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Homocystine uptake in isolated rat renal cortical tubules.

Isolated rat renal cortical tubules were used to study the nature of homocystine entry into the tubule cell and its transport interactions with cystine and the dibasic amino acids. The uptake of homocystine with time was progressive, reaching a steady state after 60 min. of incubation. Analysis of the intracellular pool after 5 and 30 min. of incubation revealed that virtually all of the transported homocystine had been converted to other metabolites of the transsulfuration pathway. The major metabolite was cystathionine with a somewhat lesser, but still significant amount as S-adenosylhomocysteine. A kinetic analysis showed that two systems for cellular entry of homocysteine existed with a Km1 of 0.17 mM and a Km2 of 7.65 mM. Arginine and lysine inhibited homocystine uptake via the low Km, high affinity system, but appeared not to inhibit the high Km, low affinity system. Cystine inhibited the low Km, high affinity system, but had an indeterminate effect on the high Km, low affinity system. Homocystine inhibited the uptake of cystine, lysine and arginine by isolated rat renal cortical tubules. The inhibition of homocystine on cystine uptake appeared to occur on both the high and low Km system for tubule cell entry of cystine. The data suggest that the low Km system for homocystine transport is shared with cystine and the dibasic amino acids. These data extend the knowledge of homocystine metabolism and provide a rational basis for new approaches to the treatment of homocystinuria.

Amino Acids

Conversion of a qualitative screening test to a quantitative measurement of urinary cystine and homocystine.

Qualitative urinary screening procedures were converted to quantitative methods for urinary cystine and homocystine based on the reactions between these amino acids and cyanide-nitroprusside reagents. Cystine and homocystine are quantified by the measurement of absorbances at 521 and 524 nm, respectively. Cyanide-nitroprusside reacts with both cystine and homocystine. However, in the presence of silver nitrate, only homocystine reacts to produce a magenta color. Following the cyanide-nitroprusside reaction, absorbance must be read within three minutes for cystine and immediately for homocystine. The stability of the absorption spectra has no apparent effect on these quantitative assays. Amino acid concentrations are expressed as ratios to creatinine, which tends to eliminate false negative results in dilute urine specimens. The normal urine value for cystine and homocystine combined is 66.8 +/- 52 (n = 50) mg per g creatinine. The normal value for homocystine alone is 29.9 +/- 16.8 (n = 24) mg per g creatinine. The simplicity of these procedures allows these quantitative methods to be used as screening tests for cystinuria and homocystinuria.

Amino Acids

Disruption of thymidylate synthesis and glycine-serine interconversion by L-methionine and L-homocystine in Raji cells.

Excessive concentrations of L-methionine inhibited the folate-dependent de novo synthesis of thymidylic acid (TMP) in Raji cells, demonstrating the usefulness of this cell line for the study of methionine-folate antagonism. The effect was also produced by L-homocystine but not by other amino acids including D-methionine and L-ethionine, suggesting that this effect is exerted by a common intermediate of methionine and homocystine metabolism. L-Methionine, L-homocysteine, S-adenosylmethionine (SAM), and S-adenosylhomocysteine (SAH) are not inhibitors of thymidylate synthase activity. On the other hand the capacity of the cells to incorporate serine 3-carbon and glycine 2-carbon into DNA is impaired by the presence of L-methionine or L-homocystine. Studies with cell-free extracts demonstrated that the glycine cleavage enzyme is inhibited by 45% by L-methionine, L-homocysteine, SAM or SAH. Serine hydroxymethylase on the other hand was slightly stimulated by these sulfur-containing compounds and this stimulation was shown to occur in the intact cell as well. These findings suggest that when levels of L-methionine metabolites are elevated, there is an increase in the use of glycine to maintain the intracellular concentration of serine, which is required for homocysteine detoxification by conversion to cystathionine. The reduction in TMP synthesis caused by excess L-methionine or L-homocystine may result from increased utilization of one-carbon units for serine synthesis.

Amino Acids

Effect of homocysteine and homocystine on platelet and vascular arachidonic acid metabolism.

Normal hemostasis depends in part on the balance achieved between proaggregatory and prothrombotic platelet thromboxane A2, measured as its stable end-product thromboxane B2 (TXB2), and vascular prostacyclin (PGI2), which inhibits platelet aggregation and is antithrombotic. Cystathionine-beta-synthase deficiency is characterized by a high frequency of thromboembolic disease. We therefore studied, in vitro, the effects of homocysteine and related compounds on platelet TXB2 and vascular PGI2 formation. In paired samples of platelet rich plasma, which had been preincubated with L-homocystine (1 mM), mean production of the two platelet cyclooxygenase products, TXB2 and 12-hydroxy-5, 8,10-heptadecatrienoic acid increased significantly from control levels [13.6% +/- 1.9 to 19.8% +/- 2.1 (P less than 0.02) TXB2 and 29.8% +/- 4.2 to 39.4% +/- 4.1 (P less than 0.01) HHT]. In the presence of D,L-homocysteine (1 mM), mean TXB2 and 12-hydroxy-5,8,10-heptadecatrienoic acid production was also significantly increased [12.7% +/- 1.5 to 16.9% +/- 1.5 (P less than 0.01) TXB2 and 27% +/- 4 to 31% +/- 4.1 (P less than 0.02) HHT]. Cystine, cysteine, or methionine (1 mM) did not have similar effects in this test system. Homocysteine and homocystine were without effect on the synthesis of vascular PGI2 by umbilical artery segments [control, 0.22 +/- 0.03 to 0.21 +/- 0.03 ng/mg with D,L-homocysteine and 0.20 +/- 0.04 control to 0.19 +/- 0.04 ng/mg with D,L-homocystine]. A homocyst(e)ine-induced increase in platelet thromboxane production in the absence of an increase in vascular prostacyclin, if present in vivo, may contribute to the vascular thromboses characteristic of human homocystinemias (homocystinurias).

Arachidonic Acid

Environmental validation of the homocystine theory of arteriosclerosis.

It has been proposed that elevated concentrations of homocystine in vascular tissue could cause arterial damage leading to arteriosclerosis. This theory is indirectly supported by research in the area of environmental toxicology, which has revealed that carbon monoxide and carbon disulfide, agents whose prolonged exposure is known to result in the development of arteriosclerotic changes, induced vitamin B6 deficiency states which predictably lead to a homocystinuria-like state. Such information provides strong indirect support of the controversial homocystine theory of arteriosclerosis.

Adult

Homocystine-induced arteriosclerosis. The role of endothelial cell injury and platelet response in its genesis.

The atherogenic mechanism of homocystinemia has been defined by measuring endothelial cell loss and regeneration, platelet consumption, and intimal lesion formation in a primate model. Three groups of baboons were studied: (a) 8 control animals; (b) 15 animals after 3 mo of continuous homocystinemia; and (c) 11 animals after 3 mo of combined homocystinemia and oral treatment with dipyridamole. Experimental homocystinemia caused patchy endothelial desquamation comprising about 10% of the aortic surface despite a 25-fold increase in endothelial cell regeneration. Neither endothelial cell loss nor regeneration was changed significantly by dipyridamole. Homocystine-induced vascular deendothelialization produced a threefold increase in platelet consumption that was interrupted by dipyridamole inhibition of platelet function. All homocystinemic animals developed typical arteriosclerotic or preatherosclerotic intimal lesions composed of proliferating smooth muscle cells averaging 10-15 cell layers surrounded by large amounts of collagen, elastic fibers, glycosaminoglycans, and sometimes lipid. Intimal lesion formation was prevented by dipyridamole therapy. We conclude that homocystine-induced endothelial cell injury resulted in arteriosclerosis through platelet-mediated intimal proliferation of smooth muscle cells that can be prevented by drug-induced platelet dysfunction.

Animals

Effect of induced elevated plasma levels of homocystine and methionine in rats on collagen and elastin structures.

Young growing rats were intraperitoneally injected with mixtures of homocystine and methionine for several weeks. The growth of the animals was inhibited. After 3 weeks 25% of the rats died and isolation of tail tendon collagen and aorta elastin showed that these proteins were deficient in chemical cross-links. Seventy-five % of the rats survived further injections for another 3 weeks and isolated collagen and elastin were found to be normal in cross-linking. The variability in susceptibility of these rats to homocystine-methionine treatment is discussed in relationship to human homocystinuria. It is speculated that the variability is due to variability in in vivo homocysteine levels.

Animals

Effect of methotrexate with 5-methyltetrahydrofolate rescue and dietary homocystine on survival of leukemic mice and on concentrations of liver adenosylamino acids.

We have increased significantly the survival time of DBA/2 mice bearing methionine-dependent L1210 or L5178Y leukemia cells by i.p. administration of lethal doses of methotrexate (five daily doses of 25 mg/kg body weight) followed by rescue with 5-methyl tetrahydrofolate (five daily doses of 20 mg/kg body weight). The mice were maintained on a semipurified choline- and cyst(e)ine-free diet containing 0.32% L-methionine. We further increased significantly the survival time of the treated animals bearing L5178Y cells, but not those bearing L1210 cells, by substitution of 0.86% DL-homocystine for the methionine in the diet. We have examined the effects of both diets in mice treated with methotrexate and 5-methyl tetrahydrofolate, singly and in combination, on the concentrations of S-adenosylmethionine and S-adenosylhomocysteine in the liver, a tissue highly active in the metabolism of these amino acids. The substitution of homocystine for methionine in the diet of untreated animals led to a significant increase in S-adenosylhomocysteine and decrease in S-adenosylmethionine in the liver, with a resultant profound decrease in the ratio of S-adenosylmethionine to S-adenosylhomocysteine which was not further altered significantly by administration of methotrexate.

Animals

Urinary homocystine levels in a newborn infant with cystathionine synthase deficiency.

A boy with homocystinuria due to cystathionine synthase deficiency was found to have hypermethioninaemia by neonatal blood screening, but was not diagnosed as homocystinuric until 3 months of age because urinary homocystine was not detected by the cyanide-nitroprusside test or on two examinations with a sensitive amino acid autoanalyser. These findings indicate that tests for urinary homocystine should be made repeatedly with an amino acid autoanalyser in newborn infants with hypermethioninaemia until the enzyme defect is identified.

Cystathionine beta-Synthase

Effect of methionine replacement by homocystine in cultures containing both malignant rat breast carcinosarcoma (Walker-256) cells and normal adult rat liver fibroblasts.

When malignant W-256 rat breast carcinosarcoma cells are mixed with an equal number of normal adult rat liver fibroblasts and allowed to grow in a medium containing sufficient L-methionine and an excess of vitamin B12 and of folic acid, the malignant cells outgrow the normal cells, and within 2 weeks the tissue culture flasks contain only neoplastic cells. However, when ample DL-homocystine or homocysteine replaces methionine in the medium containing the same amount of vitamin B12 and folic acid, and seeded with the same type and number of malignant and normal cells, the malignant cells die and the normal cells thrive. Substantiating this conclusion are the results of injections into rats of comparable numbers of cells from each group after 3 weeks of growth in tissue culture. Fatal malignancies are produced by the homocystein-cultivated cells.

Animals

Effect of nitrous oxide anaesthesia on homocystine excretion.

Research into the biotransformation of inhaled general anaesthetic agents, including nitrous oxide, has led to a better understanding of the underlying mechanisms. It is now known that nitrous oxide can react chemically with vitamin B12, oxidizing Cob(I)alamin to the inactive Cob(III) alamin form. Clinical and experimental evidence in mammals has confirmed that nitrous oxide toxicity, with symptoms suggestive of clinical vitamin B12 deficiency, occurs on exposure to nitrous oxide in a way which is dose and time related and reversible on withdrawal of the nitrous oxide. Nitrous oxide depresses the two known vitamin B12 dependent enzymes methylmalonyl CoA mutase and methionine synthetase by inactivation of their coenzymes adenosylcobalamin and methylcobalamin respectively. Methionine synthetase catalyses the conversion of homocystine to methionine, so interference with this reaction should cause methionine to be depleted and homocysteine to accumulate and to be excreted in the urine. We postulated that the detection of homocystinuria would therefore be an early indicator of nitrous oxide toxicity. Accordingly, we tested the first urine voided postoperatively of 41 patients undergoing nitrous oxide anaesthesia (17 neonates exposed to 50-66 per cent nitrous oxide for a mean of 3.0 hr, and 24 older patients exposed to 66 per cent nitrous oxide for a mean of 7.2 hr). None of these patients demonstrated homocystinuria.

Adolescent

Activation of Hageman factor by L-homocystine.

L-Homocystine activates Hageman factor, as demonstrated by its capacity to initiate clotting and to induce the evolution of plasma kinins. Perhaps, strategically located deposits of this amino acid are responsible for the unusual frequency of thrombosis in patients with homocystinuria.

Adsorption

Sulphr containing amino acids in chronic renal failure with particular reference to homocystine and cysteine-homocysteine mixed disulphide.

We measured plasma sulphur amino acids in twenty-two patients with chronic renal failure and compared the findings with those obtained in twenty-two normal subjects. In fasting blood (08.00 hours) cysteine-homocysteine mixed disulphide was significantly increased in the renal patients, mean values (+/- SD) being 8.2 +/- 3.4 and 3.1 +/- 1.0 mumol/l respectively (P less than 0.001). The increase was positively correlated with reduced renal function, as assessed by serum creatinine (r = 0.62; P less than 0.01). Homocystine was detected in nineteen patients, the mean concentration (+/- SD) being 1.7 +/- 0.6 mumol/l; it was not found in any normal subject. Methionine levels were not different but there were significant increases in cystine (P less than 0.001) and taurine (P less than 0.05) in the patients. Similar values for these amino acids were found in a second blood sample drawn at 16.00 hours. Changes in the other neutral and acidic amino acids measured were in agreement with those reported in chronic azotaemia. We concluded that plasma levels of all the principal sulphur amino acids except methionine are elevated in chronic renal failure emphasizing the importance of the kidney in sulphur excretion. Prolonged accumulation of homocysteine and cysteine-homocysteine mixed disulphide may be relevant to the development of accelerated vascular disease in patients with chronic renal failure by producing endothelial damage.

Amino Acids, Sulfur