The Effects of Homocysteine Level in the Critically Ill Patient. A Review

Abstract

Increased levels of homocysteine (HCYS) represent a risk factor for a series of physiopathological conditions: mental retardation, cardiovascular and neurodegenerative diseases, Parkinson's and Alzheimer's disease, depression, osteoporosis, endothelial dysfunction and inhibition of cell proliferation. This paper aims to present the pathophysiological implications of HCYS and the correlation of hyperhomocysteinemia (H-HCYS) with critical condition in the intensive care unit (ICU). Hypovitaminosis B and folate deficiency is directly involved in the inhibition of HCYS metabolism and the accumulation of HCYS in the plasma and tissues. Critically ill patients are more prone to H-HCYS due to hypermetabolism and accelerated synthesis produced by reactive oxygen species (ROS). In conclusion it can be affirmed that the determination and monitoring of HCYS plasma levels may be of interest in optimizing the therapy for critically ill patients. Moreover, by controlling HCYS levels, and implicitly the essential cofactors that intervene in the specific biochemical pathways, such as vitamin B6, vitamin B12 and folic acid can provide a diversified and personalized treatment for each patient.

Nuclear Transcription Factor Kappa B (NF-кB) and Molecular Damage Mechanisms in Acute Cardiovascular Diseases. A Review

“…One of the main pathologies developed at cardiovascular level is represented by atherosclerosis, which eventually can be defined as a molecular and cellular inflammation complex. [10][11][12][13] Of course, if we were to look at a molecular and cellular level, the vascular endothelium is the main involved cofactor. From a molecular viewpoint, the key player is represented by nuclear transcription factor kappa B (NF-κB), which, according to recent studies, is responsible for the modulation of molecular and epigenetic signals at this level.…”

Biomarkers and Risk Assessment — an Interdisciplinary Approach

“…The review includes the presentation of new studies that demonstrated an increase of this biomarker in patients with atherosclerosis or with cardiovascular diseases via complex pathways that involve endothelial dysfunction, LDL oxidation and monocyte aggregation. 9 This, together with the observation described in this work, that the level of HCYS is proportional to the incidence of coronary artery disease, raises the question if this biomarker, useful for critically ill patients, could also be used for assessing the cardiovascular status. As for the relation between HCYS and critically ill patients, seven recent studies are presented that prove the relationship between HCYS levels and the deterioration of the clinical condition in these patients.…”

“…In the review published by Bedreag et al in this issue of JIM, the role of homocysteine levels in predicting the evolution of critically ill patients is presented in a complex manner, from pathophysiological mechanisms involved in its action, to interrelation with different other diseases such as cardiovascular or bone diseases. 9 The relationships between homocysteine levels and particular features of the critically ill patients are described together with the potential of control of homocysteine levels in this category. The review includes the presentation of new studies that demonstrated an increase of this biomarker in patients with atherosclerosis or with cardiovascular diseases via complex pathways that involve endothelial dysfunction, LDL oxidation and monocyte aggregation.…”

“…However, an interesting approach of this article refers to the potential to control this biomarker using supplementation with vitamin B and folate, application that makes this substance not only a biomarker, but a relevant therapeutic target in critically ill patients. 9 The integration of biomarkers into complex biomarker platforms was recently proposed in different studies, in order to identify new biomarker panels that can prove superior cost-efficiency for the early detection and monitorization of high-risk conditions. 10 Such a complex biomarker panel should integrate relevant data provided by multiple tests (serum tests, imaging tests, etc) with different patient-specific information, data being processed with the help of complex bioinformatics tools.…”