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Dx Homocysteine Treatment: Read more...


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Observation:
Homocysteinemia (Elevated serum Homocysteine)

Medscape
states;
"Homocysteine is a sulfur-containing amino acid; in plasma, it undergoes oxidization and transforms to disulfides homocystine and cysteine-homocysteine, the measured plasma level reflects these 3 components.

Homocysteine play an important role in many metabolic pathways, mainly the methionine cycle to the folate cycle (see below).
The simplified picture, showing Homocysteine involvement in different metabolic pathways as well as the role of vitamin B6, B12 and Folate as a co-factor in this pathways.
Indications/Applications
Plasma and urine homocysteine tests are indicated in the screening and diagnosis of different types of homocystinuria.

Considerations
Plasma homocysteine levels are usually severely elevated in homozygous cystathionine-β synthase deficiency and moderately elevated in heterozygous cystathionine-β synthase deficiency. In the other mutations associated with homocystinuria, plasma levels can vary from high to intermediate.

Many epidemiological studies have shown that plasma homocysteine levels are higher in patients with coronary heart disease, stroke, peripheral vascular disease, or thromboembolic disease, but recent meta-analysis showed that lifelong moderate homocysteine elevation has little or no effect on coronary heart disease.

Elevated Plasma homocysteine levels are found in patients with vitamin B-12, folate (vitamin B-9), and vitamin B-6 deficiencies.

In most cases, vitamin B-12 deficiency is associated with an elevation in plasma homocysteine and methylmalonic acid levels, whereas folate deficiency is associated with elevated homocysteine levels only."

Medications Used in Treatment
1. Folates: Deplin®/ levomefolate
2. Supplements: B12 2000mg/folate 5mg and trimethylglycine 500mg purchased separately OTC

*[Editor] Homocysteine may be a weak marker for a risk of developing heart disease but it is an excellent marker for B12 and folate deficiency. The Editor advises patients whose homocysteine serum assay is greater than 8 umol/L, that vitamin replacement with methylcolbamin (B12), folate (B6) and trimethylglycine (TMG or BMG) is appropriate. Repeat laboratory tests in 8 weeks will confirm if the supplement is effective. Biotics® (B12/folate® and Oorganik®) or LEF's Homocysteine Resisthave been used by my patients with satisfactory reduction of the homocysteine blood assay. The supplements are much less expensive as the prescription Delpin®.

*[Editor] All three B oral vitamin supplements are necessary as S Billion reported "Vitamin B12 supplements are useful in folate treated patients to prevent cobalamin deficiency and its neurological consequences but they did not lower tHcy plasma levels for the patients as a [dialysis] group."

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