Abstract

BackgroundManipulation of total homocysteine concentration with oral methionine is associated with impairment of endothelial-dependent vasodilation. This may be caused by increased oxidative stress. Vitamin C is an aqueous phase antioxidant vitamin and free radical scavenger. We hypothesised that if the impairment of endothelial function related to experimental hyperhomocysteinaemia was free radically mediated then co-administration of vitamin C should prevent this.MethodsTen healthy adults took part in this crossover study. Endothelial function was determined by measuring forearm blood flow (FBF) in response to intra-arterial infusion of acetylcholine (endothelial-dependent) and sodium nitroprusside (endothelial-independent). Subjects received methionine (100 mg/Kg) plus placebo tablets, methionine plus vitamin C (2 g orally) or placebo drink plus placebo tablets. Study drugs were administered at 9 am on each study date, a minimum of two weeks passed between each study. Homocysteine (tHcy) concentration was determined at baseline and after 4 hours. Endothelial function was determined at 4 hours. Responses to the vasoactive substances are expressed as the area under the curve of change in FBF from baseline. Data are mean plus 95% Confidence Intervals.ResultsFollowing oral methionine tHcy concentration increased significantly versus placebo. At this time endothelial-dependent responses were significantly reduced compared to placebo (31.2 units [22.1-40.3] vs. 46.4 units [42.0-50.8], p < 0.05 vs. Placebo). Endothelial-independent responses were unchanged. Co-administration of vitamin C did not alter the increase in homocysteine or prevent the impairment of endothelial-dependent responses (31.4 [19.5-43.3] vs. 46.4 units [42.0-50.8], p < 0.05 vs. Placebo)ConclusionsThis study demonstrates that methionine increased tHcy with impairment of the endothelial-dependent vasomotor responses. Administration of vitamin C did not prevent this impairment and our results do not support the hypothesis that the endothelial impairment is mediated by adverse oxidative stress.

Highlights

  • Manipulation of total homocysteine concentration with oral methionine is associated with impairment of endothelial-dependent vasodilation

  • There was no change in basal total plasma homocysteine concentration (tHcy) between study dates suggesting no carry over effect

  • Basal forearm blood flow (FBF) was similar in each group suggesting low intra-experimental variation (Table 1), and basal FBF was unchanged prior to each drug infusion

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Summary

Introduction

Manipulation of total homocysteine concentration with oral methionine is associated with impairment of endothelial-dependent vasodilation. This may be caused by increased oxidative stress. Homocystinuria was first described in Belfast in 1962 [1], Carson et al identified the presence of the amino acid, homocysteine, in the urine of subjects with marked skeletal abnormalities and mental retardation. It was 1969 before McCully made the association between homocysteine and vascular disease [2]. The cause/effect relationship has not been fully established though, and we await the results of secondary prevention trials - investigating the effect of lowering tHcy

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