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Journal of Central South University(Medical Sciences) ; (12): 24-33, 2023.
Article in English | WPRIM | ID: wpr-971367


OBJECTIVES@#Hyperhomocysteinaemia (Hcy) is an independent risk factor for cardiovascular and cerebrovascular diseases. MicroRNA (miR)-18a-5p is closely related to cardiovascular diseases. This study aims to investigate the effects of miR-18a-5p on homocysteine (Hcy)-induced myocardial cells injury.@*METHODS@#H9c2 cells were transfected with miR-18a-5p mimic/miR-18a-5p mimic negative control (NC) or combined with Hcy for intervention, and untreated cells were set as a control group. The transfection efficiency was verified by real-time RT-PCR, and cell counting kit-8 (CCK-8) assay was used to determine cell viability. Flow cytometry was used to detect apoptosis and reactive oxygen species (ROS) levels. Western blotting was performed to measure the protein levels of microtubule-associated protein 1 light chain 3 (LC3)-I, LC3-II, Beclin1, p62, Bax, Bcl-2, and Notch2. Dual luciferase reporter assay was used to detect the interaction of miR-18a-5p with Notch2.@*RESULTS@#Compared with the control, treatment with Hcy or transfection with miR-18a-5p mimic alone, or combined treatment with Hcy and miR-18a-5p mimic/miR-18a-5p mimic NC significantly reduced the H9c2 cell viability, promoted apoptosis and ROS production, up-regulated the expressions of Bax and Beclin, down-regulated the expressions of Bcl-2, p62, and Notch2, and increased the ratio of LC3-II/LC3-I (all P<0.05). Compared with the combined intervention of miR-18a-5p mimic NC and Hcy group, the above indexes were more significantly changed in the combined intervention of miR-18a-5p mimic and Hcy group, and the difference between the 2 groups was statistically significant (all P<0.05). There is a targeted binding between Notch2 and miR-18a-5p.@*CONCLUSIONS@#MiR-18a-5p could induce autophagy and apoptosis via increasing ROS production in cardiomyocytes, and aggravate Hcy-induced myocardial injury. Notch2 is a target of miR-18a-5p.

Rats , Animals , Apoptosis/genetics , Autophagy/genetics , bcl-2-Associated X Protein , MicroRNAs/metabolism , Proto-Oncogene Proteins c-bcl-2/genetics , Reactive Oxygen Species , Myocytes, Cardiac/drug effects , Homocysteine/adverse effects , Hyperhomocysteinemia
Braz. j. biol ; 83: 1-8, 2023. tab
Article in English | LILACS, VETINDEX | ID: biblio-1468927


The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor [...].

O presente estudo foi desenhado para avaliar a força da associação da concentração elevada de homocisteína no plasma como um fator de risco para doença cardíaca coronária independente do fator de risco convencional. Foi um estudo de caso-controle realizado no Punjab Institute of Cardiology Lahore. Um total de 210 indivíduos com idade entre 25 e 60 anos, compreendendo 105 pacientes recém-admitidos de CHD como casos e 105 indivíduos saudáveis pareados por idade e sexo sem histórico de CHD como controle, foi recrutado para o estudo. Amostras de sangue em jejum foram obtidas de casos e controles. A homocisteína plasmática foi analisada pelo método de imunoensaio de polarização de fluorescência (FPIA) em analisador de imunoensaio automatizado (Abbott IMX). Colesterol total, triglicerídeos e colesterol HDL foram analisados usando métodos de kit calorimétrico. A concentração de colesterol LDL foi calculada pela fórmula de Friedewald. Os pacientes também foram avaliados para fatores de risco tradicionais, como idade, sexo, história familiar de DCV, hipertensão, tabagismo e atividade física, e foram comparados com indivíduos de controle. Os dados coletados foram inseridos no SPSS versão 24 para análise e interpretação. A média de idade nos grupos controles e experimentais foi de 43,00 ± 8,42 anos e 44,72 ± 8,59 anos com distribuição estatisticamente igual (p-valor = 0,144). A homocisteína plasmática média para os casos foi de 22,33 ± 9,22 µmol / L, enquanto no grupo controle foi de 12,59 ± 3,73 µmol / L. Diferença altamente significativa foi observada entre o nível plasmático médio de homocisteína em casos e controles (p ˂ 0,001). A regressão logística simples indica uma forte associação de doença cardíaca coronária com hiper-homocisteinemia (OR 7,45), que permaneceu significativamente associada com doença cardíaca coronária por multivariada regressão logística (OR 7,10, 95% C1 3,12-12,83, p = 0,000). O presente estudo conclui [...].

Humans , Young Adult , Adult , Coronary Disease/prevention & control , Coronary Disease/blood , Homocysteine/analysis
Chinese Acupuncture & Moxibustion ; (12): 489-492, 2023.
Article in Chinese | WPRIM | ID: wpr-980749


OBJECTIVE@#To observe the effects of acupuncture on neurologic function and serum inflammatory factors in patients after thrombolysis in acute ischemic stroke (AIS).@*METHODS@#A total of 102 AIS patients with onset to treatment time (OTT) ≤3 h were randomly divided into an observation group and a control group, 51 cases each group. In the control group, thrombolysis and conventional medical treatment were applied. On the basis of the treatment as the control group, acupuncture at Shuigou (GV 26), Zhongwan (CV 12), Qihai (CV 6), Neiguan (PC 6), etc. was applied in the observation group, 30 min each time, once a day. Both groups were treated for 2 weeks. Before and after treatment, the scores of National Institutes of Health stroke scale (NIHSS), modified Rankin scale (mRS), modified Barthel index (MBI) and serum level of homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) were compared, and the clinical efficacy was evaluated in the two groups.@*RESULTS@#After treatment, the scores of NIHSS, mRS and serum level of Hcy, hs-CRP were decreased compared with those before treatment (P<0.05), while the MBI scores were increased (P<0.05) in the two groups. The scores of NIHSS, mRS and serum level of Hcy, hs-CRP in the observation group were lower than those in the control group (P<0.05, P<0.01), the MBI score in the observation group was higher than that in the control group (P<0.01). The total effective rate was 88.2% (45/51) in the observation group, which was superior to 70.6% (36/51) in the control group (P<0.05).@*CONCLUSION@#Acupuncture could promote the recovery of neurologic function in patients after thrombolysis in AIS, improve the ability of daily living, which may be related to reducing the level of inflammatory factors, thus inhibiting inflammatory response and improving cerebral ischemia reperfusion injury.

Humans , United States , Ischemic Stroke , C-Reactive Protein , Acupuncture Therapy , Inflammation , Homocysteine , Hypersensitivity , Thrombolytic Therapy
Rev. bras. ginecol. obstet ; 44(4): 352-359, Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1387899


Abstract Objective To assess homocysteine (Hcy) levels in the three trimesters of pregnancy in women with fetal growth restriction (FGR) and to evaluate the role of Hcy as a possible predictor of FGR. Methods A total of 315 singleton pregnant women were included in the present prospective cohort study and were monitored since the 1st trimester of pregnancy before delivery. Newborns were monitored for the first 7 days of life. Patients who had risk factors for FGR were excluded. Fetal growth restriction was defined according to uterine fundal height (< 10 percentile), ultrasound fetometry (< 5 percentile), and anthropometry of newborns (<5 percentile). The concentrations of Hcy were detected at between 10 and 14, between 20 and 24, and between 30 and 34 weeks of pregnancy by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristics (ROC) curve test and diagnostic odds ratio (DOR) were performed to evaluate the results of ELISA. Results The concentration of Hcy in patients with FGR was 19.65 umol/L at between 10 and 14 weeks, compared with 9.28 umol/L in patients with normal fetal growth (p<0.0001). The optimal cut-off level for Hcy in the 1st trimester of pregnancy was>13.9 umol/L with AUC 0.788, sensitivity of 75%, specificity of 83.6%, and DOR of 15.2. Conclusion Assessment of serum Hcy concentration may be used as a predictor of FGR, with the highest diagnostic utility in the 1st trimester of pregnancy.

Resumo Objetivo Avaliar os níveis de homocisteína (Hcy) em três trimestres da gravidez em mulheres com restrição de crescimento fetal (FGR, na sigla em inglês) e avaliar o papel da Hcy como possível preditor de FGR. Métodos Um total de 315 gestantes solteiras foram incluídas no presente estudo de coorte prospectivo e monitoradas desde o 1° trimestre de gravidez antes do parto. Os recém-nascidos foram acompanhados durante os primeiros 7 dias de vida. Pacientes que apresentam fatores de risco para FGR foram excluídos. A FGR foi definida de acordo com a altura do fundo do útero (< percentil 10), ultrassonografia fetometria (< percentil 5) e antropometria dos recém-nascidos (< percentil 5). As concentrações de Hcy foram detectadas entre 10 e 14, entre 20 e 24 e entre 30 e 34 semanas de gravidez por ensaio de imunoabsorção enzimática (ELISA, na sigla em inglês). O teste da curva das características de operação do receptor (ROC, na sigla em inglês) e a razão de chances de diagnóstico (DOR, na sigla em inglês) foram realizados para avaliar os resultados do ELISA. Resultados A concentração de Hcy em pacientes com FGR foi de 19,65 umol/L entre 10 e 14 semanas, em comparação com 9,28 umol/L em pacientes com crescimento fetal normal (p<0,0001). O nível de corte ideal para Hcy no 1° trimestre da gravidez foi>13,9 umol/L com AUC 0,788, sensibilidade de 75%, especificidade de 83,6%, e DOR 15,2. Conclusão A avaliação da concentração sérica de Hcy pode ser usada como um preditor de FGR, com maior utilidade diagnóstica no 1° trimestre de gravidez.

Humans , Female , Pregnancy , Hyperhomocysteinemia , Fetal Growth Retardation , Homocysteine
Journal of Experimental Hematology ; (6): 305-309, 2022.
Article in Chinese | WPRIM | ID: wpr-928710


OBJECTIVE@#To observe the expression level of serum homocysteine (Hcy) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in patients with hematological diseases complicated with coronary heart disease, and analyze the relationship between serum Hcy level, MTHFR gene polymorphism and coronary heart disease.@*METHODS@#The medical records of 80 patients with coronary heart disease who completed treatment of hematological diseases during the period from March 2018 to March 2020 were selected as observation group. In addition, the medical records of 92 patients with hematological diseases who completed treatment in our hospital during the same period were selected as control group. Venous blood samples of the two groups were collected to detect serum Hcy level and MTHFR gene polymorphism. The serum Hcy levels of the two groups with different MTHFR genotypes were compared, and the effects of the above indicators on hematological diseases complicated with coronary heart disease were analyzed.@*RESULTS@#The detection rates of MTHFR gene TT and TC in the observation group were higher than those in the control group, while the distribution frequency of MTHFR genotype CC was lower (P<0.05). The serum Hcy levels of the patients with MTHFR genotype TT and TC in the observation group was higher than the control group (P<0.05). Binary logistic regression analysis showed that MTHFR gene TC/CC genotype serum Hcy overexpression may be influencing factor which induced coronary heart disease in patients with hematological diseases (OR=2.107/OR=1.634, P<0.05). ROC curves showed that the AUC of serum Hcy level of MTHFR gene TC/CC genotype and hematological disease complicated with coronary heart disease were both > 0.8. When MTHFR gene TC reaching the optimal threshold of 22.165 μmol/L, the sensitivity was 0.950 and the specificity was 0.837, While MTHFR gene CC reached the optimal threshold of 19.630 μmol/L, the sensitivity was 0.938 and the specificity was 0.826, the best predictive value could be obtained.@*CONCLUSION@#The changes of serum Hcy and MTHFR gene polymorphisms may be involved in the pathological process in patients with hematological diseases complicated with coronary heart disease. In the future, early detection of serum Hcy levels and MTHFR gene polymorphisms in patients with hematological diseases can be used to predict the risk of coronary heart disease.

Humans , Coronary Disease/genetics , Genotype , Hematologic Diseases/complications , Homocysteine , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Polymorphism, Genetic
Chinese Journal of Oncology ; (12): 562-569, 2022.
Article in Chinese | WPRIM | ID: wpr-940923


Objective: To investigate the correlation of homocysteine (HCY) and coagulation function index with the risk of breast cancer and its clinicopathological characteristics. Methods: The HCY, coagulation function test index, and clinicopathological information of female breast cancer patients (333 cases) treated in Tianjin Medical University Cancer Hospital from January 2018 to December 2018 were collected, and female patients with benign breast (225 cases) were selected during the same period for the control group. The t-test was used to compare measurement data with normal distribution, D-Dimer data were distributed discreetly and described by median, non-parametric Mann-Whitney U test was used to compare the two groups. The chi-square test was used to compare enumeration data, and the Logistic regression analysis was used for the risk analysis. Results: The levels of HCY, fibrinogen (Fbg), protein C (PC), and median D-Dimer (D-D) in peripheral blood of breast cancer patients group [(13.26±5.24) μmol/L, (2.61±0.83) g/L, (117.55±19.67)%, and 269.68 ng/ml, respectively] were higher than those in the control group [(11.58±0.69) μmol/L, (2.49±0.49) g/L, (113.42±19.82)% and 246.98 ng/ml, respectively, P<0.05]. The prothrombin time (PT), PT(INR), α2-antiplasmin (α2-AP) levels [(10.19±0.63) s, 0.91±0.07 and (110.64±13.93)%, respectively] were lower than those in the control group [(10.58±0.65) s, 0.93±0.01 and (123.81±14.77) %, P<0.05]. The serum levels of PC and median D-D in premenopausal breast cancer patients [(112.57±17.86)% and 242.01 ng/ml, respectively] were higher than those in the control group [(105.31±22.31)% and 214.75 ng/ml, respectively, P<0.05]. The levels of PT(INR), α2-AP [0.91±0.07 and (111.29±12.54)%, respectively] were lower than those of the control group[0.98±0.15 and (120.17±16.35)%, respectively, P<0.05]. The levels of HCY and median D-D in postmenopausal breast cancer patients [(14.25±5.76) μmol/L and 347.53 ng/ml, respectively] were higher than those in the control group [(11.67±2.38) μmol/L and 328.28 ng/ml, P<0.05]. The levels of PT, PT(INR), antithrombin Ⅲ (AT-Ⅲ), α2-AP levels [(10.18±0.66) s, 0.87±0.09, (97.30±12.84)% and (110.13±14.96)%] were lower than those in the control group [(10.38±0.61) s, 0.90±0.08, (102.89±9.12)%, and (127.05±12.38)%, respectively, P<0.05]. The levels of α2-AP and median D-D in T2-4 stage breast cancer patients [(111.69±14.41)% and 289.25 ng/ml, respectively] were higher than those in Tis-1 stage patients [(108.05±12.37)% and 253.49 ng/ml, respectively, P<0.05]. The levels of PT, PT (INR), Fbg, AT-Ⅲ, α2-AP, median D-D [(10.62±0.63) s, 0.95±0.06, (3.04±1.52) g/L, (103.21±9.45)%, (118.72±14.77)% and 331.33 ng/ml, respectively] in breast cancer patients with lymph node metastasis were higher than those of patients without lymph node metastasis [(10.42±0.58) s, 0.93±0.06, (2.52±0.54) g/L, (95.20±13.63)%, (106.91±13.13)% and 263.38 ng/ml, respectively, P<0.05]. In non-menopausal breast cancer patients, the level of HCY [(12.63±4.41) μmol/L] in patients with T2-4 stage was higher than that of patients with Tis-1 stage [(10.70±3.49) μmol/L, P=0.010], and the level of thrombin time [(19.35±0.90) s] of patients with T2-4 stage was lower than that of patients with Tis-1 stage [(19.79±1.23) s, P=0.015]. The levels of PT(INR), Fbg, AT-Ⅲ, α2-AP [0.97±0.56, (3.37±2.34) g/L, (102.38±8.77)% and (120.95±14.06)%] in patients with lymph node metastasis were higher than those of patients without lymph node metastasis [0.94±0.05, (2.36±0.48) g/L, (94.56±14.37)% and (109.51±11.46)%, respectively, P<0.05]. Among postmenopausal breast cancer patients, the levels of AT-Ⅲ and α2-AP in T2-4 stage patients [(98.48±11.80)% and (111.84±15.35)%, respectively] were higher than those in patients with the Tis-1 stage [(94.12±14.98)% and (105.49±12.89)%, respectively, P<0.05]. The levels of AT-Ⅲ and α2-AP in N1-3 stage patients [(103.74±9.94)% and (117.29±15.23)%] were higher than those in N0 stage patients [(95.75±13.01)% and (108.39±14.42)%, P<0.05]. Conclusions: HCY and abnormal coagulation function are related to the risk of breast cancer, T stage and lymph node metastasis in breast cancer patients.

Female , Humans , Blood Coagulation Disorders , Breast Neoplasms , Fibrinogen/metabolism , Homocysteine , Lymphatic Metastasis , Prothrombin Time
West Afr. j. med ; 39(11): 1198-1204, 2022. tables
Article in English | AIM | ID: biblio-1411021


BACKGROUND: Sickle cell disease is the commonest geneticdisorder in Nigeria, affecting 2­3% of an estimated population of 160million people. The role of genetic mutations in folate cycle genes,and the variable phenotypic expressions constituting disease severity,needs to be critically examined.OBJECTIVE: This study was carried out to establish the pattern ofmethionine synthase gene mutations (rs1805087 SNP), and its possibleassociation with disease severity in adults with sickle cell anaemia inLagos, Nigeria.METHODOLOGY: This is a cross-sectional study of seventy (70)subjects with sickle cell disease (HbSS) matched for age and genderwith known apparently healthy haemoglobin genotype AA (HbAA)subjects, as cases and controls respectively. Structured questionnaireswere used to obtain demographic, clinical and other phenotypic dataneeded to compute disease severity. Pattern of MTR A2756G genemutation and homocysteine assay (Hcy) were assessed by PolymeraseCh ain Reaction and Enzyme- linked Immun osorbent Assayrespectively. Full blood count analysis of participants was done usingthe KX-21 Automated Analyzer (Sysmex Corporation, Japan).RESULTS: The mutant genotypes MTR 2756 AG/GG were recordedin 46.4% (n =55) of subjects with disease severity score >7. Elevatedplasma homocysteine (HHcy) was significantly associated withdisease severity among HbSS subjects (OR=17.2, CI: 3.490-86.079;p=0.0001). Conversely, no significant association was observed withthe mutant genotypes MTR 2756 AG/GG and disease severity(p>0.05).CONCLUSION: While HHcy is significantly associated withphenotypic expression of HbSS, the MTR 2756 SNPs did not appearto independently influence homocysteine level or disease severity inHbSS subjects

Humans , Severity of Illness Index , Homocysteine , Methionine , Anemia, Sickle Cell
Arq. gastroenterol ; 58(2): 234-239, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285332


ABSTRACT BACKGROUND: The vitamin B12 absorption can be affected in patients with nonalcoholic fatty liver disease (NAFLD), and low serum vitamin B12 levels has been related to the high homocysteine (HCY) levels and to the degree of NAFLD. OBJECTIVE: To carry out a systematic review and metanalysis of serum vitamin B12 and HCY levels in patients with NAFLD. METHODS: Original studies including serum vitamin B12 and HCY levels in humans with NAFLD were included. The searches were performed in four databases. RESULTS: 159 studies were identified, and after excluding the duplicates and non-eligible titles, eight original articles were included. Six out of eight showed higher B12 levels in NAFLD patients (404.9±136.2 pg/mL in relation to controls 353.91±117.3 pg/mL). Seven of the eight studies also showed higher HCY levels in NAFLD patients (14.2±3.44 umol/L in relation to controls 11.05±3.6 umol/L). The results for serum vitamin B12 and HCY levels were submitted to metanalysis, showing no difference in the vitamin B12 levels between patients with NAFLD and controls. However, the levels of Hcy were higher in NAFLD patients than in controls. CONCLUSION: There was no relashionship between the vitamin B12 levels and NAFLD. The levels of HCY were significantly higher in patients with NAFLD, suggesting this could be a potential marker for liver damage.

RESUMO CONTEXTO: A absorção de vitamina B12 pode ser afetada em pacientes com doença hepática gordurosa não alcoólica (DHGNA), e baixos níveis séricos de vitamina B12 têm sido relacionados a níveis elevados de homocisteína (HCI) ao grau de DHGNA. OBJETIVO: Realizar revisão sistemática e metanálise dos níveis séricos de vitamina B12 e de HCI em pacientes com DHGNA. MÉTODOS: Estudos originais que incluíssem avaliação dos níveis séricos de vitamina B12 e de HCI em humanos com DHGNA foram incluídos. As buscas foram realizadas em quatro bases de dados. RESULTADOS: Foram identificados 159 estudos e, após exclusão das duplicatas e dos não elegíveis, oito artigos originais foram incluídos. Seis dos oito artigos apresentaram níveis mais elevados de vitamina B12 nos pacientes com DHGNA (404,9±136,2 pg/mL) em relação aos controles (353,91±117,3 pg/mL). Sete dos oito estudos determinaram os níveis de HCI, estando aumentados em pacientes com DHGNA (14,2±3,44 umol/L) em relação aos controles (11,05±3,6 umol/L). Os resultados dos níveis séricos de vitamina B12 e HCI foram submetidos à metanálise, mostrando que não há diferença nos níveis de vitamina B12 entre os pacientes com DHGNA e os controles. No entanto, os níveis de HCI foram maiores nos pacientes com DHGNA do que nos controles. CONCLUSÃO: Não houve relação entre DHGNA e nível sérico de vitamina B12. Os níveis de HCI foram significativamente maiores em pacientes com DHGNA, sugerindo que esse poderia ser um potencial marcador de lesão hepática.

Humans , Non-alcoholic Fatty Liver Disease , Vitamin B 12 , Biomarkers , Folic Acid , Homocysteine
Prensa méd. argent ; 107(3): 135-142, 20210000. tab
Article in English | LILACS, BINACIS | ID: biblio-1359564


Antecedentes: el síndrome de ovario poliquístico (SOP) es un trastorno endocrino reproductivo común, se puede identificar por hiperandrogenismo, oligomenorrea o anovulación y ovarios poliquísticos en la ecografía. Los polimorfismos de la metilentetrahidrofolato reductasa (MTHFR) C677T asociados con la hiperhomocisteinemia se encuentran entre los factores de riesgo del síndrome de ovario poliquístico. Objetivo: El presente estudio de casos y controles tiene como objetivo explorar la relación entre los polimorfismos C677T de la metilenotetrahidrofolato reductasa (MTHFR) como factor de riesgo y el síndrome de ovario poliquístico entre los pacientes jordanos que padecen esta enfermedad. Métodos: Se inscribieron en el estudio 306 sujetos (146 pacientes con SOP y 160 sujetos sanos como grupo de control). Se extrajo ADN de una muestra de sangre venosa extraída de cada participante para analizar los polimorfismos de MTHFR C677T utilizando la reacción en cadena de la polimerasa (PCR) en combinación con digestión con enzima de restricción (PCRRFLP). Posteriormente, los productos de PCR-RFLP se digirieron con la enzima HinfI, luego se sometieron a electroforesis en un gel de agarosa al 2%, se tiñeron y se examinaron bajo luz ultravioleta. Los niveles de homocisteína en plasma se analizaron utilizando el método ELISA. Resultados: Se observó una diferencia significativa en los niveles plasmáticos de homocisteína entre los pacientes con SOP frente a los sujetos de control y entre los diferentes polimorfismos de los pacientes con SOP. No se detectaron diferencias significativas en la distribución y frecuencia alélica de los polimorfismos MTHFR C677T en pacientes con SOP en comparación con los controles. El genotipo 677 / TT y el alelo T se asociaron con un aumento de 1,54 y 1,46 veces en la susceptibilidad al síndrome de ovario poliquístico. Conclusión: El estudio ha demostrado que el polimorfismo MTHFR T677T y el alelo T son posibles factores de riesgo de SOP entre las mujeres jordanas y pueden desempeñar un papel en la patogenia de la enfermedad

Background: Polycystic ovary syndrome (PCOS) is a common endocrine reproductive disorder, it can be identified by hyperandrogenism, oligomenorrhea or anovulation and polycystic ovaries on ultrasound. Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms associated with hyperhomocysteinemia are among the risk factors for PCOS. Objective: The present case control study aims to explore the relationship between Methylenetetrahydrofolate Reductase (MTHFR) C677T polymorphisms as a risk factor and PCOS among Jordanian patients suffering from this disease. Methods: 306 subjects (146 PCOS patients and 160 healthy subjects as a control group) were enrolled in the study. DNA was extracted from venous blood sample withdrawn from each participant for analyzing MTHFR C677T polymorphisms using Polymerase Chain Reaction (PCR) in combination with restriction enzyme fragment length polymorphism (PCR-RFLP). Later, PCR-RFLP products were digested with hinfI enzyme, then, electrophoresed on a 2% agarose gel, stained and examined under UV light. Plasma homocysteine levels were assayed using ELISA method. Results: A significant difference was observed in plasma homocysteine levels among PCOS patients versus the control subjects and in between the different polymorphisms of PCOS patients. No significant difference was detected in the distribution and allelic frequency of MTHFR C677T polymorphisms in PCOS patients compared to the controls. 677/TT genotype and T allele were associated with 1.54 and 1.46 folds increase in the susceptibility for PCOS. Conclusion: The study has shown that MTHFR T677T polymorphism and T allele are possible risk factors for PCOS among Jordanian women and may play a role in the pathogenesis of the disease.

Humans , Female , Polycystic Ovary Syndrome/diagnosis , Polycystic Ovary Syndrome/pathology , DNA/analysis , Polymerase Chain Reaction , Risk Factors , Genotype , Homocysteine/blood
Adv Rheumatol ; 61: 17, 2021. tab, graf
Article in English | LILACS | ID: biblio-1152736


Abstract Background: Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS. Methods: Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software. Results: Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = − 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype. Conclusion: This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings. Trial registration: This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426.(AU)

Humans , Spondylitis, Ankylosing/etiology , Homocysteine/analysis , Case-Control Studies , Methotrexate/therapeutic use , Tumor Necrosis Factor-alpha/therapeutic use
Journal of Experimental Hematology ; (6): 530-534, 2021.
Article in Chinese | WPRIM | ID: wpr-880108


OBJECTIVE@#To analyze the influence of serum homocysteine (Hcy) levels to the prognosis of newly diagnosed multiple myeloma (MM) patients, and to explore related factors affecting the prognosis of the patients.@*METHODS@#The clinical pathological data of 180 newly diagnosed MM patients treated in our hospital from March 2013 to February 2015 were collected, and the patients were divided into high and low Hcy groups based on the median Hcy. The survival curves of the patients in the two groups were drawn to compare the differences of the survival; univariate and multivariate survival analysis was used to observe the influence of serum cysteine to the prognosis of newly diagnosed MM patients; the clinicopathological data of the patients with high and low Hcy in the two groups was compared, Pearson test was used to further analyzes the relationship between Hcy and different factors, and explores the related factors of Hcy affecting the prognosis of the patients.@*RESULTS@#The median survival times of patients in the high and low Hcy groups were 32 (5-59) and 41 (7-71) months, respectively. The 3-year survival rate of the patients in high Hcy group was significantly lower than those in low Hcy group, and the difference shows statistically significant (P<0.05). The results of univariate survival analysis showed that the OS of newly diagnosed MM patients whom with advanced age, high bone disease grade, high-level bone marrow plasma cell count, LDH, C-reactive protein, Cr, β@*CONCLUSION@#Serum Hcy level has a correlation trend with the survival of newly diagnosed MM, which is affected by factors such as Hb.

Humans , Bone Marrow Cells , Homocysteine , Multiple Myeloma , Prognosis , Risk Factors
Biomedical and Environmental Sciences ; (12): 356-363, 2021.
Article in English | WPRIM | ID: wpr-878371


Objective@#This study aimed to investigate the effects of @*Methods@#In this study, 0.1% DMG was supplemented in 20% casein diets that were either folate-sufficient (20C) or folate-deficient (20CFD). Blood and liver of rats were subjected to assays of Hcy and its metabolites. Hcy and its related metabolite concentrations were determined using a liquid chromatographic system.@*Results@#Folate deprivation significantly increased pHcy concentration in rats fed 20C diet (from 14.19 ± 0.39 μmol/L to 28.49 ± 0.50 μmol/L; @*Conclusion@#DMG supplementation exhibited hypohomocysteinemic effects under folate-sufficient conditions. By contrast, the combination of folate deficiency and DMG supplementation has deleterious effect on pHcy concentration.

Animals , Male , Rats , Biomarkers/metabolism , Chromatography, Liquid , Diet , Dietary Supplements , Folic Acid Deficiency/metabolism , Homocysteine/metabolism , Liver/metabolism , Random Allocation , Rats, Wistar , Sarcosine/metabolism
Rev. colomb. reumatol ; 27(4): 278-285, oct.-dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1289331


RESUMEN Se han propuesto varios estudios que sugieren que el grupo de vitaminas B posee un rol en la fisiología ósea. Se realizó una revisión bibliográfica sobre la interacción de este con la homocisteína y la relación de ambos con el metabolismo óseo y la osteoporosis. Algunos estudios han sugerido que los niveles de vitamina B, sobre todo las vitaminas B12 y B9, se han asociado a una baja densitometría ósea y a un aumentado riesgo a fractura, y que estos, a su vez, intervienen en el metabolismo de la homocisteína, por lo que su déficit puede ocasionar un estado de hiperhomocisteinemia. Publicaciones recientes proponen que la hiperhomocisteinemia se encuentra asociada a desmineralización ósea, baja calidad de masa ósea y aumento de biomarcadores de recambio óseo, dado que influye en la actividad osteoclástica y en los enlaces cruzados de colágeno. Por lo tanto, la hiperhomocisteinemia puede ser un factor que reduce la densidad y la calidad ósea. Se necesita más información para determinar el papel que tiene cada vitamina directamente en la salud ósea, o si estas solo influyen a través de las concentraciones séricas de homocisteína.

ABSTRACT Several studies have suggested a role for B-vitamins in bone physiology. A systematic review is presented on the interaction of B-vitamins with homocysteine and the relationship of both in bone metabolism and osteoporosis. The levels of vitamin-B, particularly B12 and B9, have been associated with a low bone mineral density and an increased risk of fracture. At the same time, its deficit affects the metabolism of homocysteine, which can then result in a high serum homocysteine. Recent findings have proposed that high serum homocysteine is linked to bone demineralisation, low quality of bone mass, and an increase in bone turnover biomarkers, given the influence over the osteoclastic activity and the cross-linking of collagen molecules. Therefore, high serum homocysteine could be a factor that reduces bone density and quality. More information is needed to determine whether there is a direct role of each vitamin in bone health, or if they are just influenced by homocysteine serum concentrations.

Humans , Vitamin B Complex , Homocysteine , Bone and Bones , Bone Diseases, Metabolic , Biomarkers , Fractures, Bone , Metabolism
Med. lab ; 24(2): 111-129, 2020.
Article in Spanish | LILACS, COLNAL | ID: biblio-1097081


El deterioro cognitivo es uno de los procesos que acompañan al envejecimiento y puede depender de factores nutricionales, genéticos o ambientales. La identificación de factores de riesgo modificables proporciona un enfoque esencial para la prevención de dicho deterioro y de los trastornos neurocognitivos. Uno de los factores de riesgo involucrados es la elevada concentración de homocisteína plasmática, la cual se ha relacionado con hallazgos histopatológicos en demencia senil y enfermedad de Alzheimer. Los diferentes estudios sobre esta asociación revelan inconsistencia o contradicción en los resultados. El propósito de esta revisión es relacionar la posible interacción de tres factores en la instalación y progresión del deterioro neurocognitivo: a) factores de tipo nutricional (homocisteína, ácido fólico y vitamina B12), b) la utilización de pruebas para el diagnóstico de disfunción o deterioro cognitivo como el Mini Examen del Estado Mental, y c) la presencia de variantes genéticas polimórficas de la enzima metilentetrahidrofolato reductasa. Una consecuencia directa de esta triple relación es que el tratamiento con ácido fólico y vitamina B12 logra disminuir las elevadas concentraciones de homocisteína plasmática, asumiendo que una mejoría en los síntomas clínicos de deterioro cognitivo puede retrasar los cambios relacionados con progresión a estados demenciales. La intervención temprana mediante políticas de promoción y prevención de la salud mental puede ser efectiva si se comienza con la administración de ácido fólico y vitamina B12 en los estadios iniciales de la alteración cognitiva, logrando así reducir sus funestas consecuencias. Las políticas de salud pública centradas en la salud mental de ancianos pueden identificar a las personas con disfunción cognitiva inicial a través de la promoción de la salud y medidas preventivas; en esta etapa puede ser posible la administración de vitaminas B para reducir o minimizar la progresión del deterioro cognitivo, que podría conducir a trastornos neurocognitivos como la demencia y la enfermedad de Alzheimer

Cognitive impairment is one of the processes that accompany aging and may depend on nutritional, genetic or environmental factors. The identification of modifiable risk factors provides a crucial approach for the prevention of cognitive decline and neurocognitive disorders. One of the risk factors is the high concentration of plasma homocysteine and it has been associated to histopathological changes in senile dementia and Alzheimer´s disease. Clinical trials about this association has shown inconsistent and contradictory results. The purpose of this review is to describe the possible interaction of three factors related with cognitive impairment: a) nutritional factors (homocysteine, folic acid and vitamin B12), b) the use of mental tests such as the Mini Mental State Examination for the diagnosis of cognitive dysfunction, and c) the presence of polymorphic genetic variants of the methylenetetrahydrofolate reductase enzyme. A direct consequence of this triple relationship is the treatment with folic acid and vitamin B12, which decrease high concentrations of plasma homocysteine, with a potential for improvement of the clinical symptoms of cognitive decline, and possibly a delay in the progression towards neurocognitive disorder. Public health policies focused on mental health of older adults can identify people with initial cognitive dysfunction through health promotion and preventive measures, where it can be possible to administer B vitamins in order to reduce or minimize the progression of cognitive decline, that could lead to mental disturbances such as neurocognitive disorders

Homocysteine , Vitamin B 12 , Vitamin B 6 , Dementia , Alzheimer Disease , Cognitive Dysfunction , Folic Acid
Rev. MED ; 27(1): 73-84, ene.-jun. 2019. graf
Article in Spanish | LILACS | ID: biblio-1115221


Resumen: En este artículo se presenta el caso de una niña de 13 años con historia de cefalea de 2 años de evolución, la cual ha sido estudiada por subluxación del cristalino y fenotipo marfonoide. Para llevar a cabo la investigación se realizó una tomografía cerebral simple que evidenció trombosis de varios senos cerebrales. Posteriormente se hospitalizó a la paciente en la unidad de cuidados intensivos, mientras se anticoagulaba con enoxaparina. Se solicitó un estudio para trombofilia junto con homocisteina en sangre, ante la sospecha de homocistinuria. Luego de confirmarse el diagnóstico se recetó piridoxina y ácido fólico, con lo cual la paciente evolucionó de manera satisfactoria y recuperó las funciones perdidas. El seguimiento de este caso para la investigación permitió encontrar una disminución mayor del 20 % de la homocisteina, sin que sus niveles estuvieran por debajo de 50 µmol/L, hecho que hace a la paciente respondedora parcial a la piridoxina.

Abstract: This article presents the case of a 13-year-old girl with a 2-year history of headache, which has been studied for lens subluxation and Marfanoid phenotype. To carry out this research, a simple brain tomography was performed that showed thrombosis of several sinuses. Subsequently, the patient was hospitalized in the intensive care unit and anticoagulated with enoxaparin. A study was requested for thrombophilia along with homocysteine in blood, on suspicion of homocystinuria. After confirming the diagnosis, pyridoxin and folic acid were prescribed, with which the patient evolved satisfactorily and recovered lost functions. Follow-up on this case for the research allowed us to find a decrease in homocysteine greater than 20 %, without its levels being below 50 µmol/L, which makes the patient partially responsive to pyridoxine.

Resumo: Neste artigo, é apresentado o caso de uma menina de 13 anos, com história de cefaleia de dois anos de evolução, a qual tem sido estudada por subluxação do cristalino e fenótipo marfanoide. Para realizar a pesquisa, foi tomada uma tomografia cerebral simples que evidenciou trombose de vários seios cerebrais. Em seguida, a paciente foi internada na unidade de tratamento intensivo onde recebeu tratamento anticoagulante com enoxaparina. Foi solicitado um estudo para trombofilia junto com homocisteina em sangue, diante da suspeita de homocistinúria. Após o diagnóstico ter sido confirmado, foram receitados piridoxina e ácido fólico, com os quais o estado da paciente evoluiu de maneira satisfatória e ela recuperou as funções perdidas. O seguimento do caso para a pesquisa permitiu verificar uma diminuição maior de 20% da homocisteina, sem que seus niveis estivessem abaixo de 50 µmol/L, fato que torna a paciente apta parcialmente à piridoxina.

Humans , Female , Adolescent , Homocystinuria , Lens Subluxation , Thrombophilia , Intracranial Thrombosis , Homocysteine
J. bras. nefrol ; 41(1): 103-111, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1002421


ABSTRACT One of the mechanisms proposed for chronic kidney disease (CKD)-related cognitive impairment is the accumulation of uremic toxins due to the deterioration of the renal clearance function. Cognition can be categorized into five major domains according to its information processing functions: memory, attention, language, visual-spatial, and executive. We performed a review using the terms 'uric acid', 'indoxyl sulfate', 'p-cresyl sulfate', 'homocysteine', 'interleukins' and 'parathyroid hormone'. These are the compounds that were found to be strongly associated with cognitive impairment in CKD in the literature. The 26 selected articles point towards an association between higher levels of uric acid, homocysteine, and interleukin 6 with lower cognitive performance in executive, attentional, and memory domains. We also reviewed the hemodialysis effects on cognition. Hemodialysis seems to contribute to an amelioration of CKD-related encephalopathic dysfunction, although this improvement occurs more in some cognitive domains than in others.

RESUMO Um dos mecanismos propostos para explicar o comprometimento cognitivo relacionado à doença renal crônica (DRC) é o acúmulo de toxinas urêmicas devido à deterioração da função de depuração renal. A cognição pode ser categorizada em cinco domínios principais de acordo com suas funções de processamento de informações: memória, atenção, linguagem, visual-espacial e executiva. Realizamos uma revisão usando os termos "ácido úrico", "indoxil sulfato", "p-cresil sulfato", "homocisteína", "interleucinas" e "paratormônio". Estes são os compostos que se mostraram fortemente associados ao comprometimento cognitivo na DRC na literatura. Os 26 artigos selecionados apontam para uma associação entre níveis mais elevados de ácido úrico, homocisteína e interleucina-6 com menor desempenho cognitivo nos domínios executivo, atenção e de memória. Também revisamos os efeitos da hemodiálise na cognição. A hemodiálise parece contribuir para uma melhoria da disfunção encefalopática relacionada à DRC, embora essa melhora ocorra mais em alguns domínios cognitivos do que em outros.

Humans , Toxins, Biological/adverse effects , Uremia/complications , Renal Insufficiency, Chronic/complications , Cognitive Dysfunction/etiology , Parathyroid Hormone/adverse effects , Sulfuric Acid Esters/adverse effects , Sulfuric Acid Esters/blood , Uric Acid/adverse effects , Uric Acid/blood , Renal Dialysis/adverse effects , Interleukin-6/adverse effects , Cresols/adverse effects , Cresols/blood , Interleukin-1beta/adverse effects , Interleukin-1beta/blood , Homocysteine/adverse effects , Homocysteine/blood , Indican/adverse effects , Indican/blood
Clinics ; 74: e630, 2019. tab, graf
Article in English | LILACS | ID: biblio-989638


OBJECTIVES: Cystathionine β-synthase is a major enzyme in the metabolism of plasma homocysteine. Hyperhomocysteinemia is positively associated with hypertension and stroke. The present study was performed to examine the possible effects of Cystathionine β-synthase promoter methylation on the development of hypertension and stroke. METHODS: Using quantitative methylation-specific PCR, we determined the Cystathionine β-synthase methylation levels in 218 healthy individuals and 132 and 243 age- and gender-matched stroke and hypertensive patients, respectively. The relative changes in Cystathionine β-synthase promoter methylation were analyzed using the 2-ΔΔCt method. The percent of the methylated reference of Cystathionine β-synthase was used to represent the Cystathionine β-synthase promoter methylation levels. RESULTS: In this study, the Cystathionine β-synthase promoter methylation levels of hypertensive and stroke participants were both higher than that of the healthy individuals (median percentages of the methylated reference were 50.61%, 38.05% and 30.53%, respectively, all p<0.001). Multivariable analysis showed that Cystathionine β-synthase promoter hypermethylation increased the risk of hypertension [odds ratio, OR (95% confidence interval, CI)=1.035 (1.025-1.045)] and stroke [OR (95% CI)=1.015 (1.003-1.028)]. The area under the curve of Cystathionine β-synthase promoter methylation was 0.844 (95% CI: 0.796-0.892) in male patients with hypertension and 0.722 (95% CI: 0.653-0.799) in male patients with stroke. CONCLUSION: Cystathionine β-synthase promoter hypermethylation increases the risk of hypertension and stroke, especially in male patients.

Humans , Male , Female , Adult , Middle Aged , Aged , Promoter Regions, Genetic , DNA Methylation , Stroke/enzymology , Cystathionine beta-Synthase/metabolism , Hypertension/enzymology , Biomarkers/metabolism , Case-Control Studies , Sex Factors , Age Factors , Risk Assessment , Asian People/genetics , Homocysteine/metabolism
Sahel medical journal (Print) ; 22(2): 82-85, 2019. tab
Article in English | AIM | ID: biblio-1271708


Background: Deficiency of Vitamin B12 can lead to hyperhomocysteinemia. Hyperhomocysteinemia constitutes an abnormally high level of homocysteine in the serum, above the upper limit of normal for an environment. The two conditions are significant risk factors for the development of stroke. There is a paucity of data on the prevalence of these biochemical risk factors in stroke patients in our environment which brought about this study. Objective: The objective of the study was to determine how prevalent hyperhomocysteinemia and hypovitaminosis B12 are in acute ischemic stroke patients in Zaria. Materials and Mthods: This is a cross­sectional prospective study conducted from February 2014 to March 2015 in ABUTH Zaria. One hundred patients with clinical diagnosis of first­ever ischemic stroke confirmed by brain computed tomography scan, and another apparently healthy age­ and sex­matched one hundred controls were recruited. Their fasting serum homocysteine and Vitamin B12 were determined using the enzyme­linked immunosorbent assay technique. Prevalence of high homocysteine and low Vitamin B12 was determined.Results: Thirty­four percent (34%) of patients had high and 66% patients had normal serum homocysteine, whereas 81% of patients had low and 19% of patients had normal serum Vitamin B12, and the difference was found to be statistically significant (P < 0.05).There was significant negative correlation between serum homocysteine and Vitamin B12 among cases with P = 0.04 and r = −0.198.Conclusion: The Prevalence rates of hyperhomocysteinemia and hypovitaminosis B12 among ischemic stroke pateints were 34% and 81%, respectively

Acute Kidney Injury , Homocysteine , Hyperhomocysteinemia , Nigeria
Endocrinology and Metabolism ; : 158-168, 2019.
Article in English | WPRIM | ID: wpr-763698


BACKGROUND: Low testosterone is associated with metabolic syndrome (MetS), and homocysteine (Hcy) is elevated in individuals with MetS. We investigated the relationships of total testosterone (TT) and serum Hcy levels with MetS in male Korean workers. METHODS: We conducted a cross-sectional study including 8,606 male workers, aged 20 to 58 years, who underwent a physical examination in 2015. MetS was diagnosed based on the criteria of the 2009 harmonized definition, while the Korean standard for waist circumference (WC) was used. Participants' biochemical parameters, including TT and serum Hcy, were measured, and participants were divided into quartiles. Multiple logistic regression models were used to estimate the association of MetS and its individual components depending on TT and serum Hcy quartiles. RESULTS: The prevalence of MetS in the study population was 16%. TT was lower in participants with MetS than in those without MetS (P<0.001). By contrast, Hcy level was similar between groups (P=0.694). In multiple logistic regression analysis, the odds ratio for the lowest TT quartile was 1.29 (95% confidence interval, 1.06 to 1.57) after adjusting for potential confounders. Participants with lower TT were more likely to have high WC, hypertriglyceridemia, and low high density lipoprotein levels. Serum Hcy levels were not significantly associated with MetS. Of the five components of MetS, only WC was significantly associated with serum Hcy. CONCLUSION: In male Korean workers, TT may be an independent predictor of MetS, and serum Hcy levels could be a marker of abdominal obesity. However, future prospective studies are needed.

Humans , Male , Cross-Sectional Studies , Homocysteine , Hypertriglyceridemia , Lipoproteins , Logistic Models , Obesity, Abdominal , Odds Ratio , Physical Examination , Prevalence , Prospective Studies , Testosterone , Waist Circumference
Clinical Psychopharmacology and Neuroscience ; : 318-322, 2019.
Article in English | WPRIM | ID: wpr-763524


OBJECTIVE: This study was performed to elucidate relationships between alexithymia, suicide ideation and homocysteine levels in drug-naïve outpatients with major depressive disorder (MDD). METHODS: Sixty seven outpatients with MDD with melancholic features were evaluated by the means of the Hamilton Depression Rating Scale, the Toronto Alexithymia Scale (TAS–20), the Scale of Suicide Ideation, and homocysteine levels. RESULTS: Alexithymic subjects showed higher scores on all scales and higher homocysteine levels. Regression analysis shown higher homocysteine levels and TAS-20’ “Difficulty in Describing Feelings” dimension, in turn being associated with higher suicide ideation. CONCLUSION: In conclusion, alexithymic MDD outpatients may characterize for homocysteine dysregulation that may be linked to suicide ideation, regardless depression’ severity. However, study limitations are discussed and must be considered.

Humans , Affective Symptoms , Depression , Depressive Disorder, Major , Homocysteine , Outpatients , Suicidal Ideation , Suicide , Weights and Measures