Homocysteine, vitamin B12 and folate levels in Iranian patients with Multiple Sclerosis: A case control study
Introduction
Multiple sclerosis (MS) is one of the most common neurological disorders, which is more prevalent in women and causes major morbidity in young adults [1]. It imposes an enormous economic burden on individual and society. Its prevalence differs based on geographic latitude of countries and increased in recent years [2]. The definite mechanism of MS is still unknown, but overt reaction of the immune system to environmental factors is a well-known causing factor [2], [3], [4]. Among these factors, recent studies are focused on the role of vitamin B12, folate, and homocysteine (Hcy).
Folate and vitamin B12 have fundamental roles in CNS function especially methionine synthase-mediated conversion of homocysteine to methionine, which is essential for synthesis of DNA and RNA (Fig. 1) [5], [6]. Therefore, B12 and folate deficiency can lead to an increased level of Hcy [6].
On the other hand, Hcy may have a neurotoxin effect that activates aspartate receptor, which leads to cell death [7], [8]. Some studies showed the relation between high level of serum Hcy and low levels of serum B12 and folate in the MS groups [9], [10], [11], [12]. By contrast, some reports found no significant difference in Hcy level between MS patients and controls [12], [13]. Therefore, there are some controversies on the role of Hcy, folate, and vitamin B12 on MS pathogenesis. It seems necessary to elucidate the potential mechanisms of evolving MS and correct them for preventing more disability. It may lead to decrease the burden of disease on the society and young patients. We carried this study to determine the role of serum levels of Hcy, vitamin B12, and folate in Iranian patients with relapsing-remitting MS and compared them with healthy controls.
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Study population
This case control study was conducted at Rasool Akram Hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran. The institutional medical ethics committee approved the study, and all patients and controls enrolled after signing their written informed consent. Seventy-five patients with diagnosis of relapsing-remitting MS (RRMS) were enrolled as cases (n = 75). All of them were in remission. The diagnosis of RRMS was based on revised McDonald Criteria diagnostic scheme [14]. Age-
Results
A total of 75 RRMS patients with a mean age of 31.97 ± 9.05 years entered the study; 57 of whom were female subjects (76%). We included 75 healthy controls with the same age and sex (p = NS). Baseline characteristics of the subjects are listed in Table 1. The mean EDSS in the MS group was 2.54 (range, 2.00–8.00). There was a significant association between the type of first symptom of disease and EDSS (p < 0.001). EDSS was lower in patients with optic neuritis and pyramidal symptoms than in patients
Discussion
The purpose of this case–control study was to elucidate the role of serum Hcy, folate, and vitamin B12 levels in RRMS. We concluded that serum levels of vitamin B12 and folate decreased in RRMS patients; however, Hcy level increased.
Our findings are consistent with the most previous studies, in which low folate and vitamin B12 levels were seen in MS patients. On the other hand, there are some controversies about the role of Hcy metabolism in MS [11], [15], [16], [17]. This study is in line with
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Dietary influence on central nervous system myelin production, injury, and regeneration
2020, Biochimica et Biophysica Acta - Molecular Basis of DiseaseCitation Excerpt :Individuals with B12 deficiency present with clinical features similar to MS patients, including myelin loss [213,214]. Although several studies regarding B12 report significant reductions in serum [215–217] or cerebrospinal fluid [218,219] levels in MS patients, with some association to pediatric onset [220] and disease course [219], results remain equivocal [79,221]. Methylcobalamin (B12) supplementation in a small cohort (n = 6) of patients with chronic progressive MS improved visual and auditory evoked potentials [79].
Immune-inflammatory, metabolic and hormonal biomarkers are associated with the clinical forms and disability progression in patients with multiple sclerosis: A follow-up study
2020, Journal of the Neurological SciencesCitation Excerpt :Ferritin, albumin, lipid hydroperoxides, advanced oxidized protein products (AOPP), total antioxidant plasma capacity and nitric oxide metabolites (NOx) may predict MS diagnosis, whereas albumin and AOPP may predict clinical forms of MS, such as relapsing-remitting MS (RRMS) and progressive clinical forms of MS (ProgMS) [17]. Dysregulation of the concentration of molecules involved in different metabolic pathways, such as vitamin D [18], homocysteine (Hcy) [19–21] and folic acid [20] has been associated with MS. High levels of Hcy are associated with high disability scores [22]. However, other studies reported contradictory results [23,24].