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Chen Q, Zhang Z, Xie L, Huang C, Lin X, Tang W, Xu J, Qiu B, Xu X. A one-step aptasensor for ultrasensitive detection of lung cancer marker homocysteine based on multifunctional carbon nanotubes by square-wave voltammetry. Bioelectrochemistry 2023; 153:108464. [PMID: 37295310 DOI: 10.1016/j.bioelechem.2023.108464] [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: 03/25/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
In this work, a one-step aptasensor for ultrasensitive detection of homocysteine (HCY) is developed based on multifunctional carbon nanotubes, which is magnetic multi-walled carbon nanotubes (Fe3O4@MWCNTs) combined with the aptamer (Apt) for HCY (Fe3O4@MWCNTs-Apt). Fe3O4@MWCNTs-Apt have multiple functions as follows. (1) Apt immobilized could selectively capture all target molecules HCY in the sample; (2) Magnetic Fe3O4 nanoparticles could separate all target molecules HCY captured by Apt from the sample substrate to eliminate the background interference and achieve one-step preparation of the aptasensor; And (3), MWCNTs with good electrical conductivity become a new electrode surface, construct a three-dimensional electrode surface network, make the electron transfer easier and thus then enhance the signal response. Results show that there is a good linear relationship between peak current of square-wave voltammetry (SWV) and HCY concentration in the range of 0.01 μmol/L-1 μmol/L, with a limit of detection (LOD) 0.002 μmol/L. And, selectivity, reproducibility, precision and accuracy are all satisfactory. In addition, it could be applied to the detection of HCY in the plasma of lung cancer patients successfully, suggesting that this one-step aptasensor for HCY has a potential in practical clinical applications.
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Affiliation(s)
- Qianshun Chen
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China
| | - Zuxiong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi, PR China
| | - Li Xie
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China
| | - Chen Huang
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China
| | - Xing Lin
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China
| | - Wei Tang
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China
| | - Jiangxing Xu
- 907 Hospital, Yanping District, Nanping 353000, Fujian, PR China
| | - Bin Qiu
- Ministry of Education Key Laboratory for Analytical Science of Food Safety and Biology, Fujian Provincial Key Laboratory of Analysis and Detection for Food Safety, Fuzhou University, Fuzhou 350108, Fujian, PR China.
| | - Xunyu Xu
- Department of Thoracic Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian, PR China.
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Xiong Y, Liu M, Gu H, Li K, Zhang J, Cheng X, Jin H, Chen J, Mao C, Liu C. Fiber selectivity of peripheral neuropathy in patients with Parkinson's disease. Acta Neurol Scand 2022; 146:75-81. [PMID: 35466436 DOI: 10.1111/ane.13624] [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: 01/22/2022] [Revised: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the function of each type of peripheral nerve fiber and investigate the possible role of levodopa (LD) in peripheral neuropathy (PN) in Parkinson's disease (PD) patients. METHODS We enrolled 60 patients with idiopathic PD. All PD patients were divided into three groups: levodopa exposure >3 years (LELD), levodopa exposure ≤3 years (SELD) and de novo patients with PD (NOLD). The current perception threshold (CPT), which was measured by Neurometer at 2000, 250 and 5 Hz, the level of homocysteine, Vitamin B12 and folic acid in plasma, were compared with those of sex- and age-matched healthy controls (HCs). RESULTS Current perception threshold was higher at 250 Hz (p < .05) and 5 Hz (p < .05) in the LELD group than the NOLD, SELD, and control group. CPT was lower at 5 Hz in the NOLD than in the HCs group (p < .05). The CPT of the more affected side of PD patients was positively correlated with H-Y stage at 5 Hz current stimulation (r = .42, p = .01). Multivariate logistic regression analysis showed that elevated homocysteine levels were the risk factor of sensory nerve injury in PD patients (p < .01). Serum homocysteine levels were positively correlated with levodopa (LD) daily dose, LD equivalent daily dose, and LD cumulative lifetime dose (p < .05). CONCLUSIONS Peripheral neuropathy in PD patients can occur in the early stage of PD exhibiting as hyperesthesia and is fiber selectivity, especially for Aδ and C nerve fibers. PN in PD patients is related to PD itself and long-term LD exposure. Elevated plasma homocysteine is a risk factor for PN in PD patients.
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Affiliation(s)
- Yi‐Tong Xiong
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
- Department of Neurology Yixing People’s Hospital Yixing China
| | - Man‐Hua Liu
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Han‐Ying Gu
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Kai Li
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Jin‐Ru Zhang
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Xiao‐Yu Cheng
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Hong Jin
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Jing Chen
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Cheng‐Jie Mao
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
| | - Chun‐Feng Liu
- Department of Neurology Clinical Research Center of Neurological Diseases The Second Affiliated Hospital of Soochow University Suzhou China
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Noor A, Rahman MU, Faraz N, Samin KA, Ullah H, Ali A. Relationship of Homocysteine With Gender, Blood Pressure, Body Mass Index, Hemoglobin A1c, and the Duration of Diabetes Mellitus Type 2. Cureus 2021; 13:e19211. [PMID: 34877198 PMCID: PMC8642136 DOI: 10.7759/cureus.19211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Increased levels of homocysteine (Hcy) may lead to endothelial damage and increase the risk of cardiovascular and renal malfunction. The current study aimed to evaluate the association of serum Hcy levels with gender, body mass index (BMI), duration of diabetes mellitus type 2 (DMT2), hemoglobin A1c (HbA1c), and blood pressure (BP). Methodology A prospective observational study was conducted at Hayatabad Medical Complex in Peshawar, Pakistan in the department of endocrinology from June 2020 to June 2021. All patients with diagnosed DMT2 above the age of 18 years were included in the study. Individuals with unconfirmed diagnoses with ages over 75 years were excluded from the study. All data including the patient's age, gender, and medical history were recorded. Height and weight were used to calculate the BMI. BP was examined thrice and a mean value was recorded for each patient. For laboratory investigation, a vial of 3 ml blood was extracted keeping sterile and aseptic conditions by a trained nurse. The sample was sent for the determination of HbA1c and serum Hcy levels. Measurement of serum Hcy was done by chemiluminescent microparticle immunoassay. All data were documented by the researchers on a predefined pro forma. Results A total of 188 patients with DMT2 were included in the study with a mean age ± SD of 54.65 ± 8.42 years. Normal (<15 micromoles per liter [mcmol/l]) serum Hcy levels were reported in 75 (39.89%) individuals, while in 47 (41.59%) individuals, there was severe (>100 mcmol/l) hyperhomocysteinemia. More than half of the patients, i.e. 157 (83.52%), had HbA1c of greater than 7%, which indicated poor glycemic control. The study revealed that the majority of the female patients, i.e. 37 (78.72%), had severe hyperhomocysteinemia (p<0.0001). Similarly, there was a direct correlation between HbA1c levels and serum Hcy. Severe hyperhomocysteinemia was found in over 80% of the patients with poor glycemic control, i.e. HbA1c >7% (p<0.0001). Furthermore, the duration of DMT2 and hypertension were both significantly associated with increased levels of Hcy with p-values of <0.0001 and <0.0001, respectively. However, no association was found between hyperhomocysteinemia and BMI. Conclusion The study revealed that increased levels of serum Hcy were associated with female gender, poor glycemic control (HbA1c >7%), BP, and duration of DMT2. However, the study failed to find an association between serum Hcy and BMI. It is recommended that patients with poor glycemic control or those with the duration of DMT2 of more than five years must be regularly checked for hyperhomocysteinemia and renal function tests. Large-scale and multi-center studies are required in order to determine the validity of these findings. The current study suggests that patients with diabetes mellitus and hypertension are likely to have increased levels of Hcy and, therefore, must be regularly screened for hyperhomocysteinemia.
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Affiliation(s)
- Aqil Noor
- Endocrinology, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Noor Faraz
- Cardiology, Lady Reading Hospital Medical Teaching Institution, Peshawar, PAK
| | - Kashif A Samin
- Family Medicine, Khyber Medical University, Peshawar, PAK
| | - Hamid Ullah
- Medicine, Bacha Khan Medical College, Mardan, PAK
| | - Amjad Ali
- Medicine, Bacha Khan Medical College, Mardan, PAK
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Stein J, Geisel J, Obeid R. Association between neuropathy and B-vitamins: A systematic review and meta-analysis. Eur J Neurol 2021; 28:2054-2064. [PMID: 33619867 DOI: 10.1111/ene.14786] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/04/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peripheral neuropathy (PN) is common in patients with diseases that are in turn associated with deficiency of the B-vitamins, and vitamin treatment has shown mixed results. METHODS This systematic review and meta-analysis studied the association between PN/pain and B-vitamin biomarkers and investigated whether vitamin treatment can ameliorate the symptoms. PubMed and Web of Science were searched according to the study protocol. RESULTS A total of 46 observational and seven interventional studies were identified and included in the data synthesis. The presence of PN was associated with lowered B12 levels (pooled estimate [95% CIs] = 1.51 [1.23-1.84], n = 34, Cochran Q Test I2 = 43.3%, p = 0.003) and elevated methylmalonic acid (2.53 [1.39-4.60], n = 9, I2 = 63.8%, p = 0.005) and homocysteine (3.48 [2.01-6.04], n = 15, I2 = 70.6%, p < 0.001). B12 treatment (vs. the comparators) showed a non-significant association with symptom improvement (1.36 (0.66-2.79), n = 4, I2 = 28.9%). Treatment with B1 was associated with a significant improvement in symptoms (5.34 [1.87-15.19], n = 3, I2 = 64.6%, p = 0.059). Analysis of seven trials combined showed a non-significant higher odds ratio for improvement under treatment with the B-vitamins (2.58 [0.98-6.79], I2 = 80.0%, p < 0.001). CONCLUSIONS PN is associated with lowered plasma vitamin B12 and elevated methylmalonic acid and homocysteine. Overall, interventional studies have suggested that B-vitamins could improve symptoms of PN. Available trials have limitations and generally did not investigate vitamin status prior to treatment. Well-designed studies, especially in non-diabetes PN, are needed. This meta-analysis is registered at PROSPERO (ID: CRD42020144917).
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Affiliation(s)
- Johannes Stein
- Saarland University, Saarbrucken, Germany.,Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Juergen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
| | - Rima Obeid
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany
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Involvements of Hyperhomocysteinemia in Neurological Disorders. Metabolites 2021; 11:metabo11010037. [PMID: 33419180 PMCID: PMC7825518 DOI: 10.3390/metabo11010037] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 12/14/2022] Open
Abstract
Homocysteine (HCY), a physiological amino acid formed when proteins break down, leads to a pathological condition called hyperhomocysteinemia (HHCY), when it is over a definite limit. It is well known that an increase in HCY levels in blood, can contribute to arterial damage and several cardiovascular disease, but the knowledge about the relationship between HCY and brain disorders is very poor. Recent studies demonstrated that an alteration in HCY metabolism or a deficiency in folate or vitamin B12 can cause altered methylation and/or redox potentials, that leads to a modification on calcium influx in cells, or into an accumulation in amyloid and/or tau protein involving a cascade of events that culminate in apoptosis, and, in the worst conditions, neuronal death. The present review will thus summarize how much is known about the possible role of HHCY in neurodegenerative disease.
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Teixeira GP, Faria RX. Influence of purinergic signaling on glucose transporters: A possible mechanism against insulin resistance? Eur J Pharmacol 2020; 892:173743. [PMID: 33220279 DOI: 10.1016/j.ejphar.2020.173743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 01/27/2023]
Abstract
Metabolic disorders, such as insulin resistance, affect many people worldwide due to the prevalence of obesity and type 2 diabetes, which are pathologies that impair glycemic metabolism. Glucose is the primary energetic substrate of the body and is essential for cellular function. As the cell membrane is not permeable to glucose molecules, there are two distinct groups of glucose transporters: sodium-glucose-linked transporters (SGLTs) and the glucose transporter (GLUT) family. These transporters facilitate the entry of glucose into the bloodstream or cytoplasm where it functions in the production of adenosine 5 ́-triphosphate (ATP). This nucleotide acts in several cellular mechanisms, such as protein phosphorylation and cellular immune processes. ATP directly and indirectly acts as an agonist for purinergic receptors in high concentrations in the extracellular environment. Composed by P1 and P2 groups, the purinoreceptors cover several cellular mechanisms involving cytokines, tumors, and metabolic signaling pathways. Previous publications have indicated that the purinergic signaling activity in insulin resistance and glucose transporters modulates relevant actions on the deregulations that can affect glycemic homeostasis. Thus, this review focuses on the pharmacological influence of purinergic signaling on the modulation of glucose transporters, aiming for a new way to combat insulin resistance and other metabolic disorders.
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Affiliation(s)
- Guilherme Pegas Teixeira
- Laboratory of Toxoplasmosis and Other Protozoans, Oswaldo Cruz Institute (IOC), Avenida Brasil, 4365, CEP, Rio de Janeiro, Fiocruz, 21040-900, Brazil.
| | - Robson Xavier Faria
- Laboratory of Toxoplasmosis and Other Protozoans, Oswaldo Cruz Institute (IOC), Avenida Brasil, 4365, CEP, Rio de Janeiro, Fiocruz, 21040-900, Brazil.
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Zhao Y, Zhu R, Wang D, Liu X. Genetics of diabetic neuropathy: Systematic review, meta-analysis and trial sequential analysis. Ann Clin Transl Neurol 2019; 6:1996-2013. [PMID: 31557408 PMCID: PMC6801182 DOI: 10.1002/acn3.50892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Diabetic neuropathy (DN) is one of the most common complications of diabetes that occurs in more than 67% of individuals with diabetes. Genetic polymorphisms may play an important role in DN development. However, until now, the association between genetic polymorphisms and DN risk has remained unknown. We performed a systematic review, meta-analysis, and trial sequential analysis (TSA) of the association between all genetic polymorphisms and DN risk. METHODS Relevant published studies examining the relationship between all genetic polymorphisms and DN were obtained based on a designed search strategy up to 28 February 2019. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess overall pooled effects of genetic models as well as in subgroup analyses. Sensitive analysis and publication bias were applied to evaluate the reliability of the study. Moreover, TSA was conducted to estimate the robustness of the results. RESULTS We conducted a systematic review of a total of 1256 articles, and then 106 publications reporting on 136 polymorphisms of 76 genes were extracted. We performed 107 meta-analyses on 36 studies involving 12,221 subjects to derive pooled effect estimates for eight polymorphisms. We identified that ACE I>D, MTHFR 1298A/C, GPx-1 rs1050450, and CAT -262C/T were associated with DN, while MTHFR C677T, GSTM1, GSTT1, and IL-10 -1082G/A were not. Sensitivity analysis, funnel plot, and Egger's test displayed robust results. Furthermore, the results of TSA indicated sufficient sample size in studies of ACE, GPx-1, GSTM1, and IL-10 polymorphisms. INTERPRETATION Our study assessed the association between ACE I>D, MTHFR C677T, MTHFR 1298A/C, GPx-1 rs1050450, CAT -262C/T, GSTM1, GSTT1, and IL-10 -1082G/A polymorphisms and DN risk. We hope that the data in our research study are used to study DN genetics.
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Affiliation(s)
- Yating Zhao
- Department of NeurologyFirst Affiliated Hospital of China Medical UniversityShenyangLiaoning110001China
| | - Ruixia Zhu
- Department of NeurologyFirst Affiliated Hospital of China Medical UniversityShenyangLiaoning110001China
| | - Danni Wang
- Department of EndocrinologyThe Fifth People's Hospital of DalianDalianLiaoning116000China
| | - Xu Liu
- Department of NeurologyFirst Affiliated Hospital of China Medical UniversityShenyangLiaoning110001China
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A potential role for T-type calcium channels in homocysteinemia-induced peripheral neuropathy. Pain 2019; 160:2798-2810. [DOI: 10.1097/j.pain.0000000000001669] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Alam U, Nelson AJ, Cuthbertson DJ, Malik RA. An update on vitamin D and B deficiency in the pathogenesis and treatment of diabetic neuropathy: a narrative review. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2017-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is highly prevalent and affects up to 50% of patients with diabetes. Painful neuropathic symptoms may occur in a third of patients with diabetes and is a major cause of sleep disturbance, morbidity and poor quality of life. Effective treatment of DPN remains a major challenge as current therapeutic options have a number of undesirable side effects and only provide a partial response to neuropathic pain. Furthermore, there are a lack of treatments that modulate the natural history of DPN. A growing body of evidence suggests that vitamin B and vitamin D may have analgesic effects and neuroprotective benefits in DPN. This narrative review explores the role of these vitamins in DPN. Given their limited side effects, further mechanistic studies and good quality randomized controlled trials of their putative analgesic ability are required to define the role of vitamin B and D in DPN.
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Affiliation(s)
- Uazman Alam
- Department of Eye & Vision Sciences, Diabetes & Endocrinology Research & the Pain Research Institute, Institute of Ageing & Chronic Disease, University of Liverpool & Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL, United Kingdom
- Department of Diabetes & Endocrinology, Royal Liverpool & Broadgreen University NHS Hospital Trust, Liverpool, L7 8XP, United Kingdom
- Division of Endocrinology, Diabetes & Gastroenterology, University of Manchester, Manchester, M13 9MT, United Kingdom
| | - Andrew J Nelson
- Department of Eye & Vision Sciences, Diabetes & Endocrinology Research & the Pain Research Institute, Institute of Ageing & Chronic Disease, University of Liverpool & Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL, United Kingdom
| | - Daniel J Cuthbertson
- Department of Eye & Vision Sciences, Diabetes & Endocrinology Research & the Pain Research Institute, Institute of Ageing & Chronic Disease, University of Liverpool & Aintree University Hospital NHS Foundation Trust, Liverpool, L9 7AL, United Kingdom
| | - Rayaz A Malik
- Weill Cornell Medicine – Qatar, Qatar Foundation – Education City, P.O. Box 24144, Doha, Qatar
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, M13 9MT, United Kingdom
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15 6BH, United Kingdom
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Jiménez-Ramírez FJ, Castro LM, Ortiz C, Concepción J, Renta JY, Morales-Borges RH, Miranda-Massari JR, Duconge J. Role of treatment-modifying MTHFR677C>T and 1298A>C polymorphisms in metformin-treated Puerto Rican patients with type-2 diabetes mellitus and peripheral neuropathy. Drug Metab Pers Ther 2017; 32:23-32. [PMID: 28231061 DOI: 10.1515/dmpt-2016-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study was conducted to investigate potential association between MTHFR genotypes and diabetic peripheral neuropathy (DPN) in Puerto Ricans with type-2 diabetes mellitus (T2DM) treated with metformin. The prevalence of major MTHFR polymorphisms in this cohort was also ascertained. METHODS DNAs from 89 metformin-treated patients with T2DM and DPN were genotyped using the PCR-based RFLP assay for MTHFR677C>T and 1298A>C polymorphisms. Frequency distributions of these variants in the study cohort were compared to those reported for three reference populations (HapMap project) and controls (400 newborn specimens). Chi-square (or Fischer's exact) tests and odds ratios (OR) were used to assess association with DPN susceptibility risk (patients vs. controls) and biochemical markers (wild types vs. carriers). RESULTS Sixty-seven percent (67%) of participants carry at least one of these MTHFR polymorphisms. No deviations from Hardy-Weinberg equilibrium were detected. The genotype and allele frequencies showed statistically significant differences between participants and controls (p<0.0001 and p=0.03, respectively). Results suggest that 1298A>C but not 677C>T is associated with DPN susceptibility in this cohort (p=0.018). Different patterns of allelic dissimilarities are observed when comparing our cohort vs. the three parental ancestries. After sorting individuals by their carrier status, no significant associations were observed between these genetic variants (independently or combined) and any of the biochemical markers (HbA1c, folate, vitamin B12, homocysteine). CONCLUSIONS Prevalence of major MTHFR variants in Puerto Rican patients with T2DM is first time ever reported. The study provides further evidence on the use of this genetic marker as an independent risk factor for DPN.
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Kakavand Hamidi A, Radfar M, Amoli MM. Association between MTHFR variant and diabetic neuropathy. Pharmacol Rep 2017; 70:1-5. [PMID: 29222982 DOI: 10.1016/j.pharep.2017.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/03/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Methylene-tetrahydrofolate reductase (MTHFR) gene variant may play an important role in the pathophysiology of diabetes and its complications due to its influence on plasma homocysteine levels and also its effect on scavenging peroxynitrite radicals. Diabetic peripheral neuropathy (DPN) is one of the most common diabetic chronic complications. The aim of this study was to investigate the relationship between diabetic neuropathy and MTHFR gene C677T and 1298A ⁄C polymorphisms. METHOD Patients with type 2 diabetes N=248 were enrolled in the study, consisting of patients with neuropathy (N=141) and patients without neuropathy (N=107). MTHFR C677T polymorphism was analyzed using polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP) of genomic DNA for genotyping of samples. 1298A/C polymorphism was evaluated using ARMS-PCR. RESULT There was a significant difference in MTHFR polymorphism between the groups with and without neuropathy. CONCLUSION Our results suggest that MTHFR 677 variant confer risk for diabetic neuropathy among Iranian patients with type 2 diabetes.
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Affiliation(s)
- Armita Kakavand Hamidi
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mania Radfar
- Endocriology and Metabolism Research Center, Edocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa M Amoli
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Wang D, Zhai JX, Liu DW. Serum folate, vitamin B12 levels and diabetic peripheral neuropathy in type 2 diabetes: A meta-analysis. Mol Cell Endocrinol 2017; 443:72-79. [PMID: 28081987 DOI: 10.1016/j.mce.2017.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 12/27/2022]
Abstract
The association between serum folate and vitamin B12 levels and the risk of diabetic peripheral neuropathy (DPN) remains unclear. This meta-analysis included 16 studies of serum folate levels (1190 cases and 1501 controls) and 18 studies of serum vitamin B12 levels (1239 cases and 1562 controls) in patients with type 2 diabetes mellitus (T2DM). Reduced serum levels of folate and vitamin B12 were found in patients with T2DM and DPN compared with patients with T2DM but without DPN; weighted mean difference (WMD) = -1.64 (95% confidence interval [CI] = -2.46, -0.81) and WMD = -70.86 (95% CI = -101.55, -40.17), respectively. A subgroup analysis confirmed these associations in the Chinese population, but not in the Caucasian and mixed populations. In conclusion, these findings support the need for further controlled studies in defined patient populations and the importance of monitoring serum folate and vitamin B12 levels in patients with T2DM.
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Affiliation(s)
- Dan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China; Library, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China
| | - Jun-Xia Zhai
- Department of Novelty Retrieval, Institute of Hebei Medical Information, Shijiazhuang 050071, Hebei Province, China
| | - Dian-Wu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China.
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Clinical Manifestations of Isolated Elevated Homocysteine-Induced Peripheral Neuropathy in Adults. J Clin Neuromuscul Dis 2016; 17:106-9. [PMID: 26905910 DOI: 10.1097/cnd.0000000000000108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To characterize the clinical features of isolated elevated plasma homocysteine (eHcy)-induced peripheral neuropathy (IHIN) in adults. METHODS Charts of subjects with the diagnosis of IHIN who visited neuromuscular clinic from January 01, 2012 to September 30, 2014 were reviewed. Subjects with identifiable etiologies for neuropathy, such as B12/folate deficiency; metabolic, toxic, endocrinologic, infectious/inflammatory renal or liver diseases; or traumatic nerve injury, were excluded. Their clinical presentations were recorded and analyzed. RESULTS Thirty subjects (age: 63.2 ± 14.8 years, 13 males) were included. They all had an isolated increased homocysteine level (15.4 ± 5.3 μmol/L) but normal levels of B12, folate, and methylmalonic acid. Of 30, 14 (46.7%) had numb feet, 11 (36.7%) had numb hands, 7 (23.3%) had pain in lower extremities, and 10 (33.3%) had tingling in feet. Distal sensory deficits were present in 18/30 (60%) patients. Distal limb weakness was seen in 4 and decreased tendon reflexes in 12 patients. CONCLUSIONS Sensory deficits are predominant components of IHIN. Characterizing clinical features of IHIN would help better understand eHcy-related neuropathy and improve its management.
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Politi C, Ciccacci C, D'Amato C, Novelli G, Borgiani P, Spallone V. Recent advances in exploring the genetic susceptibility to diabetic neuropathy. Diabetes Res Clin Pract 2016; 120:198-208. [PMID: 27596057 DOI: 10.1016/j.diabres.2016.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 05/24/2016] [Accepted: 08/19/2016] [Indexed: 01/22/2023]
Abstract
Diabetic polyneuropathy and cardiovascular autonomic neuropathy are common and disabling complications of diabetes. Although glycaemic control and cardiovascular risk factors are major contributory elements in its development, diabetic neuropathy recognizes a multifactorial influence and a multiplicity of pathogenetic mechanisms. Thus genetic and environmental factors may contribute to its susceptibility, each with a modest contribution, by targeting various metabolic and microvascular pathways whose alterations intervene in diabetic neuropathy pathogenesis. This review is aimed at describing major data from the available literature regarding genetic susceptibility to diabetic neuropathies. It provides an overview of the genes reported as associated with the development or progression of these complications, i.e. ACE, MTHFR, GST, GLO1, APOE, TCF7L2, VEGF, IL-4, GPX1, eNOS, ADRA2B, GFRA2, MIR146A, MIR128A. The identification of genetic susceptibility can help in both expanding the comprehension of the pathogenetic mechanisms of diabetic nerve damage and identifying biomarkers of risk prediction and response to therapeutic intervention.
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Affiliation(s)
- Cristina Politi
- Department of Biomedicine and Prevention, Genetics Section, University of Rome "Tor Vergata", Italy
| | - Cinzia Ciccacci
- Department of Biomedicine and Prevention, Genetics Section, University of Rome "Tor Vergata", Italy
| | - Cinzia D'Amato
- Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Genetics Section, University of Rome "Tor Vergata", Italy
| | - Paola Borgiani
- Department of Biomedicine and Prevention, Genetics Section, University of Rome "Tor Vergata", Italy.
| | - Vincenza Spallone
- Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy
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16
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Zhao W, Zeng H, Zhang X, Liu F, Pan J, Zhao J, Zhao J, Li L, Bao Y, Liu F, Jia W. A high thyroid stimulating hormone level is associated with diabetic peripheral neuropathy in type 2 diabetes patients. Diabetes Res Clin Pract 2016; 115:122-9. [PMID: 26822260 DOI: 10.1016/j.diabres.2016.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/13/2015] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
AIM The association between thyroid stimulating hormone (TSH) and type 2 diabetes mellitus (T2DM) is well known. However, whether TSH is related to diabetic peripheral neuropathy (DPN) has not been studied. The aim of this study was to explore the relationship between TSH and DPN in Chinese patients with T2DM. METHODS In this cross-sectional study, 605 patients with T2DM were enrolled. Subclinical hypothyroidism (SCH) was defined as an elevated TSH level (>4.0mIU/L) and a normal free thyroxine level. DPN was evaluated by neurological symptoms, neurological signs, and electromyogram. RESULTS Serum TSH levels were significantly higher in DPN and signs of DPN compared with non-DPN T2DM patients (both P<0.01).The prevalence of DPN and signs of DPN in SCH subjects was higher than that in euthyroid subjects (both P<0.01). Spearman's correlation analysis showed that the serum TSH level was positively associated with DPN (r=0.172, P<0.01). A significant independent association between TSH and DPN was found by multiple logistic regression analysis after adjusting for potential confounding variables [odds ratio (OR)=1.365, P<0.01]. The patients were sequentially assigned to quartiles according to TSH level. Compared with quartile 1, patients in quartile 2 (P<0.01), quartile 3 (P=0.01), and quartile 4 (P<0.01) had a higher risk of DPN. Receiver-operating characteristic curve analysis revealed that the optimal cutoff point of TSH to indicate DPN was 3.045mIU/L in men and 2.94mIU/L in women. CONCLUSION TSH level is independently associated with DPN in Chinese population with T2DM. A high serum TSH level may be a potential risk factor for DPN.
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Affiliation(s)
- Weijing Zhao
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Hui Zeng
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Xiaoyan Zhang
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Fengjing Liu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jiemin Pan
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Jungong Zhao
- Department of Interventional Radiology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Zhao
- Department of Vascular Surgery, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lianxi Li
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China
| | - Fang Liu
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Key Laboratory of Diabetes, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
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Wu S, Han Y, Hu Q, Zhang X, Cui G, Li Z, Guan Y. Effects of Common Polymorphisms in the MTHFR and ACE Genes on Diabetic Peripheral Neuropathy Progression: a Meta-Analysis. Mol Neurobiol 2016; 54:2435-2444. [DOI: 10.1007/s12035-016-9823-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
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Wu S, Han Y, Hu Q, Zhang XJ, Cui GC, Li ZZ, Guan YT. RETRACTED ARTICLE: Effects of Common Polymorphisms in the MTHFR and ACE Genes on Diabetic Peripheral Neuropathy Progression: a Meta-Analysis. Mol Neurobiol 2015. [DOI: 10.1007/s12035-014-8976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Østergaard L, Finnerup NB, Terkelsen AJ, Olesen RA, Drasbek KR, Knudsen L, Jespersen SN, Frystyk J, Charles M, Thomsen RW, Christiansen JS, Beck-Nielsen H, Jensen TS, Andersen H. The effects of capillary dysfunction on oxygen and glucose extraction in diabetic neuropathy. Diabetologia 2015; 58:666-77. [PMID: 25512003 PMCID: PMC4351434 DOI: 10.1007/s00125-014-3461-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 11/06/2014] [Indexed: 12/14/2022]
Abstract
Diabetic neuropathy is associated with disturbances in endoneurial metabolism and microvascular morphology, but the roles of these factors in the aetiopathogenesis of diabetic neuropathy remain unclear. Changes in endoneurial capillary morphology and vascular reactivity apparently predate the development of diabetic neuropathy in humans, and in manifest neuropathy, reductions in nerve conduction velocity correlate with the level of endoneurial hypoxia. The idea that microvascular changes cause diabetic neuropathy is contradicted, however, by reports of elevated endoneurial blood flow in early experimental diabetes, and of unaffected blood flow when early histological signs of neuropathy first develop in humans. We recently showed that disturbances in capillary flow patterns, so-called capillary dysfunction, can reduce the amount of oxygen and glucose that can be extracted by the tissue for a given blood flow. In fact, tissue blood flow must be adjusted to ensure sufficient oxygen extraction as capillary dysfunction becomes more severe, thereby changing the normal relationship between tissue oxygenation and blood flow. This review examines the evidence of capillary dysfunction in diabetic neuropathy, and whether the observed relation between endoneurial blood flow and nerve function is consistent with increasingly disturbed capillary flow patterns. The analysis suggests testable relations between capillary dysfunction, tissue hypoxia, aldose reductase activity, oxidative stress, tissue inflammation and glucose clearance from blood. We discuss the implications of these predictions in relation to the prevention and management of diabetic complications in type 1 and type 2 diabetes, and suggest ways of testing these hypotheses in experimental and clinical settings.
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Affiliation(s)
- Leif Østergaard
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine, Aarhus University Hospital, Building 10G, Nørrebrogade 44, DK-8000, Aarhus C, Denmark,
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Biemans E, Hart HE, Rutten GEHM, Cuellar Renteria VG, Kooijman-Buiting AMJ, Beulens JWJ. Cobalamin status and its relation with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin. Acta Diabetol 2015; 52:383-93. [PMID: 25315630 DOI: 10.1007/s00592-014-0661-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/25/2014] [Indexed: 10/24/2022]
Abstract
AIMS To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with depression, cognition and neuropathy in patients with type 2 diabetes using metformin. METHODS In an observational study, among 550 type 2 diabetes patients using metformin, cobalamin and holotranscobalamin (holoTCII) levels were measured at the annual diabetes checkup, and deficiencies were defined as <148 and <21 pmol/L, respectively. Depression and cognitive function were assessed with corresponding International Classification of Primary Care codes and questionnaires; neuropathy with medical record data and a questionnaire. Confounding variables were retrieved from medical records. Multivariable logistic and linear regressions were used with cobalamin status as independent variable; depression, cognition and neuropathy as dependent variables. RESULTS The mean duration of diabetes was 8.4 years (±5.8); mean duration of metformin use was 64.1 months (±43.2), with a mean metformin dose of 1,306 mg/day. A sufficient cobalamin level was independently associated with a decreased risk of depression (OR 0.42; 95 % CI 0.23-0.78) and better cognitive performance (β = 1.79; 95 % CI 0.07-3.52) adjusted for confounders. This indicates that cobalamin-deficient patients had a 2.4 times higher chance of depression and a 1.79 point lower cognitive performance score. HoloTCII was not associated with any outcome. CONCLUSIONS Cobalamin deficiency was associated with an increased risk of depression and worse cognitive performance, while holoTCII was not. Screening for cobalamin deficiency may be warranted in diabetes patients using metformin. Physicians should consider a cobalamin deficiency in diabetes patients using metformin with a depression or cognitive decline.
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Affiliation(s)
- Elke Biemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Ansari R, Mahta A, Mallack E, Luo JJ. Hyperhomocysteinemia and neurologic disorders: a review. J Clin Neurol 2014; 10:281-8. [PMID: 25324876 PMCID: PMC4198708 DOI: 10.3988/jcn.2014.10.4.281] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/22/2014] [Accepted: 06/23/2014] [Indexed: 12/11/2022] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing amino acid that is generated during methionine metabolism. It has a physiologic role in DNA metabolism via methylation, a process governed by the presentation of folate, and vitamins B6 and B12. Physiologic Hcy levels are determined primarily by dietary intake and vitamin status. Elevated plasma levels of Hcy (eHcy) can be caused by deficiency of either vitamin B12 or folate, or a combination thereof. Certain genetic factors also cause eHcy, such as C667T substitution of the gene encoding methylenetetrahydrofolate reductase. eHcy has been observed in several medical conditions, such as cardiovascular disorders, atherosclerosis, myocardial infarction, stroke, minimal cognitive impairment, dementia, Parkinson's disease, multiple sclerosis, epilepsy, and eclampsia. There is evidence from laboratory and clinical studies that Hcy, and especially eHcy, exerts direct toxic effects on both the vascular and nervous systems. This article provides a review of the current literature on the possible roles of eHcy relevant to various neurologic disorders.
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Affiliation(s)
- Ramin Ansari
- Department of Neurology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Ali Mahta
- Department of Neurology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Eric Mallack
- Department of Pediatrics, Weill Cornell Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Jin Jun Luo
- Department of Neurology, Temple University School of Medicine, Philadelphia, PA, USA
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22
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23
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Plasma Homocysteine level and its clinical correlation with type 2 diabetes mellitus and its complications. Int J Diabetes Dev Ctries 2013. [DOI: 10.1007/s13410-013-0154-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Xu Q, Pan J, Yu J, Liu X, Liu L, Zuo X, Wu P, Deng H, Zhang J, Ji A. Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy. Diabetes Res Clin Pract 2013; 101:99-105. [PMID: 23664235 DOI: 10.1016/j.diabres.2013.03.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/12/2013] [Accepted: 03/25/2013] [Indexed: 11/24/2022]
Abstract
AIMS To compare the efficacy and safety of daily lipoic acid (300-600 mg i.v.) plus methylcobalamin (500-1000 mg i.v. or im.) (LA-MC) with that of methylcobalamin alone (MC) on diabetic peripheral neuropathy (DPN). METHODS Electronic database were searched for studies published up to November 1, 2012 and study quality was assessed in duplicate. A random or a fixed effect model was used to analyse outcomes which were expressed as risk ratios (RRs) or mean difference (MD). I(2) statistic was used to assess heterogeneity. RESULTS Seventeen studies were included. Combined data from all studies showed that the LA-MC combination therapy was significantly superior to MC monotherapy (RR=1.47; 95% CI: 1.37-1.58). Superiority of the LA-MC combination was shown in nerve conduction velocity (NCV) with WMDs of 6.89 (95% CI: 4.24-9.73) for median motor nerve conduction velocity (MNCV), 5.24 (4.14-6.34) for median sensory nerve conduction velocity (SNCV), 4.34 (3.03-5.64) for peroneal MNCV, and 4.53 (3.2-5.85) for peroneal SNCV. There were no serious adverse events associated with treatment. CONCLUSIONS The results of the meta-analysis show that treatment with LA-MC for 2-4 weeks is associated with better outcomes in NCV and neuropathic symptoms relative to MC treatment. However larger well-designed studies are required to confirm this conclusion.
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Affiliation(s)
- Qian Xu
- Department of Pharmacy, Zhu-Jiang Hospital, Southern Medical University, Guangzhou, China.
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Zheng H, Li Y, Xie N, Xu H, Huang J, Luo M. Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia. Clin Exp Hypertens 2013; 36:181-6. [DOI: 10.3109/10641963.2013.804542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Molina M, Gonzalez R, Folgado J, Real JT, Martínez-Hervás S, Priego A, Lorente R, Chaves FJ, Ascaso JF. [Correlation between plasma concentrations of homocysteine and diabetic polyneuropathy evaluated with the Semmes-Weinstein monofilament test in patients with type 2 diabetes mellitus]. Med Clin (Barc) 2013; 141:382-6. [PMID: 23332627 DOI: 10.1016/j.medcli.2012.09.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 08/02/2012] [Accepted: 09/06/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Few modifiable risk factors are known to be associated with the presence and progression of diabetic polyneuropathy (DPN). MATERIAL AND METHOD We have analyzed in 405 type 2 diabetic (T2DM) subjects (169 women) the association of plasma homocysteine with the presence of DPN measured with the Semmes-Weinstein (SW) monofilament test. A score below 4 was considered an altered SW monofilament test. Plasma homocysteine, vitamin B12 and folic acid were measured using standard procedures (ELISA). RESULTS Patients with T2DM with altered SW test have significantly higher age, evolution of disease, HbA1c and lower creatinine clearance values. In addition, plasma homocysteine values were independently and significantly higher in T2DM with DPN measured as altered SW test (13.64 ± 4.93 vs. 12.22 ± 4.48 μmol/l, P<.01) with similar vitamin B12 and folic acid values comparing the 2 groups. CONCLUSION Plasma homocysteine and HbA1c values are the 2 modifiable biological factors associated with the presence of DPN evaluated as an altered SW monofilament test in T2DM subjects.
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Affiliation(s)
- Mercedes Molina
- Servicio de Endocrinología, Hospital Clínico Universitario, Valencia, España
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González R, Pedro T, Martinez-Hervas S, Civera M, Priego MA, Catalá M, Chaves FJ, Ascaso JF, Carmena R, Real JT. Plasma homocysteine levels are independently associated with the severity of peripheral polyneuropathy in type 2 diabetic subjects. J Peripher Nerv Syst 2012; 17:191-6. [PMID: 22734904 DOI: 10.1111/j.1529-8027.2012.00408.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Peripheral polyneuropathy (PN) is a frequent complication of diabetes. However, mechanisms underlying the development of PN are multifactorial and not well understood. Our aim was to examine the association of plasma homocysteine (Hcy) with the prevalence and grade of peripheral PN in patients with type 2 diabetes (T2DM). We studied a cohort of 196 subjects with T2DM classified according to the grade of PN (Neuropathy Disability Score, NDS). Subjects with the highest grade of PN were older and had significantly increased levels of creatinine, microalbuminuria, HbA1c, and plasma Hcy compared to the other two groups. The differences in plasma Hcy values were maintained after correcting for confounding factors. Plasma Hcy, HbA1c, duration of diabetes, and age were predictors of the grade of PN. In conclusion, for each increase of 1 µmol in plasma Hcy there was a 23% increase of the risk of diabetic PN evaluated by NDS. Moreover, the grade of PN was predicted by plasma Hcy and HbA1c values, age and duration of diabetes. Further prospective studies should be conducted to confirm the association of plasma Hcy levels with the grade of PN in subjects with T2DM.
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Affiliation(s)
- Ricardo González
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Wang H, Fan D, Hong T. Is the C677T polymorphism in methylenetetrahydrofolate reductase gene or plasma homocysteine a risk factor for diabetic peripheral neuropathy in Chinese individuals? Neural Regen Res 2012; 7:2384-91. [PMID: 25538764 PMCID: PMC4268745 DOI: 10.3969/j.issn.1673-5374.2012.30.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 09/03/2012] [Indexed: 12/02/2022] Open
Abstract
The present study enrolled 251 diabetic patients, including 101 with neuropathy and 150 without neuropathy. Of the 150 patients, 100 had no complications, such as retinopathy, nephropathy, or neuropathy. Polymerase chain reaction-restriction fragment length polymorphism analysis was used to identify methylenetetrahydrofolate reductase gene variants. Plasma homocysteine levels were also measured. Homocysteine levels and the frequency of hyperhomocysteinemia were significantly higher in patients with diabetic peripheral neuropathy compared with diabetic patients without neuropathy (P < 0.05). In logistic regression analysis with neuropathy as the dependent variable, the frequency of C677T in methylenetetrahydrofolate reductase was significantly higher in patients with diabetic peripheral neuropathy compared with patients without diabetic complications. Homocysteine levels were significantly higher in patients with diabetic peripheral neuropathy carrying the 677T allele and low folic acid levels. In conclusion, hyperhomocysteinemia is an independent risk factor for diabetic neuropathy in Chinese patients with diabetes. The C677T polymorphism in methylenetetrahydrofolate reductase and low folic acid levels may be risk factors for diabetic peripheral neuropathy in Chinese patients with diabetes.
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Affiliation(s)
- Hongli Wang
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - Tianpei Hong
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
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Raza ST, Abbas S, Ahmed F, Fatima J, Zaidi ZH, Mahdi F. Association of MTHFR and PPARγ2 gene polymorphisms in relation to type 2 diabetes mellitus cases among north Indian population. Gene 2012; 511:375-9. [PMID: 23036708 DOI: 10.1016/j.gene.2012.09.072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 08/02/2012] [Accepted: 09/12/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus is a multifactorial and polygenic disease, which is considered as a major life threatening problem all over the world. There has been a worldwide effort in the identification of susceptibility genes for type 2 diabetes mellitus and its complications. At present, adequate data is not available dealing with MTHFR (rs1801133) and PPARγ2 (rs1801282) gene polymorphisms and its association with type 2 diabetes mellitus cases among north Indian populations. Thus, we conceived the need for further studies to investigate MTHFR and PPARγ2 gene polymorphisms and their susceptibility to type 2 diabetes mellitus in north Indian population. MATERIALS AND METHODS In this study, a total 175 subjects including 87 type 2 diabetes mellitus cases and 88 controls were enrolled. MTHFR and PPARγ2 gene polymorphisms in the cases and controls were evaluated by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). RESULTS The MTHFR gene CC, CT, TT genotype frequencies obtained were 40%, 43%, and 17% in type 2 diabetes mellitus cases and 56%, 29%, and 15% in healthy controls respectively. The OR for CC was 0.54 (95%CI 0.29-0.98, P=0.041, χ(2)=4.18, power=0.98), for CT 1.76 (95%CI 0.94-3.30, P=0.07, χ(2)=3.2, power=0.96), and for TT 1.2 (95%CI 0.53-2.70, P=0.66, χ(2)=0.198, power=0.76). The PPARγ2 gene GG CG, CC genotype frequencies obtained were 28%, 41%, and 31% in cases and 40%, 39%, and 21% in healthy controls respectively. OR for GG was 0.58 (95%CI 0.30-1.09, P=0.08, χ(2)=2.9, power=0.96), for CG 1.12 (95%CI 0.61-2.05, P=0.71, χ(2)=0.137, power=0.778), and for CC 1.63 (95%CI 0.82-3.23, P=0.156, χ(2)=2.01, power=0.92). CONCLUSION It might be recommended that MTHFR CC genotype seems to be a good marker for the early identification of population at risk of type 2 diabetes mellitus. While we have detected significant difference in allelic frequencies of PPARγ2 C (Proline) and G (Alanine), but at genotypic level significant difference was not detected in this case-control study. Further study with larger groups may be required to validate the study.
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Affiliation(s)
- Syed Tasleem Raza
- Department of Biochemistry, Era's Lucknow Medical College and Hospital, Lucknow, India 226003.
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Sudchada P, Saokaew S, Sridetch S, Incampa S, Jaiyen S, Khaithong W. Effect of folic acid supplementation on plasma total homocysteine levels and glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 2012; 98:151-8. [PMID: 22727498 DOI: 10.1016/j.diabres.2012.05.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/26/2012] [Accepted: 05/31/2012] [Indexed: 12/01/2022]
Abstract
AIM The evidences illustrating the effects of folic acid supplementation (FAS) in individuals with type 2 diabetes on plasma total homocysteine (tHcy) levels and glycemic control have been contradictory. The aim of the study was to systematically search and quantitatively analyze the effect of FAS on tHcy levels and HbA1c compared with placebo. METHODS We searched PubMed, Scopus, and Embase up to March 2012 without language restriction. Key words "folic acid" and "diabetes mellitus" with slight modifications based on the sources for search strategy were used. References of initially identified articles were examined to identify any other relevant studies. A random-effects model was used for estimation the pooled effect estimates (weighted mean different, WMD). RESULTS Of 6185 studies identified, 4 studies with 183 patients were included. FAS had statistically significant effect on tHcy levels [WMD, -3.52; 95% confidence interval (CI), -4.44 to -2.60]. However, the effect on HbA1c levels [WMD, -0.37; 95% CI, -1.10 to 0.35] was not significant. CONCLUSIONS Folic acid supplementation in patient with type 2 diabetes mellitus may reduce tHcy levels and have a trend to associate with better glycemic control compared with placebo. Further longitudinal studies on these intervention and outcomes are warranted.
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Affiliation(s)
- Patcharaporn Sudchada
- Pharmaceutical Care Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Alam U, Asghar O, Malik RA. Are vitamin D and B deficiency relevant to the pathogenesis and treatment of diabetic neuropathy? FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Uazman Alam
- Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Omar Asghar
- Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Rayaz A Malik
- Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
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Peripheral Neuropathy. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Golbidi S, Badran M, Laher I. Diabetes and alpha lipoic Acid. Front Pharmacol 2011; 2:69. [PMID: 22125537 PMCID: PMC3221300 DOI: 10.3389/fphar.2011.00069] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 10/18/2011] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus is a multi-faceted metabolic disorder where there is increased oxidative stress that contributes to the pathogenesis of this debilitating disease. This has prompted several investigations into the use of antioxidants as a complementary therapeutic approach. Alpha lipoic acid, a naturally occurring dithiol compound which plays an essential role in mitochondrial bioenergetic reactions, has gained considerable attention as an antioxidant for use in managing diabetic complications. Lipoic acid quenches reactive oxygen species, chelates metal ions, and reduces the oxidized forms of other antioxidants such as vitamin C, vitamin E, and glutathione. It also boosts antioxidant defense system through Nrf-2-mediated antioxidant gene expression and by modulation of peroxisome proliferator activated receptors-regulated genes. ALA inhibits nuclear factor kappa B and activates AMPK in skeletal muscles, which in turn have a plethora of metabolic consequences. These diverse actions suggest that lipoic acid acts by multiple mechanisms, many of which have only been uncovered recently. In this review we briefly summarize the known biochemical properties of lipoic acid and then discussed the oxidative mechanisms implicated in diabetic complications and the mechanisms by which lipoic acid may ameliorate these reactions. The findings of some of the clinical trials in which lipoic acid administration has been tested in diabetic patients during the last 10 years are summarized. It appears that the clearest benefit of lipoic acid supplementation is in patients with diabetic neuropathy.
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Affiliation(s)
- Saeid Golbidi
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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Jianbo L, Yuche C, Ming S, Jingrong T, Qing D, Yu Z, Jiawei C, Hongxing W. Association of homocysteine with peripheral neuropathy in Chinese patients with type 2 diabetes. Diabetes Res Clin Pract 2011; 93:38-42. [PMID: 21481484 DOI: 10.1016/j.diabres.2011.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/18/2011] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
AIM To explore the relationship between plasma total homocysteine concentration and diabetic neuropathy in Chinese patients with type 2 diabetes. METHODS Chinese patients with type 2 diabetes (n=249) were enrolled in a cross-sectional hospital based study. Diabetic neuropathy status was documented by presence of clinical signs and confirmed by electromyography. Plasma total homocysteine concentration was measured using fluorescence polarization immunoassay. Traditional risk factors for diabetic neuropathy were obtained from fasting blood samples and interviewer-questionnaire. RESULTS Plasma total homocysteine levels were higher in subjects with diabetic neuropathy than without (12.8 (9.2-14.8) μmol/l vs. 8.0 (7.7-9.1) μmol/l, p=0.005). The association of homocysteine with diabetic neuropathy was independent of major traditional risk factors for diabetic neuropathy (duration of diabetes, HbA1c) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, renal status, and Biguanide use) (OR: 1.12 (1.00-1.25), p=0.042). Furthermore, per increase of 4.0 μmol/l plasma homocysteine was related to neuropathy, after controlling for per unit increase of other factors (OR: 1.17 (0.94-1.33), p=0.045). CONCLUSION Plasma total homocysteine concentration was independently associated with occurrence of diabetic neuropathy in Chinese people. Future prospective studies are warranted to clarify the relationship.
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Affiliation(s)
- Li Jianbo
- Endocrinology and Metabolism Department, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing 210029, China.
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Bae JS, Kim OK, Kim JM. Altered nerve excitability in subclinical/early diabetic neuropathy: evidence for early neurovascular process in diabetes mellitus? Diabetes Res Clin Pract 2011; 91:183-9. [PMID: 21130514 DOI: 10.1016/j.diabres.2010.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 10/26/2010] [Accepted: 11/04/2010] [Indexed: 12/31/2022]
Abstract
We sought to investigate the peripheral nerve excitability property of early diabetic neuropathy (DN) and provide a logical hypothesis regarding the pathophysiology of subclinical/early stage of DN. The automated nerve excitability test (NET) utilizing the threshold tracking technique (TTT) was performed to measure multiple excitability indices in 30 early DN and 30 normal subjects. Early DN was defined as N0 or N1 stage of Dyck's staging method. The protocols calculated strength-duration time constant (SDTC) from duration-charge curve, parameters of threshold electrotonus (TE) and current-threshold relationship (CTR) from sequential sub-threshold current, and recovery cycle (RC) from double supra-threshold stimulation. Each parameter of test was co-analyzed with clinical and laboratory data including age, sex, BMI, HgbA1c, lipid profile, and estimated glomerular filtration rate (eGFR). Compared to normal or N0 groups, N1 group had 'fanning-in' phenomenon in TE, increased refractory period, and decreased supernormality/subnormality. Linear regression showed that parameters associated with vascular factor were significantly related with STDC: absolute TG values were positively associated with STDC, whereas eGFR values were inversely related with STDC. Nerve excitability can be altered even in the early mild DN. The pattern of alteration suggests depolarizing nerve or nerve ischemia in pathophysiology of subclinical/early DN.
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Affiliation(s)
- Jong Seok Bae
- Department of Neurology, Inje University, College of Medicine, Busan Paik Hospital, 633-165, Gaegum-dong, Busanjin-gu, Busan 614-110, Republic of Korea.
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Sabanayagam C, Shankar A. Association between plasma homocysteine and microalbuminuria in persons without hypertension, diabetes mellitus, and cardiovascular disease. Clin Exp Nephrol 2010; 15:92-9. [DOI: 10.1007/s10157-010-0361-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 09/29/2010] [Indexed: 09/29/2022]
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González R, Pedro T, Real JT, Martínez-Hervás S, Abellán MR, Lorente R, Priego A, Catalá M, Chaves FJ, Ascaso JF, Carmena R. Plasma homocysteine levels are associated with ulceration of the foot in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev 2010; 26:115-20. [PMID: 20135633 DOI: 10.1002/dmrr.1061] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To examine the association of biochemical markers of risk (plasma Hcy, microalbuminuria, lipoprotein (a)(Lp(a)) and diabetic dyslipidaemia) with the prevalence of diabetic foot ulceration in type 2 diabetic patients. METHODS Case/control study conducted in 198 type 2 diabetic patients. 89 patients have foot ulcers and 109 have no foot ulcers (control group), in order to establish ORs for diabetic foot ulceration. In all subjects plasma Hcy, Lp(a), total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein B, HbA(1c) and microalbuminuria were measured using standard procedures. RESULTS Plasma Hcy, microalbuminuria, HbA(1c) and apolipoprotein B levels were significantly higher in patients with foot ulceration compared with the control group. Plasma lipids, Lp(a), vitamin B12 and folic acid values were similar in both groups. In the logistic regression model, plasma Hcy (OR 1.09; 95% CI 1.04-1.69), microalbuminuria (OR 1,01; 95% CI 1.01-1.17) and HbA(1c) levels (OR 1.33; 95% CI 1.04-1.69) were independent risk factors for the presence of diabetic foot ulceration. CONCLUSIONS In our study, for each micromol increase in plasma Hcy levels there was a 10% increase in the risk of diabetic foot ulceration. In addition, plasma homocysteine, HbA(1c) and microalbuminuria accounted for 50% prevalence risk of diabetic foot ulceration. Further prospective studies should be conducted to confirm the association of plasma Hcy levels with the risk of foot ulceration.
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Affiliation(s)
- R González
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Talaei A, Siavash M, Majidi H, Chehrei A. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 2009; 60 Suppl 5:71-6. [PMID: 19212856 DOI: 10.1080/09637480802406153] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite many therapeutic options, painful diabetic neuropathy is still a common and challenging complication of diabetes mellitus and is often resistant to treatment with current modalities. METHODS In this randomized, single-blind clinical trial we compared the efficacy of parenteral vitamin B(12) and nortriptyline, for symptomatic improvement of pain, paresthesia, burning, freezing, stabbing and electrical sensation. Changes in nerve conduction parameters of amplitude, duration and latency were also compared. RESULTS One hundred patients (50 in each group) completed the study. After treatment, the pain score based on a visual analogue scale decreased 3.66 units in the vitamin B(12) group and 0.84 units in the nortriptyline group (P <0.001). Similarly, the paresthesia score decreased 2.98 units versus 1.06 units (P <0.001). The decrements of tingling sensation were 3.48 units versus 1.02 units (P <0.001). Changes in vibration, position, pinprick and nerve conduction parameters were not significant in two groups. CONCLUSION In conclusion, vitamin B(12) is more effective than nortriptyline for the treatment of symptomatic painful diabetic neuropathy.
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Affiliation(s)
- Afsaneh Talaei
- Department of Endocrinology, Arak University of Medical Sciences, Arak, Iran
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Abstract
Low molecular-mass plasma proteins play a key role in health and disease. Cystatin C is an endogenous cysteine proteinase inhibitor belonging to the type 2 cystatin superfamily. The mature, active form of human cystatin C is a single non-glycosylated polypeptide chain consisting of 120 amino acid residues, with a molecular mass of 13,343-13,359 Da, and containing four characteristic disulfide-paired cysteine residues. Human cystatin C is encoded by the CST3 gene, ubiquitously expressed at moderate levels. Cystatin C monomer is present in all human body fluids; it is preferentially abundant in cerebrospinal fluid, seminal plasma, and milk. Cystatin C L68Q variant is an amyloid fibril-forming protein with a high tendency to dimerize. It forms self-aggregates with massive amyloid deposits in the brain arteries of young adults, leading to lethal cerebral hemorrhage. The main catabolic site of cystatin C is the kidney: more than 99% of the protein is cleared from the circulation by glomerular ultrafiltration and tubular reabsorption. The diagnostic value of cystatin C as a marker of kidney dysfunction has been extensively investigated in multiple clinical studies on adults, children, and in the elderly. In almost all the clinical studies, cystatin C demonstrated a better diagnostic accuracy than serum creatinine in discriminating normal from impaired kidney function, but controversial results have been obtained by comparing this protein with other indices of kidney disease, especially serum creatinine-based equations. In this review, we present and discuss most of the available data from the literature, critically reviewing conclusions and suggestions for the use of cystatin C in clinical practice. Despite the multitude of clinical data in the literature, cystatin C has not been widely used, perhaps because of a combination of factors, such as a general diffidence among clinicians, the absence of definitive cut-off values, conflicting results in clinical studies, no clear evidence on when and how to request the test, the poor commutability of results, and no accurate examination of costs and of its routine use in a stat laboratory.
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Affiliation(s)
- Michele Mussap
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
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Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of and risk factors for diabetic neuropathy in a Canadian First Nation population. RESEARCH DESIGN AND METHODS This was a community-based screening study of 483 adults. Measures included glucose, A1C, cholesterol, triglycerides, homocysteine, hypertension, waist circumference, height, weight, and foot examinations. Neuropathy was defined as loss of protective sensation determined through application of a 10-g monofilament. RESULTS Twenty-two percent of participants had a previous diagnosis of diabetes, and 14% had new diabetes or impaired fasting glucose (IFG). The prevalence of neuropathy increased by glucose level: 5% among those with normal glucose levels, 8% among those with new IFG and diabetes, and 15% among those with established diabetes (P < 0.01). Those with neuropathy were more likely to have foot deformities (P < 0.01) and callus (P < 0.001) than those without neuropathy. Among those with dysglycemia (>or=6.1 mmol/l), the mean number of foot problems for those with insensate feet was 3 compared with 0.3 among those with sensation (P < 0.001). In multivariate logistic regression female sex, low education, A1C, smoking, and homocysteine were independently associated with neuropathy, after controls for age. CONCLUSIONS Neuropathy prevalence is high, given the young age of our participants (mean 40 years) and was present among those with undiagnosed diabetes. The high number and type of foot problems places this population at increased risk for ulceration; the low level of foot care in the community increases the risk. Homocysteine is a risk factor that may be related to lifestyle and requires further investigation.
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Affiliation(s)
- Sharon G Bruce
- Department of Community Health Services, University of Manitoba, Winnipeg, Manitoba, Canada.
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Williams HM, Lippok H, Doherty G. Nitric oxide and peroxynitrite signalling triggers homocysteine-mediated apoptosis in trigeminal sensory neurons in vitro. Neurosci Res 2008; 60:380-8. [DOI: 10.1016/j.neures.2007.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 12/12/2007] [Accepted: 12/14/2007] [Indexed: 11/17/2022]
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Vanotti A, Osio M, Mailland E, Nascimbene C, Capiluppi E, Mariani C. Overview on pathophysiology and newer approaches to treatment of peripheral neuropathies. CNS Drugs 2007; 21 Suppl 1:3-12; discussion 45-6. [PMID: 17696588 DOI: 10.2165/00023210-200721001-00002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Peripheral neuropathies are extremely heterogeneous nosological entities. One of the most common symptoms is pain, the underlying mechanisms of which are numerous and complex. Inflammation, reparative processes, and anatomical and gene expression alterations lead to chronic pain, the persistence of which is sustained by peripheral and central sensitisation mechanisms. Treatment of peripheral neuropathies is targeted to its symptomatic and aetiological features. For pain relief, several types of drugs may be used, notably antidepressants (e.g. tricyclic antidepressants, selective serotonin reuptake inhibitors, and both serotonin and noradrenaline [norepinephrine] reuptake inhibitors), antiepileptic drugs (e.g. carbamazepine, phenytoin, lamotrigine, valproic acid, gabapentin, topiramate and pregabalin), NSAIDs and opioid analgesics. Aetiological therapy is aimed at modifying the pathophysiological mechanisms underlying the neuropathy, some of which are common in different neuropathic conditions. Certain drugs are known to exert more than one action on different pathophysiological mechanisms. This is the case with acetyl-L-carnitine (ALC), which can be considered both a symptomatic therapy that can be used in any kind of painful neuropathy, and an aetiological therapy, at least in diabetic neuropathy and neuropathies induced by nucleoside reverse transcriptase inhibitors and cancer chemotherapeutic agents. ALC acts via several mechanisms, inducing regeneration of injured nerve fibres, reducing oxidative stress, supporting DNA synthesis in mitochondria, and enhancing nerve growth factor concentrations in neurons.
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Solomon LR. Disorders of cobalamin (Vitamin B12) metabolism: Emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev 2007; 21:113-30. [DOI: 10.1016/j.blre.2006.05.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Anan F, Yonemochi H, Masaki T, Takahashi N, Nakagawa M, Eshima N, Saikawa T, Yoshimatsu H. Homocysteine levels are associated with the results of 123I-metaiodobenzylguanidine myocardial scintigraphy in type 2 diabetic patients. Eur J Nucl Med Mol Imaging 2006; 34:28-35. [PMID: 16896659 DOI: 10.1007/s00259-006-0200-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Accepted: 06/09/2006] [Indexed: 12/19/2022]
Abstract
PURPOSE Elevated total plasma homocysteine (tHcy) levels and cardiovascular autonomic dysfunction are associated with a high mortality in type 2 diabetic patients. We tested the hypothesis that hyperhomocysteinemia is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients not receiving insulin treatment. METHODS The study group consisted of 17 type 2 diabetic patients with high tHcy levels (>15 mmol/l, age 58+/-5 years, high tHcy group). The control group consisted of 23 age-matched type 2 diabetic patients with normal tHcy levels (<or=15 mmol/l, age 58+/-9 years, normal tHcy group). Cardiovascular autonomic function was assessed by baroreflex sensitivity, heart rate variability, plasma norepinephrine concentrations, and cardiac (123)I-metaiodobenzylguanidine (MIBG) scintigraphy. RESULTS Early and delayed (123)I-MIBG myocardial uptake values were lower (p<0.005 and p<0.01, respectively) and the percent washout rate of (123)I-MIBG was higher (p<0.001) in the high tHcy group than in the normal tHcy group. The fasting plasma insulin concentrations (p<0.0001) and the homeostasis model assessment (HOMA) index values (p<0.0001) were higher in the high tHcy group than in the normal tHcy group. Multiple regression analysis revealed that the level of tHcy was independently predicted by the HOMA index values and the myocardial uptake of (123)I-MIBG at the delayed phase. CONCLUSION Our results demonstrate that high levels of tHcy are associated with depressed cardiovascular autonomic function and insulin resistance in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Futoshi Anan
- Department of Cardiovascular Science, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Oita, 879-5593, Japan.
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Francis DA, Christopher AT, Beasley BD. Conservative treatment of peripheral neuropathy and neuropathic pain. Clin Podiatr Med Surg 2006; 23:509-30. [PMID: 16958385 DOI: 10.1016/j.cpm.2006.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There are many types of peripheral nerve disorders that lead to peripheral neuropathy. Symptoms associated with peripheral neuropathy lack consistent, easy to treat qualities, and provide a constant challenge for physicians who encounter the sequelae of neuropathy. This review discusses medications, nutritional supplements, and topical and physical modalities that are effective in treating neuropathy associated with diabetes.
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Affiliation(s)
- David A Francis
- Green Country Podiatry Center, 3647 South Harvard, Tulsa, OK 74133-2227, USA
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McCarty MF. Adjuvant strategies for prevention of glomerulosclerosis. Med Hypotheses 2006; 67:1277-96. [PMID: 16828231 DOI: 10.1016/j.mehy.2004.11.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 11/29/2004] [Indexed: 12/23/2022]
Abstract
The glomerulosclerosis which frequently complicates diabetes and severe hypertension is mediated primarily by increased mesangial production and activation of transforming growth factor-beta (TGF-beta), which acts on mesangial cells to boost their production of matrix proteins while suppressing extracellular proteolytic activity. Hyperglycemia and glomerular hypertension work in various complementary ways to stimulate superoxide production via NADPH oxidase in mesangial cells; the resulting oxidant stress results in the induction and activation of TFG-beta. Nitric oxide, generated by glomerular capillaries and by mesangial cells themselves, functions physiologically to oppose mesangial TGF-beta overproduction; however, NO bioactivity is compromised by oxidant stress. In addition to low-protein diets and drugs that suppress angiotensin II activity, a variety of other agents and measures may have potential for impeding the process of glomerulosclerosis. These include vitamin E, which blunts the rise in mesangial diacylglycerol levels induced by hyperglycemia; statins and (possibly) policosanol, which down-regulate NADPH oxidase activity by diminishing isoprenylation of Rac1; lipoic acid, whose potent antioxidant activity antagonizes the impact of oxidant stress on TGF-beta expression; pyridoxamine, which inhibits production of advanced glycation endproducts; arginine, high-dose folate, vitamin C, and salt restriction, which may support glomerular production of nitric oxide; and estrogen and soy isoflavones, which may induce nitric oxide synthase in glomerular capillaries while also interfering with TGF-beta signaling. Further research along these lines may enable the development of complex nutraceuticals which have important clinical utility for controlling and preventing glomerulosclerosis and renal failure. Most of these measures may likewise reduce risk for left ventricular hypertrophy in hypertensives, inasmuch as the signaling mechanisms which mediate this disorder appear similar to those involved in glomerulosclerosis.
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Affiliation(s)
- Mark F McCarty
- NutriGuard Research, 1051 Hermes Ave., Encinitas, CA 92024, USA.
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Spoelstra-De Man AME, Smulders YM, Dekker JM, Heine RJ, Bouter LM, Nijpels G, Stehouwer CDA. Homocysteine levels are not associated with cardiovascular autonomic function in elderly Caucasian subjects without or with type 2 diabetes mellitus: the Hoorn Study. J Intern Med 2005; 258:536-43. [PMID: 16313477 DOI: 10.1111/j.1365-2796.2005.01578.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Homocysteine and cardiovascular autonomic function are both predictors of cardiovascular disease and death, particularly in patients with diabetes. The mechanism by which homocysteine causes disease is unknown. The objective of our study was to determine whether hyperhomocysteinaemia is associated with impaired cardiovascular autonomic function in an age-, sex-, and glucose tolerance-stratified sample of an elderly Caucasian population. METHODS We studied 609 subjects, 252 with normal glucose metabolism, 173 with impaired glucose metabolism, and 184 with type 2 diabetes. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during (i) spontaneous breathing, (ii) six deep breaths over 1 min, and (iii) an active change in position from lying to standing. From these readings, 10 parameters of autonomic function were assessed (three Ewing tests, six heart rate variability tests and one test of baroreflex sensitivity). These 10 measurements were summarized in a single cardiovascular autonomic dysfunction score (CADS). RESULTS Comparing values of autonomic function measures in the lowest versus the highest quartile of homocysteine revealed no significant association between homocysteine level and autonomic function in the whole study group, nor in the individual glucose tolerance groups. Multiple adjustment for age, sex, waist-to-hip ratio, serum creatinine, use of antihypertensives and fasting insulin, confirmed this result. We found no evidence of effect modification of glucose tolerance status on the association between homocysteine and autonomic dysfunction (P for interaction for CADS = 0.79). CONCLUSIONS There is no evidence for an association between homocysteine levels and cardiovascular autonomic function in either diabetic or nondiabetic subjects. Cardiovascular autonomic dysfunction does not help explain why hyperhomocysteinaemia is related to cardiovascular mortality.
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Affiliation(s)
- A M E Spoelstra-De Man
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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Elias AN, Eng S. Homocysteine concentrations in patients with diabetes mellitus--relationship to microvascular and macrovascular disease. Diabetes Obes Metab 2005; 7:117-21. [PMID: 15715884 DOI: 10.1111/j.1463-1326.2004.00376.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alan N Elias
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of California, Irvine Medical Center, Orange, CA 92868, USA.
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Yilmaz H, Agachan B, Ergen A, Karaalib ZE, Isbir T. Methylene tetrahydrofolate reductase C677T mutation and left ventricular hypertrophy in Turkish patients with type II diabetes mellitus. BMB Rep 2004; 37:234-8. [PMID: 15469701 DOI: 10.5483/bmbrep.2004.37.2.234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was designed to investigate, in the Turkish population, the association of methylene tetrahydrofolate reductase (MTHFR) C677T polymorphism and left ventricular hypertrophy (LVH) in patients with type II diabetes mellitus. Our study included 249 patients with type II diabetes mellitus (102 men, 147 women) and 214 healthy volunteers as controls (91 men, 123 women). MTHFR C677T genotypes were determined by polymerase chain reaction, restriction fragment length polymorphism techniques. No differences were observed in the distribution of MTHFR genotypes or allele frequencies in the cases versus the controls. The frequency of the MTHFR-mutated allele (T) was 31.7% in the type II diabetes mellitus versus 31.1% of the controls. The homozygous mutation (T/T) in the MTHFR gene was identified in 12% of the type II diabetes mellitus versus 9.3% of the controls. Patients with the TT genotype showed a higher prevalence of LVH when compared to patients with the CC and CT genotypes (p = 0.01). The MTHFR gene C677T mutation may be a possible risk factor for the development of LVH in the type II diabetic patients.
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Affiliation(s)
- Hulya Yilmaz
- Institute of Experimental Medical Research, Department of Molecular Medicine, Istanbul University, Istanbul, Turkey
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