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As a consequence of the biochemical reactions in which homocysteine is involved, deficiencies of vitamin B 6, folic acid (vitamin B 9), and vitamin B 12 can lead to high homocysteine levels. [2] Other possible causes of hyperhomocysteinemia include genetics, excessive methionine intake, and other diseases. [3]
Methylenetetrahydrofolate reductase deficiency is the most common genetic cause of elevated serum levels of homocysteine (hyperhomocysteinemia). It is caused by genetic defects in MTHFR, which is an important enzyme in the methyl cycle. [1] Common variants of MTHFR deficiency are asymptomatic and have only minor effects on disease risk. [2]
PEMT modulates levels of blood plasma homocysteine, which is either secreted or converted to methionine or cysteine. High levels of homocysteine are linked to cardiovascular disease and atherosclerosis, particularly coronary artery disease. [32] PEMT deficiency prevents atherosclerosis in mice fed high-fat, high-cholesterol diets. [33]
In the body, homocysteine can be recycled into methionine or converted into cysteine with the aid of vitamin B 6, B 9, and B 12. [3] High levels of homocysteine in the blood (hyperhomocysteinemia) is regarded as a marker of cardiovascular disease, likely working through atherogenesis, which can result in ischemic injury.
The US Food and Drug Administration (FDA) approved betaine trimethylglycine (also known by the brand name Cystadane) for the treatment of homocystinuria, a disease caused by abnormally high homocysteine levels at birth. [22] Trimethylglycine is also used as the hydrochloride salt (marketed as betaine hydrochloride or betaine HCl).
Homocysteine is elevated (5-MTHF is used to convert homocysteine to methionine) as in vitamin B 12 deficiency, whereas methylmalonic acid is normal (elevated in vitamin B 12 deficiency). [citation needed] More specifically, according to a 2014 UK guideline, [30] A serum folate level of less than 7 nmol/L (3 μg/L) is indicative of folate ...