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Phokaewvarangkul O, Bhidayasiri R, Garcia-Ruiz P, Odin P, Riederer P, Müller T. Homocysteine, vitamin B metabolites, dopamine-substituting compounds, and symptomatology in Parkinson's disease: clinical and therapeutic considerations. J Neural Transm (Vienna) 2023; 130:1451-1462. [PMID: 37603058 DOI: 10.1007/s00702-023-02684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Abstract
Emerging studies suggest a correlation between elevated plasma homocysteine (hcy) levels and the risk of atherosclerosis, vascular disorders, and neurodegenerative diseases, including Parkinson's disease (PD). This narrative review delves into the intricate relationships between Hcy, vitamin B metabolites, dopamine-substituting compounds, and various symptoms of PD. Patients undergoing a long-term L-dopa/dopa-decarboxylase inhibitor (DDI) regimen, especially without a concurrent catechol-O-methyl transferase (COMT) inhibitor or methyl group-donating vitamin supplementation, such as vitamins B6 and B12, exhibit an elevation in Hcy and a decline in vitamin B metabolites. These altered concentrations appear to be associated with heightened risks of developing non-motor symptoms, including peripheral neuropathy and cognitive disturbances. The review underscores the impact of levodopa metabolism via COMT on homocysteine levels. In light of these findings, we advocate for the supplementation of methyl group-donating vitamins, notably B6 and B12, in patients undergoing a high-dose L-dopa/DDI regimen, particularly those treated with L-dopa/carbidopa intestinal gel (LCIG) infusion.
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Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
| | - Pedro Garcia-Ruiz
- Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Restorative Parkinson Unit, Lund University, 221 84, Lund, Sweden
| | - Peter Riederer
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany
| | - Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany
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Quan Y, Xu J, Xu Q, Guo Z, Ou R, Shang H, Wei Q. Association between the risk and severity of Parkinson's disease and plasma homocysteine, vitamin B12 and folate levels: a systematic review and meta-analysis. Front Aging Neurosci 2023; 15:1254824. [PMID: 37941998 PMCID: PMC10628521 DOI: 10.3389/fnagi.2023.1254824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Background Parkinson's disease (PD) is recognized as the second most prevalent progressive neurodegenerative disease among the elderly. However, the relationship between PD and plasma homocysteine (Hcy), vitamin B12, and folate has yielded inconsistent results in previous studies. Hence, in order to address this ambiguity, we conducted a meta-analysis to summarize the existing evidence. Methods Suitable studies published prior to May 2023 were identified by searching PubMed, EMBASE, Medline, Ovid, and Web of Science. The methodological quality of eligible studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Meta-analysis and publication bias were then performed using R version 4.3.1. Results The results of our meta-analysis, consisting of case-control and cross-sectional studies, showed that PD patients had lower folate and vitamin B12 levels (SMD [95%CI]: -0.30[-0.39, -0.22], p < 0.001 for Vitamin B12; SMD [95%CI]: -0.20 [-0.28, -0.13], p < 0.001 for folate), but a significant higher Hcy level (SMD [95%CI]: 0.86 [0.59, 1.14], p < 0.001) than healthy people. Meanwhile, PD was significantly related to hyperhomocysteinemia (SMD [95%]: 2.02 [1.26, 2.78], p < 0.001) rather than plasma Hcy below 15 μmol/L (SMD [95%]: -0.31 [-0.62, 0.00], p = 0.05). Subgroup analysis revealed associations between the Hcy level of PD patients and region (p = 0.03), age (p = 0.03), levodopa therapy (p = 0.03), Hoehn and Yahr stage (p < 0.001), and cognitive impairment (p < 0.001). However, gender (p = 0.38) and sample size (p = 0.49) were not associated. Conclusion Hcy, vitamin B12, and folic acid potentially predict the onset and development of PD. Additionally, multiple factors were linked to Hcy levels in PD patients. Further studies are needed to comprehend their roles in PD.
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Affiliation(s)
- Yuxin Quan
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jisen Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Xu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiqing Guo
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ahlskog JE. Levodopa, homocysteine and Parkinson's disease: What's the problem? Parkinsonism Relat Disord 2023; 109:105357. [PMID: 36922273 DOI: 10.1016/j.parkreldis.2023.105357] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
Elevated circulating homocysteine levels have been associated with cognitive impairment and cardio-cerebro-vascular events. Levodopa treatment of Parkinson's disease tends to further elevate circulating homocysteine levels due to the metabolism of levodopa via catechol-O-methyltransferase (COMT). COMT co-factors are vitamins B12, B6 and folic acid. Accumulating deficiencies of these vitamins are presumed to be the substrate for the homocysteine elevation. B-vitamin therapy reduces homocysteine levels. This begs the question of whether Parkinson's disease patients on levodopa should be concurrently treated with ongoing B-vitamin therapy (versus long-term monitoring of B-vitamins/homocysteine). There is a substantial literature on this topic that has accumulated over the last quarter-century, and this topic is still debated. This review summarizes the relevant literature with the aim of approximating closure on this issue. Also, noteworthy is that Parkinson's disease patients with renal insufficiency may not tolerate cyanocobalamin, the standard oral B12 supplement due to facilitation of renal decline; alternatives are discussed.
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Affiliation(s)
- J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA.
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Two Faces of Catechol-O-Methyltransferase Inhibitor on One-Carbon Metabolism in Parkinson's Disease: A Meta-Analysis. Nutrients 2023; 15:nu15040901. [PMID: 36839259 PMCID: PMC9964466 DOI: 10.3390/nu15040901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Levodopa (L-dopa) and catechol-O-methyltransferase (COMT) inhibition are widely used therapeutics in Parkinson's disease (PD). Despite their therapeutic effects, it was raised that nutrients involved in one-carbon metabolism can be deteriorated by PD therapies. The aim of this meta-analysis was to investigate the impact of L-dopa and COMT inhibitors on levels of homocysteine (Hcy), vitamin B12 and folate in patients with PD. A total of 35 case-control studies from 14 different countries were selected through PubMed, MEDLINE and Google Scholar and were meta-analyzed. In the L-dopa group, the Hcy level was higher compared to the PD without L-dopa group (SMD: 5.11 μmol/L, 95% CI: 3.56 to 6.66). Moreover, vitamin B12 and folate levels in the L-dopa group were lower compared to the healthy control (SMD: -62.67 pg/mL, 95% CI: -86.53 to -38.81; SMD: -0.89 ng/mL, 95% CI: -1.44 to -0.33, respectively). The COMT inhibitor group showed lower levels of Hcy (SMD: -3.78 μmol/L, 95% CI: -5.27 to -2.29) and vitamin B12 (SMD: -51.01 pg/mL, 95% CI: -91.45 to -10.57), but higher folate levels (SMD: 1.78 ng/mL, 95% CI: -0.59 to 4.15) compared to the L-dopa group. COMT inhibitors may ameliorate L-dopa-induced hyper-homocysteine and folate deficiency but exacerbate vitamin B12 deficiency.
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Could Vitamins Have a Positive Impact on the Treatment of Parkinson's Disease? Brain Sci 2023; 13:brainsci13020272. [PMID: 36831815 PMCID: PMC9954544 DOI: 10.3390/brainsci13020272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder after Alzheimer's disease. Pathophysiologically, it is characterized by intracytoplasmic aggregates of α-synuclein protein in the Lewy body and loss of dopaminergic neurons from substantia nigra pars compacta and striatum regions of the brain. Although the exact mechanism of neurodegeneration is not fully elucidated, it has been reported that environmental toxins such as MPTP, rotenone, paraquat, and MPP+ induce oxidative stress, which is one of the causative factors for it. To date, there is no complete cure. However, the indispensable role of oxidative stress in mediating PD indicates that antioxidant therapy could be a possible therapeutic strategy against the disease. The deficiency of vitamins has been extensively co-related to PD. Dietary supplementation of vitamins with antioxidant, anti-inflammatory, anti-apoptotic, and free radical scavenging properties could be the potential neuroprotective therapeutic strategy. This review summarizes the studies that evaluated the role of vitamins (A, B, C, D, E, and K) in PD. It will guide future studies in understanding the potential therapeutic role of vitamins in disease pathophysiology and may provide a framework for designing treatment strategies against the disease.
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Rahnemayan S, Ahari SG, Rikhtegar R, Riyahifar S, Sanaie S. An umbrella review of systematic reviews with meta-analysis on the role of vitamins in Parkinson's disease. Acta Neurol Belg 2023; 123:69-83. [PMID: 35920987 DOI: 10.1007/s13760-022-02055-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This umbrella review aimed to systematically review the available literature and assess the association of dietary intake or serum levels of different vitamins and the risk of PD, to help find out more efficient treatments for PD patients by replenishing the deficiency of vitamins. METHODS Pubmed/Medline, Scopus, Google Scholar and hand searching bibliographies of retrieved articles in duplicate, were used to detect all relevant meta-analyses investigating the relationship between vitamins and PD. After study selection, data were extracted from previously published meta-analyses and pooled by Review Manager version 5.4 and CMA software version 2.2.064 to achieve effect sizes. Level of statistical significance was set at P ≤ 0.05. RESULTS 14 meta-analyses were included in the meta-review. Serum vitamin D and B12 levels were significantly lower in PD (SMD = -0.67 and SMD = -0.40 respectively). Homocysteine (Hcy) levels were significantly higher in PD patients (SMD = 1.26). Also the odds ratio for highest vs. lowest vitamin E intake was 0.73 which was significant. However, there was no significant difference between vitamin A, C and B6 intake or serum levels in PD vs. control groups. CONCLUSION Serum vitamin D and B12 levels were significantly lower in PD in comparison to healthy individuals, while Hcy level was significantly higher in PD patients. Also higher vitamin E intake was associated with significantly lower risk of development of PD in comparison to lower vitamin E intake. However, there was no significant difference between risk of PD and higher vitamin A, C and B6 intake or serum levels of folate.
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Affiliation(s)
- Sama Rahnemayan
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Rikhtegar
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, University Duisburg-Essen, Duisburg, Germany
| | - Sevda Riyahifar
- Department of Biostatics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran.
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Lister T. Nutrition and Lifestyle Interventions for Managing Parkinson's Disease: A Narrative Review. J Mov Disord 2020; 13:97-104. [PMID: 32498495 PMCID: PMC7280935 DOI: 10.14802/jmd.20006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 01/20/2023] Open
Abstract
The etiology of Parkinson's disease (PD) is not fully understood, but environmental toxin overexposure, increased intestinal permeability, and dysbiosis related to nutrition and lifestyle habits are thought to be contributors. Considering these nutrition and lifestyle implications, there is a lack of practice-based programs utilizing interventions for managing symptoms or slowing the progression of the disease. The purpose of this narrative review was to identify relevant research related to nutrition and lifestyle interventions for PD, evaluate the research utilizing the evidence analysis process of the Academy of Nutrition and Dietetics to assess the quality of each research article, and group the research into categories. A grading of recommendations assessment, development and evaluation (GRADE) of either good, fair, limited, or not assignable was allocated to each category of research, including diet patterns, vitamin D, B-complex, omega-3 fatty acids, coenzyme Q10, probiotics, physical activity, stress, and sleep. An intervention based on the research presented in the review may be utilized for coaching people with PD on symptom management.
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Affiliation(s)
- Tracy Lister
- Maryland University of Integrative Health, Laurel, MD, USA
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Elevated Serum Homocysteine Levels Have Differential Gender-Specific Associations with Motor and Cognitive States in Parkinson's Disease. PARKINSONS DISEASE 2019; 2019:3124295. [PMID: 31275543 PMCID: PMC6560330 DOI: 10.1155/2019/3124295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
Background Studies attempting to elucidate an association between homocysteine and symptom progression in Parkinson's disease (PD) have had largely discrepant findings. This study aimed to investigate elevated serum homocysteine levels and symptom progression in a cohort of PD patients. Methods Serum homocysteine, folate, and vitamin B12 levels were measured in 205 people with PD and 78 age-matched healthy controls. People with Parkinson's disease underwent a battery of clinical assessments to evaluate symptom severity, including motor (MDS-UPDRS) and cognitive (ACE-R) assessments. Multivariate generalised linear models were created, controlling for confounding variables, and were used to determine whether serum markers are associated with various symptom outcome measures. Results People with Parkinson's disease displayed significantly elevated homocysteine levels (p < 0.001), but not folate or vitamin B12 levels, when compared to healthy controls. A significant positive correlation between homocysteine and MDS-UPDRS III score was identified in males with Parkinson's disease (rs = 0.319, p < 0.001), but not in females, whereas a significant negative correlation between homocysteine levels and total ACE-R score was observed in females with Parkinson's disease (rs = −0.449, p < 0.001), but not in males. Multivariate general linear models confirmed that homocysteine was significantly predictive of MDS-UPDRS III score in male patients (p=0.004) and predictive of total ACE-R score in female patients (p=0.021). Conclusion Elevated serum homocysteine levels are associated with a greater motor impairment in males with Parkinson's disease and poorer cognitive performance in females with Parkinson's disease. Our gender-specific findings may help to explain previous discrepancies in the literature surrounding the utility of homocysteine as a biomarker in PD.
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Licking N, Murchison C, Cholerton B, Zabetian CP, Hu SC, Montine TJ, Peterson-Hiller AL, Chung KA, Edwards K, Leverenz JB, Quinn JF. Homocysteine and cognitive function in Parkinson's disease. Parkinsonism Relat Disord 2017; 44:1-5. [PMID: 28807493 DOI: 10.1016/j.parkreldis.2017.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/31/2017] [Accepted: 08/07/2017] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Increased plasma homocysteine (HC) is a risk factor for dementia in the general population. Levodopa therapy causes increased plasma HC, but it remains unclear whether elevated plasma HC is associated with cognitive impairment in Parkinson's disease (PD). METHODS The study population includes all participants in the Pacific Northwest Udall Center (PANUC) Clinical cohort at the time of the study, consisting of 294 individuals with PD who had a standardized neuropsychological assessment and plasma collection for HC measurement. We tested the hypothesis that elevated plasma HC is inversely related to cognitive function in patients with PD. RESULTS As expected, plasma HC was positively associated with age, disease duration, disease severity, and levodopa usage, while cognitive function was associated with age, education, gender, and APOE genotype, so subsequent analyses controlled for these covariates. When plasma HC was dichotomized as normal (<14 μmol/L) or elevated (≥14 μmol/L), subjects with hyper-homocysteinemia had lower scores on Digit Symbol (p = 0.031), Hopkins Verbal Learning Task (HVLT) Delayed Recall (p = 0.004), and semantic verbal fluency (p = 0.049). When examined as a continuous variable, plasma HC was inversely associated with HVLT Delayed Recall (p = 0.009)) and semantic verbal fluency (p = 0.004), but was not significantly related to Digit symbol, Trail-making test, Judgment of Line Orientation, phonemic verbal fluency, MMSE, or MOCA. When analysis was restricted to non-demented subjects (n = 231), the findings were unchanged. CONCLUSIONS We conclude that plasma HC is significantly associated with some aspects of cognitive function in PD, and may represent a treatable risk factor for cognitive decline in PD.
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Affiliation(s)
- Nicole Licking
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Parkinson's Disease Research, Education, and Clinical Center, Portland Veterans Affairs Medical Center, Portland, OR, United States
| | - Charles Murchison
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Brenna Cholerton
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Cyrus P Zabetian
- Parkinson's Disease Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Neurology, University of Washington, Seattle, WA, United States
| | - Shu-Ching Hu
- Parkinson's Disease Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States; Department of Neurology, University of Washington, Seattle, WA, United States
| | - Thomas J Montine
- Department of Pathology, Stanford University, Palo Alto, CA, United States
| | - Amie L Peterson-Hiller
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Parkinson's Disease Research, Education, and Clinical Center, Portland Veterans Affairs Medical Center, Portland, OR, United States
| | - Kathryn A Chung
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Parkinson's Disease Research, Education, and Clinical Center, Portland Veterans Affairs Medical Center, Portland, OR, United States
| | - Karen Edwards
- Department of Epidemiology, University of California at Irvine, United States
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States; Parkinson's Disease Research, Education, and Clinical Center, Portland Veterans Affairs Medical Center, Portland, OR, United States.
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The Effect of Hyperhomocysteinemia on Motor Symptoms, Cognitive Status, and Vascular Risk in Patients with Parkinson's Disease. PARKINSONS DISEASE 2016; 2016:1589747. [PMID: 27642535 PMCID: PMC5014982 DOI: 10.1155/2016/1589747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
Factors related with hyperhomocysteinemia (HHcy) and the impact of HHcy in Parkinson's disease (PD) are not well understood. We investigated the factors associated with increased levels of homocysteine (Hcy) and the relationship between HHcy and motor symptoms, cognitive status, and vascular risk in patients with Parkinson's disease. Among 60 patients (29 males, 48.3%) with PD, the stage of the disease, the severity of clinical symptoms, and the patients' cognitive status were measured using a modified Hoehn and Yahr Staging Scale (mHY), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and Mini-Mental State Examination (MMSE), respectively. Patients were also noted for having dyskinesia and hallucinations. Serum vitamin B12, folic acid, and plasma Hcy levels were measured. Furthermore, the presence of vascular risk factors was recorded. Finally, we investigated carotid artery intima-media thickening and stenosis using colour Doppler ultrasonography as well as the presence of ischemic lesions using brain imaging techniques. Plasma Hcy levels were higher with advanced age and in males. In addition, there was an inverse relationship between Hcy and vitamin B12 levels. There was no correlation between HHcy and the stage of the disease, severity of motor symptoms, cognitive status as assessed by the MMSE, vascular risk factors, carotid artery atherosclerotic findings, and ischemic brain lesions. Plasma Hcy levels may rise due to several factors in PD. However, the resulting HHcy has no significant effect on the clinical picture in terms of motor features, cognitive status, and vascular diseases.
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Karolczak K, Pieniazek A, Watala C. Inhibition of glutamate receptors reduces the homocysteine-induced whole blood platelet aggregation but does not affect superoxide anion generation or platelet membrane fluidization. Platelets 2016; 28:90-98. [PMID: 27560773 DOI: 10.1080/09537104.2016.1204438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Homocysteine (Hcy) is an excitotoxic amino acid. It is potentially possible to prevent Hcy-induced toxicity, including haemostatic impairments, by antagonizing glutaminergic receptors. Using impedance aggregometry with arachidonate and collagen as platelet agonists, we tested whether the blockade of platelet NMDA (N-methyl-D-aspartate), AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) and kainate receptors with their inhibitors: MK-801 (dizocilpine hydrogen maleate, [5R,10S]-[+]-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine), CNQX (7-nitro-2,3-dioxo-1,4-dihydroquinoxaline-6-carbonitrile) and UBP-302 (2-{[3-[(2S)-2-amino-2-carboxyethyl]-2,6-dioxo-3,6-dihydropyrimidin 1(2H)-yl]methyl}benzoic acid) may hamper Hcy-dependent platelet aggregation. All the tested compounds significantly inhibited Hcy-augmented aggregation of blood platelets stimulated either with arachidonate or collagen. Hcy stimulated the generation of superoxide anion in whole blood samples in a concentration-dependent manner; however, this process appeared as independent on ionotropic glutamate receptors, as well as on NADPH oxidase and protein kinase C, and was not apparently associated with the extent of either arachidonate- or collagen-dependent platelet aggregation. Moreover, Hcy acted as a significant fluidizer of surface (more hydrophilic) and inner (more hydrophobic) regions of platelet membrane lipid bilayer, when used at the concentration range from 10 to 50 µmol/l. However, this effect was independent on the Hcy action through glutamate ionotropic receptors, since there was no effects of MK-801, CNQX or UBP-302 on Hcy-mediated membrane fluidization. In conclusion, Hcy-induced changes in whole blood platelet aggregation are mediated through the ionotopic excitotoxic receptors, although the detailed mechanisms underlying such interactions remain to be elucidated.
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Affiliation(s)
- Kamil Karolczak
- a Department of Haemostatic Disorders, Chair of Biomedical Sciences , Medical University of Lodz , Lodz , Poland
| | - Anna Pieniazek
- b Department of Medical Biophysics, Faculty of Biology and Environmental Protection , University of Lodz , Lodz , Poland
| | - Cezary Watala
- a Department of Haemostatic Disorders, Chair of Biomedical Sciences , Medical University of Lodz , Lodz , Poland
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Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Crespo-Facorro B, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. Neurosci Biobehav Rev 2016; 69:280-98. [PMID: 27531233 DOI: 10.1016/j.neubiorev.2016.08.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elevated plasma homocysteine (Hcy) levels have been associated with cognitive dysfunction in a wide range of conditions. The aim of this review is to establish which cognitive domains and populations are the most affected. METHODS We systematically review the literature and consider all articles that showed any relationship between plasma Hcy levels and scores achieved on cognitive performance tests in both, the general population and patients suffering from central nervous system disorders and other diseases. When effect sizes were available and combinable, several meta-analyses were performed. RESULTS We found 111 pertinent articles. There were 24 cohort studies, 18 randomized trials, 21 case-control studies, and 48 cross-sectional studies. This review reveals a positive trend between cognitive decline and increased plasma Hcy concentrations in general population and in patients with cognitive impairments. Results from the meta-analyses also confirm this trend. Treatment with vitamin supplementation fails to show a reduction in cognitive decline. DISCUSSION Further investigations are warranted to clarify this relationship. Earlier detection of the elevated Hcy levels may be an effective intervention to prevent cognitive impairment and dementia.
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Affiliation(s)
- Esther Setién-Suero
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Marta Suárez-Pinilla
- Sackler Centre for Consciousness Science, Department of Informatics, University of Sussex, United Kingdom
| | - Paula Suárez-Pinilla
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
| | - Rosa Ayesa-Arriola
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain; CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain
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Ibrahimagic OC, Smajlovic D, Dostovic Z, Pasic Z, Kunic S, Iljazovic A, Hajdarevic DS. HYPERHOMOCYSTEINEMIA AND ITS TREATMENT IN PATIENTS WITH PARKINSON'S DISEASE. Mater Sociomed 2016; 28:303-306. [PMID: 27698607 PMCID: PMC5034996 DOI: 10.5455/msm.2016.28.303-306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/05/2016] [Indexed: 11/04/2022] Open
Abstract
Introduction: Homocysteine is process-product of methionine demethylation. It has proatherogenic, prothrombotic, prooxidative, proapoptotic, osteoporotic, neurotoxic, neuroinflamatory, and neurodegenerative effects. Hyperhomocysteinemia correlates with C667T MTHFR mutation, decrease of folic acid and vitamin B, as well as prolonged use of certain medications. Materials and Methods: We measured levels of homocysteine in thirty patients (15::15) with “de novo” Parkinson’s disease, with average age 64.17 ± 13.19 (28-82) years (Department of Neurology, University Clinical Center Tuzla). Normal level of homocysteine for women was 3.36-20.44 micromole/l and 5.9-16 micromole/l for men. We followed the effects of medicament approach (folic acid) every six months for next five years. Results: 20% of patients with “de novo” Parkinson’s disease exhibited hyperhomocysteinemia. An average level of homocysteine was 13.85 ± 5.82 micromole/l. Differences due to age and homocysteine levels, regardless of sex, were not concluded. For the next five years intake of folic acid (periodically, 1-2 months, 5 mg per day, orally) was effective to normalized levels of homocysteine in all. Conclusion: Hyperhomocysteinemia is present in every fifth patient with “de novo” Parkinson’s disease. Folic acid is medication of choice in treatment of hyperhomocysteinemia coexisting with Parkinson’s disease.
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Affiliation(s)
- Omer C Ibrahimagic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dzevdet Smajlovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zikrija Dostovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zejneba Pasic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Suljo Kunic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amra Iljazovic
- Department of Neurology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Comi C, Magistrelli L, Oggioni GD, Carecchio M, Fleetwood T, Cantello R, Mancini F, Antonini A. Peripheral nervous system involvement in Parkinson's disease: evidence and controversies. Parkinsonism Relat Disord 2014; 20:1329-34. [PMID: 25457816 DOI: 10.1016/j.parkreldis.2014.10.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND In recent years, non-motor features of Parkinson's disease (PD) have received increasing attention and PD is currently considered a systemic rather than a pure basal ganglia disorder. Among the systemic features, peripheral neuropathy (PN) is a recent acquisition since the first case-control study reporting increased frequency of PN in PD dates back to 2008. METHODS We reviewed available literature on peripheral nervous system (PNS) involvement in PD. RESULTS Evidence of α-synuclein deposition in the PNS and small nerve fiber deterioration in both drug-naïve and treated PD patients is becoming stronger. In addition, several recent reports documented a significant role of levodopa exposure together with group B vitamin deficiency in facilitating the development of PN and case reports suggested that treatment with continuous levodopa intestinal infusion may increase the risk of acute PN compared to both oral levodopa and other dopaminergic treatments. CONCLUSION It is currently debated whether PN is an intrinsic disease-related feature, a consequence of levodopa treatment or both. In this review, we will discuss the different hypotheses, as well as our perspective on open issues and controversies.
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Affiliation(s)
- C Comi
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy; Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy.
| | - L Magistrelli
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy
| | - G D Oggioni
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy
| | - M Carecchio
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy
| | - T Fleetwood
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy
| | - R Cantello
- Movement Disorders Centre, Neurology Unit, Department of Translational Medicine, University of Eastern Piedmont, "Amedeo Avogadro", Novara, Italy
| | - F Mancini
- Parkinson's Disease and Movement Disorders Centre, Neurology Unit, San Pio X Clinic, Fondazione Opera San Camillo, Milan, Italy
| | - A Antonini
- Parkinson's Disease and Movement Disorders Unit, IRCCS Ospedale San Camillo, Venice, Italy
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Stanger O, Fowler B, Piertzik K, Huemer M, Haschke-Becher E, Semmler A, Lorenzl S, Linnebank M. Homocysteine, folate and vitamin B12in neuropsychiatric diseases: review and treatment recommendations. Expert Rev Neurother 2014; 9:1393-412. [DOI: 10.1586/ern.09.75] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hu XW, Qin SM, Li D, Hu LF, Liu CF. Elevated homocysteine levels in levodopa-treated idiopathic Parkinson's disease: a meta-analysis. Acta Neurol Scand 2013; 128:73-82. [PMID: 23432663 DOI: 10.1111/ane.12106] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 12/14/2022]
Abstract
To assess the association between the elevation of plasma homocysteine (Hcy) level and long-term levodopa (L-dopa) therapy in idiopathic Parkinson's disease (PD). We performed a systematic literature review to recruit original studies published up to May 14, 2012. Studies enrolled should be controlled, with specific information of long-term L-dopa application and plasma Hcy in patients with PD. Effects were summarized using standardized mean differences (SMDs) or weighted mean differences (WMDs). Our search enrolled 22 eligible studies. Plasma Hcy levels were significantly higher in L-dopa-treated patients than those in healthy controls [SMD 0.97; 95% confidence interval (CI) 0.80-1.14, P < 0.001], L-dopa-naïve patients with PD (SMD 0.99; 95% CI 0.54-1.44, P < 0.001), and untreated patients (SMD 0.52; 95% CI 0.18-0.86, P < 0.01). However, its levels in untreated patients with PD were not significantly higher than in healthy controls (SMD 0.24; 95% CI -0.03 to 0.51, P > 0.05). Patients with PD treated with L-dopa plus catechol-O-methyltransferase inhibitor (COMT-I) showed lower plasma Hcy concentrations compared with L-dopa-treated patients (WMD 4.62; 95% CI 2.89-6.35, P < 0.001). L-dopa treatment is associated with the increase in plasma Hcy level in patients with PD. COMT-I may attenuate L-dopa-induced elevation of Hcy level.
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Affiliation(s)
- X-W Hu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Sławek J, Roszmann A, Robowski P, Dubaniewicz M, Sitek EJ, Honczarenko K, Gorzkowska A, Budrewicz S, Mak M, Gołąb-Janowska M, Koziorowska-Gawron E, Droździk M, Kurzawski M, Bandurski T, Białecka M. The impact of MRI white matter hyperintensities on dementia in Parkinson's disease in relation to the homocysteine level and other vascular risk factors. NEURODEGENER DIS 2012; 12:1-12. [PMID: 22831964 DOI: 10.1159/000338610] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 03/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear. OBJECTIVE The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD. METHODS A total of 192 patients with PD and 184 age- and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined. RESULTS Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH. CONCLUSIONS WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.
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Affiliation(s)
- Jarosław Sławek
- Department of Neurological-Psychiatric Nursing, St. Adalbert Hospital, Gdańsk, Poland.
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Nascimento CMC, Stella F, Garlipp CR, Santos RF, Gobbi S, Gobbi LTB. Serum homocysteine and physical exercise in patients with Parkinson's disease. Psychogeriatrics 2011; 11:105-12. [PMID: 21707858 DOI: 10.1111/j.1479-8301.2011.00356.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperhomocysteinemia is a major risk factor for cerebral and peripheral vascular diseases, as well as cortical and hippocampal injury, including an increased risk of dementia and cognitive impairment. Elevated serum homocysteine (Hcy) concentrations are common in patients with Parkinson's disease (PD) who have been treated with levodopa; however, physical exercises can help reduce Hcy concentrations. The aim of the present study was to compare serum Hcy levels in patients with PD who partook in regular physical exercises, sedentary PD patients, and healthy controls. METHODS Sixty individuals were enrolled in the present study across three groups: (i) 17 patients who did not partake of any type of exercise; (ii) 24 PD patients who exercised regularly; and (iii) 19 healthy individuals who did not exercise regularly. All participants were evaluated by Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab and England scale (measure daily functionality). The serum levels of Hcy were analyzed by blood samples collected of each participant. An analysis of variance and a Tukey's post hoc test were applied to compare and to verify differences between groups. Pearson's correlation and stepwise multiple regression analyses were used to consider the association between several variables. RESULTS Mean plasma Hcy concentrations in individuals who exercised regularly were similar to those in the healthy controls and significantly lower than those in the group that did not exercise at all (P= 0.000). In addition, patients who did not exercise were receiving significantly higher doses of levodopa than those patients who exercised regularly (P= 0.001). A positive relationship between levodopa dose and Hcy concentrations (R(2) = 0.27; P= 0.03) was observed in patients who did not exercise, but not in those patients who exercised regularly (R(2) = 0.023; P= 0.15). CONCLUSIONS The results of the present study suggest that, even with regular levodopa therapy, Hcy concentrations in PD patients who exercise regularly are significantly lower than in patients who do not exercise and are similar Hcy concentrations in healthy controls.
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Affiliation(s)
- Carla Manuela Crispim Nascimento
- Laboratory of Aging and Physical Activity (LAFE), Biosciences Institute, Department of Physical Education, São Paulo State University, Rio Claro Campus, Brazil.
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Müller T. Motor complications, levodopa metabolism and progression of Parkinson's disease. Expert Opin Drug Metab Toxicol 2011; 7:847-55. [PMID: 21480824 DOI: 10.1517/17425255.2011.575779] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Oxidative stress is an essential component of neuronal death in Parkinson's disease (PD). Clinically, progression of PD is also characterised by onset of motor complications (MC). MC results from the peripheral and central degree of fluctuations of levodopa (LD) and of dopamine. AREAS COVERED This review highlights aspects of LD and dopamine metabolism in chronic neurodegeneration in PD. A Medline search (terms: homocysteine, LD, PD, progression [from 2000 onwards]) was performed and considered preclinical and clinical investigations. The author discusses pharmacokinetic and metabolic aspects of chronic LD administration in PD patients and provides a therapeutic concept to reduce probable PD accelerating consequences of chronic LD application. EXPERT OPINION The author suggests that the future 'ideal' oral LD therapy should be homocysteine-reducing, methyl-group-donating, oxidative-stress-decreasing and antiglutamatergic while also allowing continuous delivery to the brain. This may slow the progression of PD and delay the onset of MC, both of which represent unmet needs in the treatment of PD patients.
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Affiliation(s)
- Thomas Müller
- St. Joseph Hospital Berlin-Weissensee, Department of Neurology , Gartenstr. 1, 13088 Berlin, Germany.
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21
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Lee SH, Kim MJ, Kim BJ, Kim SR, Chun S, Ryu JS, Kim GS, Lee MC, Koh JM, Chung SJ. Homocysteine-lowering therapy or antioxidant therapy for bone loss in Parkinson's disease. Mov Disord 2010; 25:332-40. [PMID: 19938151 DOI: 10.1002/mds.22866] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We investigated whether homocysteine (Hcy)- lowering therapy or an antioxidant prevented bone loss in Parkinson's disease (PD) patients taking levodopa. Forty-two PD patients with low bone mineral density (BMD) taking levodopa were randomly assigned to Hcy-lowering therapy (5 mg folate and 1500 microg vitamin B(12) daily), alpha-lipoic acid (alpha-LA) therapy (1200 mg daily), or control groups. Primary outcomes were BMD changes from baseline to 12 months. Secondary outcomes were changes in Hcy level, and C-telopeptide (CTX) levels at 12 months. Forty-one patients completed the study. Hcy-lowering therapy resulted in significantly greater BMD changes at the lumbar spine (4.4%), total femur (2.8%), and femur shaft (2.8%) than control (P = 0.005-0.023). BMD changes in the alpha-LA therapy group were similar to those of the control group, but changes at the trochanter (4.6%) were significantly greater in the alpha-LA therapy group than in the control group after adjustment for body mass index changes. Hcy concentrations decreased to 35.2% +/- 13.4% in the Hcy-lowering therapy group, but increased in other groups. Serum CTX levels at 12 months tended to be lower in the Hcy-lowering group (0.442 +/- 0.024 ng/mL) than control group (0.628 +/- 0.039 ng/mL) (P = 0.159). This small trial suggests that Hcy-lowering therapy may prevent bone loss in PD patients taking levodopa.
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Affiliation(s)
- Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Effect of entacapone on plasma homocysteine levels in Parkinson’s disease patients. Neurol Sci 2010; 31:565-9. [DOI: 10.1007/s10072-010-0262-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/31/2010] [Indexed: 10/19/2022]
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Belcastro V, Pierguidi L, Castrioto A, Menichetti C, Gorgone G, Ientile R, Pisani F, Rossi A, Calabresi P, Tambasco N. Hyperhomocysteinemia recurrence in levodopa-treated Parkinson’s disease patients. Eur J Neurol 2009; 17:661-5. [DOI: 10.1111/j.1468-1331.2009.02894.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Müller T. Levodopa/carbidopa and entacapone in the treatment of Parkinson's disease: efficacy, safety and patient preference. Patient Prefer Adherence 2009; 3:51-9. [PMID: 19936145 PMCID: PMC2778405 DOI: 10.2147/ppa.s4084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Levodopa (LD) is the oldest, most efficacious and best-tolerated drug for dopaminergic substitution of patients with Parkinson's disease (PD). Its main drawback is its short half-life, which supports onset of motor complications in the long term. Therefore well-informed PD patients mostly accept LD therapy as late as possible. Recent LD trials indicate that a combination of LD with carbidopa (CD) and the catechol-O-methyltransferase (COMT) inhibitor entacapone (EN) may reduce the onset of these motor complications to a certain extent. This observation is further supported by pharmacokinetic trials and experimental research, but there is still a need to confirm this in a clinical trial, which is under way. Additionally, combined LD/CD/EN was superior to LD/CD administration regarding cognition, muscle behavior and gastrointestinal function in small clinical trials. Moreover there is accumulating evidence that combined COMT inhibition with LD administration reduces homocysteine synthesis. In the long term, homocysteine elevation supports onset of arteriosclerosis-related disorders, which are more frequent in PD patients according to epidemiological studies than in the normal healthy population. The introduction of LD/CD/EN in one tablet supported patients' preference of COMT inhibition as an essential component of LD/DDI therapy, as this combination reduced number and size of tablets.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital
Berlin-Weißensee, Berlin, Germany
- IGSN, Ruhr University of Bochum, Bochum, Germany
- Correspondence: Thomas Müller, MD, Department
of Neurology, St. Joseph Hospital Berlin-Weißensee, Gartenstr. 1,
13088 Berlin, Germany, Tel +49 30 92790223, Fax +49 30
92790703, Email ,
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Rodriguez-Oroz MC, Lage PM, Sanchez-Mut J, Lamet I, Pagonabarraga J, Toledo JB, García-Garcia D, Clavero P, Samaranch L, Irurzun C, Matsubara JM, Irigoien J, Bescos E, Kulisevsky J, Pérez-Tur J, Obeso JA. Homocysteine and cognitive impairment in Parkinson's disease: a biochemical, neuroimaging, and genetic study. Mov Disord 2009; 24:1437-44. [PMID: 19452554 DOI: 10.1002/mds.22522] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The role of the plasma level of homocysteine (Hcy), as a primary outcome, and the effect of silent cerebrovascular lesions and genetic variants related to Hcy metabolism, as secondary outcomes, in the cognitive decline and dementia in Parkinson's disease (PD) were studied. This case-control study focused on 89 PD patients of minimum 10 years of evolution and older than 60 years, who were neuropsychologically classified either as cognitively normal (n = 37), having mild cognitive impairment (Petersen criteria) (n = 22), or suffering from dementia (DSM-IV) (n = 30), compared with cognitively normal age-matched control subjects (n = 30). Plasma levels of Hcy, vitamins B12 and B6, folic acid, polymorphisms in genes related to Hcy metabolism (MTHFR, MTR, MTRR, and CBS) and silent cerebrovascular events were analyzed. Plasma levels of Hcy were increased in PD patients (P = 0.0001). There were no differences between the groups of patients. The brain vascular burden was similar among PD groups. There was no association between polymorphisms in the studied genes and the Hcy plasma levels or cognitive status in PD patients. We found no evidence for a direct relationship between Hcy plasma levels and cognitive impairment and dementia in PD. No indirect effect through cerebrovascular disease or genetic background was found either.
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Affiliation(s)
- Maria C Rodriguez-Oroz
- Department of Neurology, University Clinic and Medical School of Navarra, Pamplona, Spain.
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Müller T, Kuhn W. Homocysteine levels after acute levodopa intake in patients with Parkinson's disease. Mov Disord 2009; 24:1339-43. [PMID: 19425084 DOI: 10.1002/mds.22607] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Levodopa (L-dopa) administered with a dopadecarboxylase inhibitor (DDI) increases homocysteine plasma levels. This may support the onset of atherosclerosis-related disorders and neuropsychiatric complications in patients with Parkinson's disease (PD). This homocysteine elevation is considered as long-term effect of chronic L-dopa/DDI treatment. Little is known about the acute effects of L-dopa/DDI intake on homocysteine generation. The objective of this trial was to investigate the relations between L-dopa and homocysteine after acute L-dopa/DDI administration in PD patients with different L-dopa metabolism. Thirty PD patients were divided into groups with superior (I) and less (II) L-dopa absorption after standardized intake of 125 mg L-dopa/benserazide with determination of L-dopa, 3-O-methyl-dopa (3-OMD) and homocysteine in plasma at baseline, 30, 60, and 90 minutes. There was a homocysteine increase in Group I (F = 5; P = 0.005) and a moderate decrease in Group II (F = 4.27; P = 0.01). A rise of 3-OMD (F = 10.51; P < 0.0001) appeared in Group I, but not in Group II (F = 0.91; P = 0.44), accordingly L-dopa accumulation was better in Group I than in Group II. Thus, in conclusion, L-dopa metabolism is an important component for homocysteine elevation after one time L-dopa/DDI administration in PD patients.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Germany.
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Methylenetetrahydrofolate reductase polymorphisms and plasma homocysteine in levodopa-treated and non-treated Parkinson's disease patients. J Neurol Sci 2009; 287:64-8. [PMID: 19786283 DOI: 10.1016/j.jns.2009.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/03/2009] [Accepted: 09/08/2009] [Indexed: 11/20/2022]
Abstract
Genetic C677T and A1298C polymorphisms in 5,10-methylenetetrahydrofolate reductase (MTHFR) and levodopa therapy in Parkinson's disease (PD) may increase homocysteine (Hcy) level. We examined whether connecting both polymorphisms influences the effect of levodopa on Hcy. MTHFR genotypes and Hcy, vitamin B(12), and folate levels were determined in 48 levodopa-treated PD patients (PD-L), 28 non-treated PD patients (PD-N) and 110 controls. Hcy was remarkably higher in PD-L than in PD-N and controls (p<0.001); similarly, the differences were seen in different age subgroups and in both genders. Furthermore, Hcy differences between PD-L and PD-N were evident in 677C/T, T/T, C/T + A/A, T/T + A/A (all p<0.05), and 1298A/A (p<0.001), but not in others such as 677C/C, and C/C + A/A. Hcy in PD-N and controls was comparable for all genotypes. In PD-L, Hcy was the highest in 677T/T, then in C/T, and in C/C with a significant difference from T/T (p=0.014), but was not different among A1298C genotypes. Likewise, Hcy was the highest in 677T/T+1298A/A, intermediate in C/T+A/A, and the lowest in C/C+A/A. In PD-N, Hcy was similar among all genotypes. In conclusion, Hcy elevation may be caused by levodopa administration, and further promoted by 677C/T and T/T, but not by A1298C genotypes. The promoting elevation in 1298A/A is attributed to combining the 677T allele. Neither C677T nor A1298C genotypes contribute to elevating Hcy in PD-N.
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Müller T. Possible treatment concepts for the levodopa-related hyperhomocysteinemia. Cardiovasc Psychiatry Neurol 2009; 2009:969752. [PMID: 20029636 PMCID: PMC2794520 DOI: 10.1155/2009/969752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 06/13/2009] [Accepted: 07/16/2009] [Indexed: 01/08/2023] Open
Abstract
The saga of harmful levodopa (LD) in the treatment of Parkinson's disease (PD) resulted from outcomes of animal-and cell culture studies and the clinical observation of motor complication related to the short half life of LD. Further aspects of LD long term application, the LD associated homocysteine increase and its emerging consequences on progression, and onset of neuropsychiatric symptoms and of vascular disease are only partially considered. Therapeutic approaches for this LD-mediated neurotoxic homocysteine increase are vitamin supplementation or LD application with an inhibitor of catechol-O-methyltransferase (COMT). However, forcing central dopamine metabolism further down the methylation path by central blocking of COMT and MAO-B may reduce oxidative stress and homocysteine levels. But it may also increase N-methylation of tetrahydroisoquinolines to neurotoxic N-methylated tetrahydroisoquinolines. These compounds were observed in cerebrospinal fluid and plasma of long term LD-treated PD patients. Therefore LD application with peripheral COMT inhibition may be safer.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Gartenstr. 1, 13088 Berlin, Germany
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Peripheral COMT inhibition prevents levodopa associated homocysteine increase. J Neural Transm (Vienna) 2009; 116:1253-6. [DOI: 10.1007/s00702-009-0275-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 07/17/2009] [Indexed: 01/17/2023]
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Shin HW, Sohn YH. Hyperhomocysteinemia in patients with Parkinson's disease and relationship to vitamin B level. J Mov Disord 2009; 2:33-6. [PMID: 24868350 PMCID: PMC4027693 DOI: 10.14802/jmd.09008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 03/30/2009] [Accepted: 03/26/2009] [Indexed: 01/09/2023] Open
Abstract
Background: Plasma homocysteine (Hcy) levels are increased in patients with Parkinson’s disease (PD) undergoing levodopa treatment. We measured the Hcy levels in PD patients and assessed the relationship between Hcy level and features of PD, cognitive function and vitamin B status. Methods: Concentrations of Hcy, vitamin B12 and folate were measured in 33 PD patients and 41 normal control individuals. Mini-mental Status Examination (MMSE) was assessed in all subjects. In PD patients, Hoehn & Yahr stage and Unified Parkinson Disease Rating Scale (UPDRS) motor scores were also examined. Results: Plasma Hcy levels were lower in PD patients than in control individuals. Hcy level was inversely correlated with vitamin B12 and folate levels in the PD group but not in control individuals. Age, symptom duration, UPDRS motor scores, MMSE score, levodopa dose and duration of treatment did not differ between patients with Hcy >14 μmol/L and those with Hcy <14 μmol/L. Conclusions: Plasma Hcy levels were increased in PD patients with levodopa treatment and were related to vitamin B level. These results indicate that vitamin supplementation may be beneficial in levodopa-treated PD patients, although hyperhomocysteinemia did not affect the motor and cognitive status of PD patients.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Parkinson/Alzheimer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Sohn
- Department of Neurology and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Barone P, Burn DJ, van Laar T, Hsu C, Poewe W, Lane RM. Rivastigmine versus placebo in hyperhomocysteinemic Parkinson's disease dementia patients. Mov Disord 2009; 23:1532-40. [PMID: 18581467 DOI: 10.1002/mds.21997] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The effects of rivastigmine versus placebo in Parkinson's disease dementia (PDD) patients with elevated or normal/low plasma homocysteine were determined. In this prospective analysis of a 24-week, randomly assigned, placebo-controlled study of rivastigmine in PDD, subpopulations comprised patients with plasma homocysteine >or=14 micromol/L (elevated) or <14 micromol/L (normal/low). Coprimary outcomes were the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and Alzheimer Disease Cooperative Society-Clinical Global Impression of Change (ADCS-CGIC). Secondary outcomes included additional measures of cognition, including attention and executive function, daily function, and neuropsychiatric symptoms. Adverse events (AEs) were monitored. In total, 342 of 541 patients provided samples for analysis, from which 72% had elevated plasma homocysteine. Hyperhomocysteinemic patients showed treatment differences (rivastigmine vs. placebo) of 4.0 on ADAS-cog and 0.7 on ADCS-CGIC (both P < 0.01), and significant treatment differences on secondary outcomes. Rivastigmine- and placebo-treated hyperhomocysteinemic patients (16.5% and 14.6%) discontinued the study because of AEs. Patients with normal/low homocysteine showed no treatment differences on primary or secondary outcomes (1.4 on the ADAS-cog and 0.1 on ADCS-CGIC, both P = ns); 16.7% and 10.3% rivastigmine- and placebo-treated patients discontinued because of AEs. Elevated homocysteine was associated with greater rivastigmine treatment differences than normal/low homocysteine.
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Affiliation(s)
- Paolo Barone
- Dipartimento di Scienze Neurologiche, Università Federico II di Napoli, Naples, Italy.
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Hypertrophy of intima media of the carotid artery due to L-dopa therapy in Parkinson's disease. Adv Ther 2008; 25:201-7. [PMID: 18409033 DOI: 10.1007/s12325-008-0035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recent studies have shown that L-dopa therapy used in patients with Parkinson's disease might cause thickening of the carotid artery intima media. It is known that intima-media thickening is a sign of systemic atherosclerosis. The purpose of this study was to clarify the correlation between L-dopa medication and carotid artery intima-media thickness (IMT) in patients with Parkinson's disease. METHODS Twenty-five patients with Parkinson's disease who used L-dopa (LD+) and 17 patients who did not use L-dopa (LD-) treatment were included in this study. Colour Doppler with B-mode carotid ultrasonography was performed. The Hoehn-Yahr scale was used for staging of Parkinson's disease in an 'on' state. The Student t test was used for statistical analysis. RESULTS The IMT of the left internal carotid and external carotid arteries were found to be thicker in patients treated with L-dopa. The mean IMT of the left internal carotid artery was 0.937+/-0.391 mm in the LD+ group and 0.677+/-0.138 mm in the LD-group (P=0.013). The mean IMT of the left external carotid artery was 0.956+/-0.531 mm in the LD+ group and 0.646+/-0.18 mm in the LD-group (P=0.037). CONCLUSION The IMT of the carotid artery was found to be thicker in patients who were treated with L-dopa. In conclusion, patients treated with L-dopa appear to be at a higher risk of thickening of the intima media of the carotid artery.
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