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Homocysteinemia as a Biomarker in Kidney Disease

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Biomarkers in Kidney Disease

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Abstract

Homocysteine is an amino acid containing sulfur in the form of the thiol group. Homocysteine is a metabolite of the essential amino acid methionine. First, methionine is converted to S-adenosylmethionine, which is then converted to S-adenosylhomocysteine, wherein transmethylation processes take place. Homocysteine finally emerges from S-adenosylhomocysteine. It then enters either the transsulfuration pathway when converted to cystathionine or the remethylation pathway when converted back into methionine in the presence of the 5-methyltetrahydrofolate reductase, cystathionine β-synthase, and methionine synthase and with the participation of vitamin B12 and folic acid. Therefore, the decreased activities of these enzymes, as well as the deficit of the vitamin B12 and folic acid, are frequent causes of hyperhomocysteinemia. In addition, chronic kidney disease and the use of certain drugs are also very important factors that cause hyperhomocysteinemia.

In the bloodstream, homocysteine is found in one of two forms, the bound and the free form, which together makes up the total homocysteine. The most suitable sample for determining the circulating levels of total homocysteine is plasma. Enzymatic and immunochemical methods are most commonly used in routine clinical practice. Reference values of the total homocysteine vary among different countries and even among different laboratories as a result of the use of different methods for determining the levels of total homocysteine but also the different lifestyles of the residence.

The plasma total homocysteine level is positively correlated with the serum creatinine values, and it is in a high inverse correlation with the glomerular filtration rate, so it could be used as a marker of renal hypofunction. In addition, the kidneys possess enzymes involved in metabolic pathways. That is why chronic kidney disease is one of the most common causes of hyperhomocysteinemia. The level of homocysteine in patients with chronic kidney disease can be elevated even in the initial stages. Hyperhomocysteinemia is present in most patients with glomerular filtration rate <60 ml/min/1.73 m2, with the highest values in patients on chronic dialysis treatment. Hyperhomocysteinemia occurs in 50–60 % of patients with transplanted kidneys. On the other hand, hyperhomocysteinemia is an important factor that contributes to the structural damage of the kidney, both glomerular and tubular, along with damage to the interstitial tissue. Therefore, when there are hyperhomocysteinemia and absence of the deficiency of the vitamin B12 and folic acid, it is necessary to examine the renal function.

Homocysteine is a vascular toxin, and it is one of the risk factors for the development of coronary heart disease, cerebrovascular disease, and peripheral artery disease. Also, it has a role in the development of venous thrombosis. Therefore, in patients with chronic kidney disease, the plasma concentration of homocysteine is a significant determinant of the risk of morbidity and mortality from cardiovascular disease. The measurement of homocysteine in patients with renal dysfunction is necessary for making decisions about therapeutic treatment, especially if the patient has not yet had signs of development of cardiovascular disease.

In addition, it is assumed that homocysteine has a role in the pathogenesis of other pathological conditions, such as neurodegenerative diseases, dementia, cognitive disorders, osteoporosis, epigenetic changes, hypertension, as well as the stimulation of an immune response.

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Abbreviations

5-MTHF:

Methyltetrahydrofolate

5-MTHFR:

Methyltetrahydrofolate reductase

ADMA:

Asymmetric dimethylarginine

apo A-I:

Apolipoprotein A-I

ATP:

Adenosine triphosphate

bHcy:

Bound homocysteine

BHL:

Bleomycin hydrolase

BHMT:

Betaine-homocysteine methyltransferase

CBS:

Cystathionine β-synthase

CKD:

Chronic kidney disease

CMIS:

Chronic malnutrition-inflammation state

CSE:

Cystathionine γ-lyase

CVD:

Cardiovascular disease

DM:

Diabetes mellitus

DN:

Diabetic nephropathy

DNA:

Deoxyribonucleic acid

eNOS:

Endothelial nitric oxide synthase

ESRD:

End-stage renal disease

fHcy:

Free homocysteine

GFR:

Glomerular filtration rate

H2S:

Hydrogen sulfide

Hcy:

Homocysteine

HDL:

High-density lipoprotein

HHcy:

Hyperhomocysteinemia

HTL:

Homocysteine thiolactone

IL:

Interleukin

Km:

Michaelis constant

LDL:

Low-density lipoprotein

MAT:

Methionine adenosyltransferase

MCP-1:

Monocyte chemoattractant protein-1

Met:

Methionine

MIP-2:

Macrophage inflammatory protein-2

MMP:

Matrix metalloproteinase

MS:

Methionine synthase

NAC:

N-acetylcysteine

NF-κB:

Nuclear factor kappa-light-chain-enhancer of activated B cells

NO:

Nitric oxide

NS:

Syndroma nephroticum

oxLDL:

Oxidized low-density lipoprotein

PON1:

Paraoxonase-1

ROS:

Reactive oxygen species

SAH:

S-adenosylhomocysteine

SAM:

S-adenosylmethionine

TAFI:

Thrombin activatable fibrinolysis inhibitor

TGF-β1:

Transforming growth factor β1

tHcy:

Total homocysteine

t-PA:

Tissue plasminogen activator

tRNA:

Transfer ribonucleic acid

VSMC:

Vascular smooth muscle cells

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Authors and Affiliations

  1. Department of Pathophysiology, Medical Faculty Novi Sad, University of Novi Sad, Hajduk Veljkova 1, 21000, Novi Sad, Serbia

    Velibor Čabarkapa & Mirjana Đerić

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  1. Velibor Čabarkapa
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  2. Mirjana Đerić
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Correspondence to Velibor Čabarkapa .

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Editors and Affiliations

  1. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

Definitions

Homocysteinylation

The reaction in which the Hcy in the form of homocysteine thiolactone binds to amino groups of amino acids, leading to a dysfunction of the proteins.

Hyperhomocysteinemia

Increasing levels of total homocysteine (tHcy), which implies an increase in the level of the free (fHcy) and bound Hcy (bHcy).

Hypomethylation

Reduction in the volume of the transmethylation reactions in hyperhomocysteinemia (HHcy), due to the inhibition of the methyltransferase by the increased levels of S-adenosylhomocysteine (SAH).

Remethylation

The conversion of Hcy into methionine by the enzyme methionine synthase, the folic acid as a donor of the methyl groups, and of vitamin B12 as a cofactor.

Transmethylation

The reaction of the methyl group transfer from the donor to the acceptor. This reaction takes place during the conversion of methionine into Hcy, and it is dependent on the intermediates S-adenosylmethionine (SAM) and SAH.

Transsulfuration

Reaction to the conversion of Hcy into cystathionine with the participation of vitamin B6. Cystathionine, after being converted into various compounds, is excreted by the kidneys, which are the pathways for eliminating Hcy from the body.

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Čabarkapa, V., Đerić, M. (2015). Homocysteinemia as a Biomarker in Kidney Disease. In: Patel, V. (eds) Biomarkers in Kidney Disease. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7743-9_2-1

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