35 healthy normotensive subjects. All subjects were men between the ages of 35 and 60 years. Exclusion criteria were obesity, dyslipidemia, diabetes mellitus, smoking and current use of any medication. All patients underwent 24-h ambulatory blood pressure monitoring and sampling of blood and urine. Antioxidant enzymes activity, reduced/oxidized glutathione ratio (GSH/GSSG), and lipid peroxidation (malondialdehyde) were determined in erythrocytes. Parameters measured in the plasma of test subjects were plasma antioxidant status, lipid peroxidation (8-isoprostane), plasma vitamin C and E, and the blood pressure modulators renin, aldosterone, endothelin-1 and homocysteine. Daytime systolic and diastolic blood pressures of hypertensives were negatively correlated with plasma antioxidant capacity (r=-0.46, p<0.009 and r=-0.48, p<0.007), plasma vitamin C levels (r=-0.53, p<0.003 and r=-0.44, p<0.02), erythrocyte activity of antioxidant enzymes, and erythrocyte GSH/GSSG ratio, with hypertensives showing higher levels of oxidative stress. Blood pressures showed a positive correlation with both plasma and urine 8-isoprostane. Neither plasma vitamin E nor the assessed blood pressure modulator levels showed significant differences between the groups or correlation with blood pressures. These findings demonstrate a strong association between blood pressure and some oxidative stress-related parameters and suggest a possible role of oxidative stress in the pathophysiology of essential hypertension.
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Affiliation(s)
- Ramón Rodrigo
- Laboratory of Renal Pathophysiology, Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile.
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Poduri A, Kaur J, Thakur JS, Kumari S, Jain S, Khullar M. Effect of ACE inhibitors and β-blockers on homocysteine levels in essential hypertension. J Hum Hypertens 2008; 22:289-94. [DOI: 10.1038/sj.jhh.1002325] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Aslam S, Santha T, Leone A, Wilcox C. Effects of amlodipine and valsartan on oxidative stress and plasma methylarginines in end-stage renal disease patients on hemodialysis. Kidney Int 2006; 70:2109-15. [PMID: 17063175 DOI: 10.1038/sj.ki.5001983] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with end-stage renal disease (ESRD) receiving hemodialysis (HD) treatment have a markedly shortened life expectancy in large part owing to cardiovascular disease (CVD), not explained by established risk factors. We tested the hypothesis that therapy with valsartan, an angiotensin receptor blocker and amlodipine, an antioxidant calcium channel blocker will reduce oxidative stress and the plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase. We confirmed that compared with age- and gender-matched healthy controls, ESRD patients have excessive oxidative stress and arginine methylation as indexed by elevated plasma levels of oxidation products of lipids (13-hydroxyoctadecadienoic acid (13-HODE)), thiols (oxidized:reduced glutathione, oxidized glutathione (GSSG):GSH), proteins, and nucleic acids, and the methylation products ADMA and symmetric dimethylarginine (SDMA). We undertook a double blind, crossover study of equi-antihypertensive treatment with amlodipine and valsartan for 6 weeks each to test our hypothesis. Both treatments significantly reduced GSSG:GSH, 8-hydroxy 2-deoxyguanosine, ADMA, and SDMA levels and amlodipine reduced 13-HODE. We conclude that hypertensive patients with ESRD receiving HD have evidence of extensive oxidation of lipids, thiols, proteins, and nucleic acids and methylation of arginine that could contribute to CVD. Many of these changes can be reduced by short-term treatment with amlodipine and valsartan.
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Affiliation(s)
- S Aslam
- Department of Internal Medicine, Division of Nephrology and Hypertension, Georgetown University Hospital, Washington, District of Columbia 20007, USA.
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Sharma P, Senthilkumar RD, Brahmachari V, Sundaramoorthy E, Mahajan A, Sharma A, Sengupta S. Mining literature for a comprehensive pathway analysis: a case study for retrieval of homocysteine related genes for genetic and epigenetic studies. Lipids Health Dis 2006; 5:1. [PMID: 16430779 PMCID: PMC1395315 DOI: 10.1186/1476-511x-5-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 01/23/2006] [Indexed: 02/07/2023] Open
Abstract
Homocysteine is an independent risk factor for cardiovascular diseases. It is also known to be associated with a variety of complex disorders. While there are a large number of independent studies implicating homocysteine in isolated pathways, the mechanism of homocysteine induced adverse effects are not clear. Homocysteine-induced modulation of gene expression through alteration of methylation status or by hitherto unknown mechanisms is predicted to lead to several pathological conditions either directly or indirectly. In the present manuscript, using literature mining approach, we have identified the genes that are modulated directly or indirectly by an elevated level of homocysteine. These genes were then placed in appropriate pathways in an attempt to understand the molecular basis of homocysteine induced complex disorders and to provide a resource for selection of genes for polymorphism screening and analysis of mutations as well as epigenetic modifications in relation to hyperhomocysteinemia. We have identified 135 genes in 1137 abstracts that either modulate the levels of homocysteine or are modulated by elevated levels of homocysteine. Mapping the genes to their respective pathways revealed that an elevated level of homocysteine leads to the atherosclerosis either by directly affecting lipid metabolism and transport or via oxidative stress and/or Endoplasmic Reticulum (ER) stress. Elevated levels of homocysteine also decreases the bioavailability of nitric oxide and modulates the levels of other metabolites including S-adenosyl methionine and S-adenosyl homocysteine which may result in cardiovascular or neurological disorders. The ER stress emerges as the common pathway that relates to apoptosis, atherosclerosis and neurological disorders and is modulated by levels of homocysteine. The comprehensive network collated has lead to the identification of genes that are modulated by homocysteine indicating that homocysteine exerts its effect not only through modulating the substrate levels for various catalytic processes but also through regulation of expression of genes involved in complex diseases.
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Affiliation(s)
- Priyanka Sharma
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
- Dr. B. R. Ambedkar Centre for Biomedical Research, University of Delhi, Delhi-110007, India
| | - RD Senthilkumar
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Vani Brahmachari
- Dr. B. R. Ambedkar Centre for Biomedical Research, University of Delhi, Delhi-110007, India
| | - Elayanambi Sundaramoorthy
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Anubha Mahajan
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Amitabh Sharma
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
| | - Shantanu Sengupta
- Department of Proteomics and Structural Biology, Institute of Genomics and Integrative Biology, Mall Road, Delhi-110007, India
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