Serum Homocysteine Levels Research Articles

The effect of homocysteine-lowering therapy on the formation of carotid atherosclerosis: A follow-up study in the rural areas of northwest China

ObjectiveTo explore the risk factors for carotid atherosclerosis in the rural areas of Northwest China, and to assess whether reducing serum homocysteine can prevent carotid atherosclerosis in subjects with hyperhomocysteinemia. MethodThis observational study with 767 participants aged 40 years or older was conducted over 3 years. Color Doppler ultrasonography was performed to measure carotid atherosclerosis. We recorded biochemical indexes and carotid ultrasound results in the first and fourth years. ResultA total of 767 individuals (48.5 % men) were analyzed. Older age, hypertension, and higher levels of baseline low-density lipoprotein cholesterol (LDL-C) were risk factors for increased carotid intima-media thickness (CIMT), carotid plaque, and carotid stenosis (All P < 0.05). No association was found between decreased serum homocysteine (Hcy) levels and CIMT, carotid plaque, or carotid stenosis in individuals with hyperhomocysteinemia. ConclusionOlder age, hypertension, and higher baseline levels of LDL-C were independent risk factors for carotid atherosclerosis. Reducing serum Hcy levels may not prevent carotid atherosclerosis in the general population with hyperhomocysteinemia.

Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches?

Solitary functioning kidney (SFK) can be defined as the absence or hypofunction of a kidney due to acquired or congenital reasons. A congenital solitary functioning kidney (cSFK) is more common than is an acquired one (aSFK) and is characterized by the anatomical absence (agenesis) or hypofunction (hypoplasia; hypodysplasia) of one kidney from birth. Among the acquired causes, the most important is nephrectomy (Nx) (due to the donor, trauma or mass resection). Patients with SFK are at risk for the development of chronic kidney disease (CKD) in the long term. This risk potential is also significantly affected by hypertension. The relationship between hypertension and subclinical chronic inflammation is a connection that has not yet been fully clarified pathogenetically, but there are many studies highlighting this association. In recent years, studies examining different fibrosis and inflammation biomarkers in terms of the evaluation and prediction of renal risks have become increasingly popular in the literature. Oxidative stress is known to play an important role in homocysteine-induced endothelial dysfunction and has been associated with hypertension. In our study, we aimed to investigate the relationship between ambulatory blood pressure monitoring (ABPM) and urinary/serum fibrosis and inflammatory markers in patients with SFK. We prospectively investigated the relationship between ABPM results and soluble urokinase plasminogen activator receptor (suPAR), procollagen type III N-terminal peptide (PIIINP), homocysteine and other variables in 85 patients with SFK and compared them between cSFK and aSFK groups. In the etiology of SFK, a congenital or acquired origin may differ in terms of the significance of biomarkers. In particular, the serum homocysteine level may be associated with different clinical outcomes in patients with cSFK and aSFK.

Iron Metabolism Dysregulation and Atherosclerotic Changes in Obstructive Sleep Apnoea

The Syndrome of obstructive sleep apnoea (OSA) is associated with an increased risk of arterial hypertension, metabolic syndrome, diabetes mellitus type 2, brain-vascular damages and atherosclerosis. The aim of this study is to assess the connection between iron metabolism dysregulation in OSA and atherosclerotic changes of carotid arteries. Thirty-five OSA patients with brain-vascular atherosclerotic evidences were included in this study; changes were evaluated by carotid artery intima-media thickness (IMT) and flow-mediated dilatation (FMD). Their results were compared to an equal number of healthy volunteers. Haematological and biochemical assays were performed in all participants in the study. Serum hepcidin levels are statistically significantly increased in OSA patients with atherosclerotic a. carotis changes (101.9±10.1 µg/L) compared to the control group (18.5±2.5 µg/L); $$P&lt;0.001$$. Serum homocysteine levels are significantly higher in OSA than in healthy people. Average IMT (1.22±0.19) and ABI (1.71±0.14) values in OSA patients with atherosclerotic a. carotis changes are increased in comparison to the control group (0.34±0.07, 1.11±0.06, resp.); $$P&lt;0.001$$. Serum vitamin B12 levels were lower in OSA patients with atherosclerotic changes in carotid arteries (71.7±9.9 pmol/L) compared to the controls (449.7±21.4 pmol/L); $$P&lt;0.001$$. A connection between iron homeostasis and atherosclerotic changes was established during this study. Increased hepcidin and homocysteine concentrations might be connected to an elevated risk of cardio- and brain-vascular diseases in OSA. The use of these markers in the routine practice may be very useful for early atherosclerosis assessment in OSA.

The Potential of Magnesium Sulfate to Change Serum Lysyl Oxidase and Nitrite Levels in Patients with Atherosclerosis: A Double-Blind Clinical Trial Study

Background: Lysyl oxidase (LOX) and magnesium contribute to vascular development and stability. This research describes how magnesium sulfate (MgSO4 ) regulates the serum levels of LOX and nitric oxide in patients with moderate coronary artery disease (CAD). Methods: This was a randomized double-blind placebo-controlled clinical trial with 76 patients with moderate CAD divided into four groups. The subjects were randomly assigned to groups that took either capsules containing placebo or MgSO4 (300 mg) daily for 6 months. Thus, the experiment included Mg-treated groups with one and two vessels with atherosclerotic plaque (MgVR1 and Mg-VR2) and placebo-treated groups with one and two vessels with atherosclerotic plaque (placebo-VR1 and placeboVR2). Every 3 months, LOX, homocysteine, nitrite, and lipid profile levels were measured. Women and men with moderate CAD who were more than 55 and 50 years old, respectively, were included. Results: Total cholesterol and triglyceride (TG) levels significantly decreased 6 months after intervention (P&lt;0. 01). Decrease of serum homocysteine levels was seen in all groups during the study, but the reduction in the placebo groups was greater than the Mg-treated groups (P&lt;0.001). Three months after treatment with MgSO4 , LOX had stayed at high levels, and it then returned to baseline in the 6-month follow up (P&lt;0.001). The rise in nitrite levels in the placebo-VR2 group was significantly greater than in the Mgso4 -VR2 group (P&lt;0.001). Conclusion: magnesium sulfate may prevent the progression of arteriosclerosis through modulating LOX and homocysteine levels and preventing the increase of nitrite levels. Trial Registration: Identifier: IRCT20151028024756N3; https://www.irct.ir/trial/29097.

Evaluation of Homocysteine, Trace Element, and Vitamin Levels in Male Individuals with Hemorrhoidal Disease

Objectives: Hemorrhoidal disease is a common and uncomfortable condition affecting people worldwide, primarily in the lower rectal region. This study explores the relationship between hemorrhoidal disease and the levels of homocysteine, folic acid, vitamin B12, zinc, and copper in men.&#x0D; Methods: A prospective study included 38 male patients with internal hemorrhoids (Group I) and 38 healthy male individuals (Group II). Venous blood samples were collected after a 12-hour fast and analyzed for homocysteine, folic acid, vitamin B12, zinc, and copper levels. Statistical analyses, including the Kolmogorov-Smirnov test, Mann-Whitney U or Two-Sample t-test, Receiver Operating Characteristic (ROC) analysis, and Multivariate Binary Logistic regression, were performed.&#x0D; Results: Group I and Group II had similar age and body mass index (BMI). Homocysteine and copper levels were significantly higher in Group I, while folic acid and vitamin B12 levels were significantly lower. High homocysteine levels (≥11.2 µmol/L) had a sensitivity of 92.11%, while low vitamin B12 (

Early symptoms and signs of bony and brain lesions associated with hyperhomocysteinemia: Evidence with scintigraphic images of skeleton and brain

Elevated homocysteine level in serum or hyperhomocysteinemia is considered to be closely associated with neurological disorders such as stroke and cardiovascular diseases. However, to date, there have been limited studies on symptoms specifically associated with elevated homocysteine levels

COVID-19 Hypercoagulability Association with Serum Levels of Homocysteine and SCUBE-1

COVID-19 Hypercoagulability Association with Serum Levels of Homocysteine and SCUBE-1

Effects of rasagiline combined with levodopa and benserazide hydrochloride on motor function and homocysteine and IGF-1 levels in elderly patients with Parkinson’s disease

BackgroundDuring the course of their illness, people with Parkinson’s disease may see changes in their insulin-like growth factor (IGF-1) and serum homocysteine (Hcy) indices. In this study, patients with intermediate to severe Parkinson’s disease were examined for how Resagiline and levodopa and benserazide hydrochloride affected their motor performance, serum levels of homocysteine (Hcy), and insulin-like growth factor (IGF-1).MethodsFrom June 2020 to December 2021, a total of 100+ cases of Parkinson’s patients over 60 years old in the middle and late stages of Parkinson’s were seen in the outpatient and inpatient departments of the Third People’s Hospital of Chengdu City and had a detailed observation record, and according to the inclusion criteria, the patients who met the criteria were randomly grouped into a clinical observation group and a control group. The subjects in the control group received only levodopa and benserazide hydrochloride treatment, while the observation group was treated with Resagiline in combination with the clinical control group. The total treatment observation period was 1 year for both groups, and the motor function and serum Hcy and IGF-1 indexes of both groups were compared after the end of treatment.ResultsWe randomly and evenly grouped 64 patients who met the requirements of the inclusion criteria into a clinical observation group and a control group, each with 32 patients, from among 168 patients over 60 years of age with detailed observation records in the middle and late stages of Parkinson’s. After the 1-year observation period, we found that the total effective rate after treatment in the clinical observation group (93.75%) and significantly higher than that in the control group (68.75%) (P < 0.05); after 1 year of treatment, the UPDRS score decreased in both groups, and the observation group was significantly lower than the control group (P < 0.05); after treatment, serum Hcy decreased and IGF-1 increased in both groups, and the observation group was higher than the control group mean values (P < 0.05).ConclusionsIn patients with Parkinson’s disease who are in the middle and late stages of the disease, the administration of Resagiline combined with levodopa and benserazide hydrochloride can significantly lower the body’s serum Hcy level, significantly raise IGF-1 levels, and significantly improve motor function in patients with Parkinson’s disease. It can also have significant therapeutic effects.

Study to Evaluate Serum Homocysteine Levels as Marker of Peripheral Arterial Disease in a Tertiary Care Hospital in India

Background: The study is aimed to evaluate the association between raised serum Homocysteine levels and severity of Peripheral Vascular Disease (PVD) and its role as a prognostic marker in PVD. Thereby, Vitamin K therapy can be instituted for lowering Homocysteine levels as prophylaxis against cerebral and coronary events in PVD patients. Methods: The serum homocysteine levels was measured in all patients admitted for peripheral vascular disease of upper and/or lower limb and to correlate the abovevalues with Doppler ultrasonography (USG) in the duration between 2020-2022(18 months) Results: The comparison of homocysteine levels with Doppler shows corresponding significant increase in Serum homocysteine levels only in cases of moderate PVD. Statistical analysis with binary logistic regression does show a significant association with moderate severity of PVD and serum homocysteine levels with 80% predictability. Conclusions: There was significant association of homocysteinemia only in Moderate PVD with no statistically significant correlation with mild, severe cases of peripheral arterial disease (PAD) and radiological normal cases, further large randomized trials are required to elucidate its clinical relevance in PAD as a prognostic marker of Severity.

Low vitamin B12 levels may predict the risk of ischemic stroke: A cross-sectional study

BackgroundTo examine serum vitamin B12 concentrations in relation to the risk of ischemic stroke among hospitalized patients in the Department of Neurology. MethodsWe performed a cross-sectional study involving 2,212 inpatients discharged from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University, from January 2020 to January 2022. The results of laboratory assays such as serum vitamin B12, homocysteine, and folate levels were measured. Logistic regression analysis was used to investigate the association between serum vitamin B12 concentrations and ischemic stroke, with adjustment for a number of relevant demographic and lifestyle factors and comorbidities. ResultsA total of 961 (43.4%) patients had an ischemic stroke. In the fully adjusted model, logistic regression analysis suggested a positive association between serum vitamin B12 levels<150 pg/mL (aOR: 1.42; 95% CI 1.02–1.97; p = 0.035), serum vitamin B12 150–300 pg/mL (aOR: 1.37; 95% CI 1.11–1.68; p = 0.003) and the prevalence of ischemic stroke. Furthermore, an inverse association was observed between serum vitamin B12 levels ≥ 900 pg/mL (aOR: 0.38; 95% CI: 0.19–0.77; p =0.007) and the prevalence of ischemic stroke. Moreover, the cut-off value of vitamin B12 concentration was 316.4 pg/mL and the discrimination power of the score evaluated by AUC-ROC was 0.71 (95%CI 0.68–0.73, p<0.001) in the vitamin B12 and ischemic stroke. ConclusionFindings suggest that low vitamin B12 levels may predict the risk of ischemic stroke, early and timely supplementation of vitamin B12 can improve the short-term prognosis of ischemic stroke patients.

Homocysteine and Vitamin D Levels: An Association with Depression and its Severity

Objective: To determine the association of serum Homocysteine and serum vitamin D levels with depression and its severity.Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Psychiatry, Armed Forces Institute of Mental Health (AFIMH), Rawalpindi, Pakistan, from December 2021 to May 2022. Methods: We recorded demographic data, including age, gender, and socioeconomic status of consecutively sampled 155 subjects. Depression and its severity was assessed by applying the Urdu version of the Hamilton Depression Rating Scale (HAM-D U). Blood samples were collected to assess serum homocysteine and serum vitamin D before commencing any treatment for depression; these samples were assessed at the Armed Forces Institute of Pathology (AFIP Rawalpindi).Results: The mean Hamilton Depression Rating Scale (HAM-D U) score was 17.14 ± 4.29 with minimum and maximum scores as 8 and 22. There were 97 (62.6%) cases that had mild to moderate depression, and 58 (37.4%) patients had severe depression. The frequencies of intermediate to severe Homocysteine levels were statistically higher in individuals with severe depression (p &lt; 0.001), while vitamin D deficiency was also statistically higher in individuals experiencing severe depression (p &lt; 0.001). Conclusion: Raised serum homocysteine levels and deficiency of serum vitamin D is associated with the severity of depression.&#x0D; How to cite this: Bajwa AA, Khan S, Raza H, Nazir TB. Homocysteine and Vitamin D Levels: An Association with Depression. Life and Science. 2023; 4(4): 372-378. doi: http://doi.org/10.37185/LnS.1.1.385

Association of Serum Homocysteine Level with Acute Ischaemic Stroke among Young Adult Patients: Experience at a Largest Medical College Hospital in Bangladesh

Background: Hyperhomocysteinemia is emerging as a possible risk factor for stroke, possibly because of accelerated atherosclerosis. Objectives: This study was conducted to evaluate the association between the serum homocysteine level and ischemic stroke in young Bangladeshi patients. Methodology: This cross-sectional study was carried out among patients 18 to 40 years of either gender with sign and symptoms of acute focal neurological deficit, in the Department of Medicine of Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. History taking and physical examination were done in a predesigned data collection sheet. Then required investigations like CT-scan of brain, fasting serum homocysteine, fasting blood sugar, 2 hours ABF blood glucose, HbA1c and fasting lipid profile were done. Results: Out of 96 patients after completing brain imaging 61(65.0%) patients were found suffering from ischemic stroke. Among the patients 74 had normal homocysteine level, 17 patients had moderate hyperhomocysteinemia and 5 patients had intermediate hyperhomocysteinemia. Mean levels of fasting serum homocysteine were significantly higher in patients those had ischemic stroke (16.02 μmol/L, 95% CI: 12.87 to 19.87) compared with those who did not have ischemic stroke (10.47 μmol/L, 95% CI: 9.16 to 11.95, P&lt;0.001). Logistic regression showed fasting homocysteine as an important independent risk factor, with an adjusted OR of 1.1 (95% CI: 1.1 to 1.2; p=0.04966) for every 1 μmol/L increase in homocysteine. Conclusion: The relationship between increasing homocysteine and ischemic stroke risk is strong, graded, and significant. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):24-29

Relationship between the methylenetetrahydrofolate reductase (MTHFR) rs1801133 SNP and serum homocysteine levels of Zhuang hypertensive patients in the central region of Guangxi

BackgroundThe relationship between the methylenetetrahydrofolate reductase (MTHFR) single nucleotide polymorphism (SNP) and serum homocysteine (Hcy) levels or H-type hypertension in different populations is inconsistent. This study aimed to explore the association between the MTHFR rs1801133 SNP and serum Hcy levels of Zhuang hypertensive patients in the central region of Guangxi.MethodsA total of 606 Zhuang inpatients with essential hypertension were recruited in our hospital from August 2016 to December 2018. The patients were divided into H-type hypertension (Hcy > 10 µmol/L, n = 528) and non–H-type hypertension (Hcy ≤ 10 µmol/L, n = 78) groups. At the same time, an age- and sex-matched group of 379 subjects with normal physical examination in our hospital were selected as the control group. Blood biochemical measurements and genotyping of the MTHFR rs1801133 SNP were performed.ResultsThe prevalence of H-type hypertension was 87.13%. The levels of serum Hcy in patients with hypertension were higher than those in control group (14.20 ± 5.78 μmol/L vs. 11.97 ± 5.39 μmol/L, P < 0.001), especially in patients with H-type hypertension (15.08 ± 5.65 μmol/L, P < 0.001). The frequencies of TT genotype (22.73%) and T allele (46.21%) in patients with H-type hypertension were significantly higher than those in control group (11.35% and 30.47%, respectively) and non–H-type hypertension group (10.26% and 28.85%, respectively; P < 0.001 for all). Multivariate linear regression analysis showed that serum Hcy levels were significantly correlated with creatinine, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, and the MTHFR rs1801133 genotypes in control group, while serum Hcy levels were significantly correlated with creatinine, triglyceride, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, glycosylated hemoglobin, and the MTHFR rs1801133 genotypes in H-type hypertension group (P < 0.05–0.001). Serum Hcy levels in the T allele carriers were higher than those in the T allele noncarriers in both H-type hypertension and control groups.ConclusionsThere was closely related between the MTHFR rs1801133 SNP and serum Hcy levels in Zhuang patients with H-type hypertension in the central region of Guangxi. The MTHFR SNP may be an important reason for the increase of serum Hcy levels in Zhuang patients with H-type hypertension in this region.

Vitamin B-12, Homocysteine, and Hematological Parameters in Ischemic Stroke Patients

Background: A cerebrovascular accident or stroke is one of the leading causes of disability and death in the world. Several risk factors have been detected and extensively studied and are part of preventive strategies. Emerging risk factors for ischemic that have recently acquired interest are vitamin B-12 and homocysteine levels. A study has been conducted in a tertiary hospital in Chennai to evaluate the levels of vitamin B-12, homocysteine, and hematological variables. Aims: The objective of the study was to estimate the serum levels of homocysteine and vitamin B-12 in patients with ischemic stroke and transient ischemic attack and to analyze hematological parameters, including complete blood counts and peripheral smear and correlate with vitamin B-12. Materials and Methods: A total of 80 individuals with either ischemic stroke or transient ischemic attack were included in the study. Vitamin B-12, homocysteine, complete blood counts, and peripheral smear were analyzed for the patients. Results: Either frank or subclinical vitamin B-12 deficiencies were noted in 59 (73.8%) of the study population. Fifty-seven (71.2%) of the study population had elevated homocysteine. Fifty (62.5%) had a high neutrophil-to-lymphocyte (N:L) ratio and 52 (65%) had elevated red cell distribution width. Conclusion: High homocysteine levels are prevalent among ischemic stroke patients and this elucidates that homocysteine has a role in the thrombus formation and is a risk factor for the development of the stroke. It was also noted that vitamin B-12 deficiency, either frank or subclinical, is prevalent among these patients and can be a target for supplementation strategies.

Serum Levels of Hcy, sST2 and CA-125 in CHF Patients and Their Correlation with Cardiac Function Classification.

The relationships between serum levels of homocysteine (Hcy), soluble stromelysin 2 (sST2), and tumor-associated cancer antigen 125 (CA-125) and heart failure requires further investigation. The aim of the present study was to evaluate the levels of Hcy, sST2 and CA-125 in patients with congestive heart failure and to correlate these with cardiac function, thereby providing a reference for the clinical diagnosis and treatment of heart failure. Seventy patients with chronic heart failure (CHF) diagnosed between August 2020 and July 2022 were classified into heart failure groups II (n = 25), III (n = 23) and IV (n = 22). Seventy individuals with normal physical examination results were selected as the healthy group. Serum Hcy, sST2 and CA-125 levels for all participants were evaluated and correlated with each other and with cardiac function classification. The diagnostic value of individual Hcy, sST2, CA-125 levels for CHF was evaluated, as well as a combination of these factors. Hcy, sST2, and CA-125 levels were lower in the healthy group than in the heart failure group. Moreover, a progressive increase in Hcy, sST2, and CA-125 levels were observed in heart failure groups II, III, and IV. Individual Hcy, sST2 and CA-125 levels, as well as a combination of these factors, were significantly correlated with cardiac function classification (p < 0.05). Hcy, sST2 and CA-125 levels each showed diagnostic value for CHF, with the three combined having the best diagnostic value. Abnormally high levels of Hcy, sST2 and CA-125 occur in CHF patients and are positively correlated with cardiac function classification. Individual levels of these factors, and particularly a combination of the three, show good sensitivity and specificity for CHF diagnosis that could be widely used in clinical practice.

Exploring the Interplay Between Vitamin B12-related Biomarkers, DNA Methylation, and Gene-Nutrition Interaction in Esophageal Precancerous Lesions

Vitamin B12 depletion has been suggested to be associated with esophageal precancerous lesions (EPL). However, the potential mechanisms remain unclear. This study aims to evaluate the role of vitamin B12 and its regulated epigenetic modification in EPL and provide preliminary information on the identification of potential molecular biomarkers for the early prediction of EPL. We collected information and samples from the Early Diagnosis and Early Treatment Project of Esophageal Cancer database from 200 EPL cases and 200 matched controls. Vitamin B12, one-carbon metabolism biomarkers, genetic polymorphism of TCN2 C776G, and DNA methylation were compared. Preliminarily identified candidate promoters of differentially methylated CpG positions were further verified by targeted bisulfite sequencing. EPL cases had significantly lower serum levels of vitamin B12 and transcobalamin II, and higher serum levels of homocysteine and 5-methyltetrahydrofolate than controls. The TCN2 C776G polymorphism was found to be associated with susceptibility to EPL and may interact with vitamin B12 nutritional status to influence the risk of EPL in male subjects. In addition, global hypomethylation related to vitamin B12 depletion was observed in EPL cases, along with region-specific hypermethylation of UGT2B15 and FGFR2 promoters. This study suggests that vitamin B12 depletion may be associated with aberrant DNA methylation and increased risk of EPL through the one-carbon metabolism pathway, presents that the TCN2 C776G polymorphism may interact with vitamin B12 nutritional status to affect EPL risk in males, and also identifies specific locations in the UGT2B15 and FGFR2 promoters with potential as promising molecular biomarkers.

Effect of ginkgo leaf tablets combined with compound carbidopa on patients with Parkinson’s disease

Purpose: To determine the effect of a combination of ginkgo leaf tablets with compound carbidopa tablets on cognitive function, serum homocysteine (Hcy), malondialdehyde (MDA) and neuron-specific enolase (NSE) levels in patients with Parkinson's disease (PD).Methods: A total of eighty (80) PD patients admitted to The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China between December 2020 and December 2022 were randomly divided into two groups: Western medicine group (n = 40, using compound carbidopa tablets alone) and combination group (n = 40, using ginkgo leaf tablets combined with compound carbidopa tablets), and orally treated for 3 months. Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognitive function before and after treatment. High-performance liquid chromatography was used to determine serum Hcy levels, while enzyme-linked immunosorbent assay (ELISA) was used to evaluate serum MDA and NSE levels. Adverse reactions were also recorded during treatment.Results: Total response rate following treatment in combination group was significantly higher than in Western medicine group (95.00 vs 80.00 %, p &lt; 0.05). After treatment, MMSE and MoCA scores in combination group were significantly higher (p &lt; 0.05) than those in Western medicine group, while serum Hcy, MDA and NSE levels in combination group were significantly lower than those in Western medicine group (p &lt; 0.05). During treatment, there was no significant difference in incidence of adverse reactions between the two groups (p &gt; 0.05).Conclusion: Ginkgo leaf tablets in combination with carbidopa significantly improve cognitive functions associated with PD with high safety, when compared to carbidopa tablets alone. However, further clinical trials are commended to validate these findings.

Hyperhomocysteinemia Increases Vascular Risk in Stroke Patients with Chronic Kidney Disease.

We aimed to assess the prognostic impact of hyperhomocysteinemia (HHcy) on the recurrent vascular event risk in stroke patients with or without chronic kidney disease (CKD). In this prospective observational study, 621 patients (mean age, 69.5 years; male, 62.2%) with ischemic stroke or transient ischemic attack were consecutively enrolled within 1 week of onset and followed-up for 1 year. HHcy was defined as elevated levels of fasting total homocysteine ＞15 µmol/L. CKD was defined as an estimated glomerular filtration rate of ＜60 mL/min/1.73 m2 or a history of renal replacement therapy. The primary outcome was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, major peripheral artery disease, and vascular death. The prevalence of HHcy was 18.5%. Patients with HHcy were more likely to have intracranial (37.4% versus 24.8%; p=0.008) and extracranial (20.9% versus 13.0%; p=0.037) artery stenosis than were those without HHcy. At 1 year, patients with HHcy were at a greater risk of MACE than were those without HHcy (annual rate, 17.8% versus 10.4%; log-rank p=0.033). In the Cox proportional hazard regression models, HHcy was independently associated with an increased risk of MACE in patients with CKD (adjusted hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.02-4.20), whereas HHcy was not predictive of MACE in those without CKD (adjusted HR, 1.00; 95% CI, 0.30-3.32). Elevated levels of serum homocysteine can be an important modifiable risk factor in stroke patients with CKD, but not in those without CKD.

Hyperhomocysteinaemia Promotes Doxorubicin-Induced Cardiotoxicity in Mice.

Doxorubicin, a widely used chemotherapeutic drug in clinical oncology, causes a series of cardiac side effects referred to as doxorubicin-induced cardiotoxicity. Hyperhomocysteinaemia is an independent risk factor for multiple cardiovascular diseases. However, whether hyperhomocysteinaemia contributes to doxorubicin-induced cardiotoxicity is currently unknown. In this study, we explored the pathogenic effects of hyperhomocysteinaemia induced by dietary methionine supplementation (2% wt/wt in rodent chow) in a mouse model of doxorubicin-induced cardiotoxicity. Our data showed that methionine supplementation doubled serum homocysteine levels, inducing mild hyperhomocysteinaemia. Doxorubicin at a cumulative dosage of 25 mg/kg body weight led to significant weight loss and severe cardiac dysfunction, which were further exacerbated by methionine-induced mild hyperhomocysteinaemia. Doxorubicin-induced cardiac atrophy, cytoplasmic vacuolisation, myofibrillar disarray and loss, as well as cardiac fibrosis, were also exacerbated by methionine-induced mild hyperhomocysteinaemia. Additional folic acid supplementation (0.006% wt/wt) prevented methionine-induced hyperhomocysteinaemia and inhibited hyperhomocysteinaemia-aggravated cardiac dysfunction and cardiomyopathy. In particular, hyperhomocysteinaemia increased both serum and cardiac oxidative stress, which could all be inhibited by folic acid supplementation. Therefore, we demonstrated for the first time that hyperhomocysteinaemia could exacerbate doxorubicin-induced cardiotoxicity in mice, and the pathogenic effects of hyperhomocysteinaemia might at least partially correlate with increased oxidative stress and could be prevented by folic acid supplementation. Our study provides preliminary experimental evidence for the assessment of hyperhomocysteinaemia as a potential risk factor for chemotherapy-induced cardiotoxicity in cancer patients.

Relation of Serum Homocysteine Levels and Chronic Kidney Disease in Patients with Systemic Lupus Erythematosus

Abstract Background SLE is an autoimmune disease characterized by the production of autoantibodies to components of the cell nucleus in association with diverse clinical manifestations affecting almost all organ systems. It is a complex disease with variable presentations, course, and prognosis characterized by remissions and flares. The etiology of SLE remains unknown and is clearly multifactorial. Many observations suggest a role for genetic, hormonal, immunologic, and environmental factors. Objective To evaluate the relation between serum homocysteine levels and occurrence of chronic renal disease, renal functions, severity of proteinuria and progression to end stage renal disease in patients with systemic lupus erythematosus. Patients and Methods This study include 70 SLE patients with biopsy proven lupus nephritis who fulfill four or more of 2012 American College of Rheumatology (ACR) criteria for SLE. They were recruited from Rheumatology Outpatient Clinic and Rheumatology Inpatient Department of Ain Shams University Hospitals. Twenty healthy individuals were included as controls. Written consents were obtained from all patients participating in the study. Results In this study there was highly statistically significant difference between patients and controls as regards serum homocysteine levels, 17 patients had mild, 8 moderate and 5 severe hyperhomocysteinaemia, with (p- &amp;lt;0.001). Hypertension was recorded in 32 SLE patients (45.7%) and no one of controls was hypertensive. Carotid examination showed an overall increased intimal thickness (CIMT) in the 8 (11.4 %) SLE patients (3 of them have hypertension). There was highly statistically significant relation between levels of homocysteine with carotid intimal thickness imaging in patients group p-value &amp;lt;0.001. The current study proved that there statistically a significant correlation between serum homocysteine levels and class of CKD, 40 had normal and 30 had subnormal HC levels, mild HHC was observed in 17, moderate HHC in 8 cases, while sever HHC was 5 of cases with p- &amp;lt;0.001. Conclusion This study demonstrates that homocysteine is modifiable marker in SLE patients; hyperhomocysteinemia was significantly correlated with renal function and progression to end stage renal disease. The current study shows statistically significant relation between serum homocysteine levels and patients age, disease duration, diabetes mellitus, and hypertension. There were significant positive correlation between homocysteine levels and both blood urea nitrogen (BUN) and 24 hr urinary protein. Also, there statistically significant relation between homocysteine and CKD classes in SLE patients, 40% of patients with class IV LN had hyperhomocysteinamia.