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Homocysteine, vitamin B metabolites, dopamine-substituting compounds, and symptomatology in Parkinson’s disease: clinical and therapeutic considerations

  • Neurology and Preclinical Neurological Studies - Review Article
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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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Data availability

Data supporting the findings of this study is available from the corresponding author, [Bhidayasiri R], upon reasonable request.

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Author notes

  1. Onanong Phokaewvarangkul and Roongroj Bhidayasiri have contributed equally to this manuscript as first authors.

Authors and Affiliations

  1. 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

    Onanong Phokaewvarangkul & Roongroj Bhidayasiri

  2. The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand

    Roongroj Bhidayasiri

  3. Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain

    Pedro Garcia-Ruiz

  4. Division of Neurology, Department of Clinical Sciences Lund, Restorative Parkinson Unit, Lund University, 221 84, Lund, Sweden

    Per Odin

  5. Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany

    Peter Riederer

  6. Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Gartenstr. 1, 13088, Berlin, Germany

    Thomas Müller

Authors
  1. Onanong Phokaewvarangkul
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  2. Roongroj Bhidayasiri
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  3. Pedro Garcia-Ruiz
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  4. Per Odin
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  5. Peter Riederer
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  6. Thomas Müller
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Contributions

OP: conception for the article, performing literature search and data analysis, and writing of the first draft manuscript. RB: conception and organisation for the article, performing literature search and data analysis, and critique and writing of the revised draft manuscript. PG-R: conception and organisation for the article, review, and critique of the manuscript. WJ: conception and organisation for the article, review, and critique the manuscript. PO: conception and organisation for the article, review, and critique the manuscript. PR: conception and organisation for the article, review, and critique the manuscript. TM: conception and organisation for the article, review, and critique and writing of the revised draft manuscript.

Corresponding author

Correspondence to Roongroj Bhidayasiri.

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Phokaewvarangkul, O., Bhidayasiri, R., Garcia-Ruiz, P. et al. Homocysteine, vitamin B metabolites, dopamine-substituting compounds, and symptomatology in Parkinson’s disease: clinical and therapeutic considerations. J Neural Transm 130, 1451–1462 (2023). https://doi.org/10.1007/s00702-023-02684-9

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