Delayed diagnosis of coeliac disease increases cancer risk

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Effects of alternate supplementation with Folic acid and Vitamin B12 on Homocysteine plasma levels in Hemodialysis patients.

Background. Treatment with folic acid and Vitamin B12 appears to be effective to reduce total plasma homocysteine levels, but it is unknown whether vitamin B12 alone reduces tHcy values in patients with normal levels of vitamin B12. The aim of the present study was to explore the effect of the individual supplementation with folic acid or vitamin B12 on tHcy concentrations and MTHFR polymorphism in HD patient and correlate tHcy concentrations with MTHFR genotype before and after vitamins supplementation. Methods. Two hundred unselected patients (119 men) were recruited from the “Umberto I” Hospital (Frosinone, Italy) and from Dialysis Unit of University Hospital “Tor Vergata”. These patients have been randomized blindly into two groups of one hundred subjects each. Unfortunately, during the study 36 patients of the first group and 16 of the second group died.The 1st group was treated initially with vitamin B12 for two months and with folic acid for the following two months. The 2nd group was treated initially with folic acid and then with Vitamin B12. A wash out period of 2 months followed the treatment in both groups. Results. tHcy concentrations decreased in both groups following the alternate vitamins therapy, and the decrease is genotype-dependent. The decrease is more accentuated for the T/T genotype (p<0.05) and is more significant when the treatment was started with folic acid (p<0.01). Conclusions. The alternate vitamins treatment demonstrated for the first time the importance of folate therapy and the secondary contribution of vitamin B12 in lowering tHcy in HD patients

Erythrocyte glutathione transferase: A new biomarker in chronic kidney diseases

Background: Glutathione transferases (GSTs) are enzymes involved in the cell detoxification. Increased levels of GST expression have been observed in tissues exposed to contaminants and in human erythrocytes of uremic patients under chronic hemodialysis (HD). A previous study reported that no difference in the erythrocyte GST expression has been detected in patients under conservative therapy. Aim of our study was to compare erythrocyte GST (e-GST) activity in chronic kidney disease (CDK), in chronic hemodialysis (HD) and in healthy subjects. Methods: A total of 72 CKD patients under conservative therapy, 62 HD patients and 80 healthy subjects were enrolled. CKD patients were divided in four groups according to the National Kidney Foundation Dialysis Outcomes Quality Initiative (NK-DOQI). Erythrocyte GST activity was assayed by means of a spectrophotometer procedure at 340 nm on haemolysed whole blood adapted to an automated Modular P800 apparatus (Roche). Results: The e-GST activity was enhanced in HD patients (10.24± 2.74 U/g Hb) when compared to healthy subjects (5.8±1.8 U/g Hb). Contrary to previous reports, a significant increase of e-GST activity related to CKD stage was also observed in pre-dialysis patients (7.4± 2.43 U/g Hb, 8.13±4.55 U/g Hb, 9.46±2.49 U/g Hb, and 12.35± 2.74 U/g Hb in stages I to IV). Interestingly, e-GST activity in stage IV patients is higher than in HD subjects. No correlation has been found between e-GST activity and levels of classical systemic inflammation markers. Conclusion: The present findings suggest that e-GST could be a good marker for toxin exposition. The e-GST activity could be a new biomarker useful to substitute or to be complementary to the time

Erythrocyte glutathione transferase: a potential new biomarker in chronic kidney diseases which correlates with plasma homocysteine

Glutathione transferases (GSTs) are a superfamily of enzymes involved in cell detoxification. Previous studies reported an increased expression of erythrocyte glutathione transferase (e-GST) in end-stage renal disease patients on maintenance hemodialysis (MHD), but physiological e-GST levels in chronic kidney diseases patients under conservative therapy (CKD). We re-evaluated the e-GST levels in 72 CKD patients and studied the correlation between this enzyme and the plasma homocysteine (Hcy) in 62 MHD patients. This amino acid is an important cardiovascular risk factor and it is present at high concentrations in more than 90% uremic patients. A new automated procedure for GST activity, validated by intra-assay and inter-assay measurements and by recovery experiments, confirmed an increased e-GST activity in HD patients (10.24 ± 2.74 U/gr Hb) compared to healthy subjects (5.8 ± 1.8 U/gr Hb). Interestingly, a significant increase of e-GST activity was also observed in pre-dialysis patients related to the NK-DOQI stages (7.4 ± 2.43 U/gr Hb, 8.13 ± 4.55 U/gr Hb, 9.46 ± 2.49 U/gr Hb, 12.35 ± 2.74 U/gr Hb in stages from I to IV, respectively). No correlation has been found between e-GST activity and hemoglobin, transferrin, sideremia and markers of systemic inflammation. For the first time a significant correlation was observed between increased plasma Hcy levels and e-GST activity (P < 0.0001) in MHD patients. Thus, e-GST proposes as new biomarker in CKD and MHD patients

Influence of dialysis techniques and alternate vitamin supplementation on homocysteine levels in patients with known MTHFR genotypes

Treatment with folic acid and vitamin B12 appears capable of reducing total plasma homocysteine levels (tHcy), but it is unknown whether vitamin B12 alone reduces tHcy values. In this study we investigate the effects of alternate vitamins supplementation on homocysteine levels in patients treated by diffusive and convective dialysis techniques.Treatment with folic acid and vitamin B12 appears capable of reducing total plasma homocysteine levels (tHcy), but it is unknown whether vitamin B12 alone reduces tHcy values. In this study we investigate the effects of alternate vitamins supplementation on homocysteine levels in patients treated by diffusive and convective dialysis techniques