Homocysteine remethylation

An alternative reaction for the remethylation of homocysteine to methionine can be accomplished by betaine homocysteine methyltrans-ferase, which uses betaine instead of 5-MTHF as the methyl donor. Unlike the MS reaction, which is believed to be ubiquitously present in all tissues, the betaine homocysteine methyl-transferase reaction occurs only in the liver and kidney. Betaine is not a required nutrient since the liver can synthesize betaine from choline. Betaine supplements, however, have been shown to lower plasma total homocysteine concentrations successfully in subjects with deficient homocysteine remethylation due to defects in MTHFR or MTRR and in those with deficient CBS activity. 

In 1969, McCully made an important observation when he noticed severe vascular pathology caused by defects in homocysteine remethylation in children with homocystinuria (McCully, 1969). Like patients with CBS deficiency, these children had markedly elevated levels of tHcy in their blood and urine, but their blood levels of methionine were lower than... 

Once inside the cell, folates participate in a number of interconnected metabolic pathways involving (1) thymidine and purine biosynthesis necessary for DNA synthesis, (2) methionine synthesis via homocysteine remethylation, (3) methylation reactions involving S-adenosylmethionine (AdoMet), (4) serine and glycine interconversion, and (5) metabolism of histidine and formate (see Figure 8). Via these pathways. 

Variability of presentation characterizes this homocysteine remethylation defect as well. Several patients have been reported from one family one with seizures and muscle weakness, a second with schizophrenia and retardation, and a third who was asymptomatic. Subsequently, patients with a more malignant neonatal presentation were reported, and hence both variants should be part of the differential diagnosis of sepsis neonatorum . 

The remethylation cycle allows the conversion of homocysteine back to methionine by two pathways. The first and major pathway is catalyzed by the enzyme, methionine synthase, and links the folate cycle with homocysteine metabolism. Methionine synthase requires the cofactor, meth-ylcobalamin. The second pathway utilizes the enzyme, betaine-homocysteine methyltransfer-ase [8]. This pathway remethylates homocysteine using a methyl group derived from betaine, formed via oxidation of choline, and is presumably responsible for up to 50 % of homocysteine remethylation [10]. Both methionine and homocysteine play important roles in protein synthesis, folding, and function. 

Renal patients increased metaboUte levels could be due to holoTC abnormal distribution, altered receptor activity for renal TC II uptake and altered TC II function. Treatment with folic add and vitamin B12 reduces MMA and Hey levels, but only during the treatment, which suggests a chronic alteration in homocysteine remethylation (Herrmann et al. 2003a). Elderly subjects with renal failure require more eirculating holoTC to deliver sufficient amounts of vitamin B12 into the cells and maintain normal cellular vitamin B12 status (Herrmann et al. 2003a). 

Folate metabolism is not limited to the cytoplasmic compartment. Most of the folate in tissues is found in the mitochondrion and cytosol (Horne et al. 1997). Individual folate-dependent pathways are compartmentalized within organelles. The cytoplasmic and mitochondrial compartments each possess a parallel array of enzymes catalysing the interconversion of folate coenzymes that carry one-carbon units. The mitochondrial folate metabolism favours incorporation of one-carbon groups from serine and release of formate, while the cytoplasmic metabolism favours incorporation of one-carbon units from formate with purine and thymidine synthesis and homocysteine remethylation. 

When acting as a methyl donor, 5-adenosylmethionine forms homocysteine, which may be remethylated by methyltetrahydrofolate catalyzed by methionine synthase, a vitamin Bj2-dependent enzyme (Figure 45-14). The reduction of methylene-tetrahydrofolate to methyltetrahydrofolate is irreversible, and since the major source of tetrahydrofolate for tissues is methyl-tetrahydrofolate, the role of methionine synthase is vital and provides a link between the functions of folate and vitamin B,2. Impairment of methionine synthase in Bj2 deficiency results in the accumulation of methyl-tetrahydrofolate—the folate trap. There is therefore functional deficiency of folate secondary to the deficiency of vitamin B,2. 

Supplements of 400 Ig/d of folate begun before conception result in a significant reduction in the incidence of neural mbe defects as found in spina bifida. Elevated blood homocysteine is an associated risk factor for atherosclerosis, thrombosis, and hypertension. The condition is due to impaired abihty to form methyl-tetrahydrofolate by methylene-tetrahydrofolate reductase, causing functional folate deficiency and resulting in failure to remethylate homocysteine to methionine. People with the causative abnormal variant of methylene-tetrahydrofolate reductase do not develop hyperhomocysteinemia if they have a relatively high intake of folate, but it is not yet known whether this affects the incidence of cardiovascular disease. 

Patients with homocystinuria are at risk for cerebrovascular and cardiovascular disease and thromboses 676 Prognosis is more favorable in the pyridoxine-responsive patients 677 Homocystinuria can occur when homocysteine is not remethylated back to form methionine 677... 

One form of remethylation deficit involves defective metabolism of folic acid, a key cofactor in the conversion of homocysteine to methionine 677... 

Methionine synthase deficiency (cobalamin-E disease) produces homocystinuria without methylmalonic aciduria 677 Cobalamin-c disease remethylation of homocysteine to methionine also requires an activated form of vitamin B12 677 Hereditary folate malabsorption presents with megaloblastic anemia, seizures and neurological deterioration 678... 

About half of the homocysteine so generated is remethylated to methionine, with either betaine or 5-methyltetra-hydrofolic acid (methyl-FH4) serving as methyl donor. 

A newer therapeutic approach is the administration of betaine (6-12 g daily), which lowers homocysteine levels by favoring remethylation [33], A theoretical hazard of betaine treatment is increasing the blood methionine, sometimes to an extravagant degree ( 1 mmol/1). Experience to date indicates that betaine administration is safe, with no major side effects except for a fishy odor to the urine. Other therapeutic approaches have included the administration of salicylate to ameliorate the thromboembolic diathesis. Patients also have been treated with dietary supplements of L-cystine, since the block of the transsulfura-tion pathway in theory could diminish the synthesis of this amino acid. 

Cobalamin-c disease remethylation of homocysteine to methionine also requires an activated form of vitamin B12. In the absence of normal B12 activation, homocystinuria results from a failure of normal vitamin B12 metabolism. Complementation analysis classifies defects in vitamin B12 metabolism into three groups cblC (most common), cblD and cblF. Most individuals become ill in the first few months or weeks of life with hypotonia, lethargy and growth failure. Optic atrophy and retinal changes can occur. Methylmalonate excretion is excessive, but less than in methylmalonyl-CoA mutase deficiency, and without ketoaciduria or metabolic acidosis. 

Important pathways requiring SAM include synthesis of epinephrine and of the 7-methylgua-nine cap on eukaryotic mRNA, Synthesis of SAM from methionine is shown in Figure T17-3. After donating the methyl group, SAM is converted to homocysteine and remethylated in a reaction catalyzed by N-methyl THF-homocysteine methyltransferase requirii both vitamin Bj2 and N-meth d-THF. The methionine produced is once again used to make SAM. 

Homocysteine (Hey) metabolism is closely linked to that of the essential amino acid methionine and thus plays a central role in several vital biological processes. Methionine itself is needed for protein synthesis and donates methyl groups for the synthesis of a broad range of vital methylated compounds. It is also a main source of sulphur and acts as the precursor for several other sulphur-containing amino acids such as cystathionine, cysteine and taurine. In addition, it donates the carbon skeleton for polyamine synthesis [1,2]. Hey is also important in the metabolism of folate and in the breakdown of choline. Hey levels are determined by its synthesis from methionine, which involves several enzymes, its remethylation to methionine and its breakdown by trans-sulphuration. 

Hydrolysis of SAM After donation of the methyl group, S-adenosylhomocysteine is hydrolyzed to homocysteine aid adenosine. Homocysteine has two fates. If there is a deficiency of methionine, homocysteine may be remethylated to methionine (see Figure 20.8). If methionine stores are adequate, homocysteine rmty enter the transsulfuration pathway, where it is converted to cysteine. 

The product of transmethylation, S-adenosylhomocysteine, is converted (step g) into homocysteine in an unusual NAD-dependent hydrolytic reaction (Eq. 15-14) by which adenosine is removed (step g).302c Homocysteine can be reconverted to methionine, as indicated by the dashed line in Fig. 24-16. This can be accomplished by the vitamin B12-and tetrahydrofolate-dependent methionine synthase, (Eq. 16-43), which transfers a methyl group from methyl-tetrahydrofolate303 303b by transfer of a methyl group from betaine, a trimethylated glycine (Eq. 24-33)304, or by remethylation with AdoMet (Fig. 24-16).304a... 

In the folate cycle, which is linked to the methionine cycle, homocysteine is remethylated to methionine by the vitamin B -dependent enzyme methionine synthase (MS), thereby completing the cycle. 5-Methyltetrahydrofolate (CH3-THF) acts as a methyl donor in this reaction, which produces methionine and tetrahydrofolate (THF). 

SAM) by methionine adenosyltransferase. SAM serves as a methyl donor for a variety of methyl acceptors, including DNA, protein, neurotransmit-ters, and phospholipids. 5-Adenosylhomocysteine (SAH) is produced following methyl donation by SAM, and homocysteine is formed through the liberation of adenosine from SAH by the enzyme SAH hydrolase. Unlike methionine and cysteine, homocysteine is not incorporated into polypeptide chains during protein synthesis. Instead, homocysteine has one of two metabolic fates transsulfuration or remethylation to methionine. 

During the remethylation of homocysteine to methionine, the methyl group from 5-MTHF is transferred to cobalamin, which serves as an... 

Figure 21-3. The methionine synthase reaction. Methionine synthase catalyzes the remethylation of homocysteine to methionine. In the first half reaction (1), a methyl group is transferred from 5-methyl tetrahydrofolate (5-MTHF) to the reduced form of cobalamin [Cob(I)], generating methyl-cobalamin [Methyl-Cob(III)] and tetrahydrofolate (THF). During the second half reaction (2), the methyl group is transferred from methylcobalamin to homocysteine, generating methionine. During the catalytic reaction, Cob(I) occasionally becomes oxidized, producing an inactive form of cobalamin, cob(II)alamin [Cob(II)]. The enzyme methionine synthase reductase (MTRR) then reactivates Cob(II) through reductive methylation, producing methyl-Cob(III). SAM, 5-adenosylmethionine SAH, 5-adeno-sylhomocysteine.

The fraction of intracellular homocysteine that does not undergo transsulfuration or remethylation is secreted into the extracellular space and ultimately finds its way into the blood. One major source of blood homocysteine is the liver, but some homocysteine is secreted into the blood by endothelial cells, circulating blood cells, and other tissues. Only about 2% of homocysteine in blood remains in its reduced, thiol form. The remainder circulates as a variety of different oxidation adducts, which include the disulfide, homocystine, as well as homocysteine-cysteine mixed disulfide and several protein-bound disulfides.About 70% of total homocysteine in blood is bound to the protein albumin through a disulfide linkage.When blood homocysteine is measured in the clinical laboratory, a reducing agent is added to the sample... 

Folate (vitamin B9) Methionine cycle methyl donor in the remethylation of homocysteine to methionine via methionine synthase... 

The mammalian synthesis of methionine is more complex and requires cobalamin, a coenzyme form of vitamin B12. Note that because methionine is an essential amino acid, it must be supplied in the diet methionine that is used for methylation (Fig. 15-20) is degraded to homocysteine, and this is remethylated to give methionine. These reactions merely recycle methionine and do not constitute a means of net synthesis. 

As discussed in Section 10.3.4.2, the metabolic fate of homocysteine arising from methionine is determined not only by the activity of cystathionine synthetase and cystathionase, hut also the rate at which it is remethylated to methionine (which is dependent on vitamin B12 and folate status) and the requirement for cysteine. 

The identification of hyperhomocysteinemia as an independent risk factor in atherosclerosis and coronary heart disease (Section 10.3.4.2) has led to suggestions that intakes of vitamin Be higher than are currently considered adequate to meet requirements may be desirable. Homocysteine is an intermediate in methionine metabolism and may undergo one of two metabolic fates, as shown in Figure 9.5 remethylation to methionine (a reaction that is dependent on vitamin B12 and folic acid) or onward metabolism leading to the synthesis of cysteine (trans-sulfuration). Therefore, intakes of folate, vitamin B12, and/or vitamin Be may affect homocysteine metabolism. 

Two reactions are of special interest thymidylate synthetase (Section 10.3.3) and remethylation of homocysteine to methionine (Section 10.3.4). This latter reaction is central to the control of the metabolism of one-carbon compounds and folate. 

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