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Folate Deficiency Was Associated with Increased Alanine Aminotransferase and Glutamyl Transpeptidase Concentrations in a Chine

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Folate Deficiency Was Associated with Increased Alanine Aminotransferase and Glutamyl Transpeptidase Concentrations in a Chine J Nutr Sci Vitaminol, 62, 265–271, 2016 Folate Deficiency Was Associated with Increased Alanine Aminotransferase and Glutamyl Transpeptidase Concentrations in a Chinese Hypertensive Population: A Cross-Sectional Study Wen-Xing LI1,2, Wei LI3, Jia-Qian CAO4,5, Haiyue YAN3, Yuanyuan SUN3, Hong ZHANG3, Qiang ZHANG3, Ling TANG3, Manman WANG3, Jing-Fei HUANG2,6,7 and Dahai LIU3,* 1 Institute of Health Sciences, Anhui University, Hefei 230601, Anhui, P. R. China 2 State Key Laboratory of Genetic Resources and Evolution, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, P. R. China 3 Center for Stem Cell and Translational Medicine, School of Life Sciences, Anhui University, Hefei 230601, Anhui, P. R. China 4 CAS Key Laboratory of Pathogenic Microbiology & Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, P. R. China 5 University of Chinese Academy of Sciences, Beijing 100049, P. R. China 6 KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, Suzhou 215123, Jiangsu, P. R. China 7 Collaborative Innovation Center for Natural Products and Biological Drugs of Yunnan, Kunming 650223, Yunnan, P. R. China (Received February 29, 2016) Summary Alanine aminotransferase (ALT), aspartate transaminase (AST), and glutamyl transpeptidase (GGT) were three key enzymes in the hepatic metabolism. This study aimed to investigate the effect of homocysteine (Hcy) metabolism gene polymorphisms and serum Hcy and folate level on the hepatic functions in a Chinese hypertensive population. A repre- sentative sample with 480 subjects aged 28–75 was enrolled in 2005.9–2005.12 from six hospitals in different Chinese regions. Serum ALT, AST and GGT were measured by using an automatic biochemistry analyzer. Serum Hcy was measured by high-performance liq- uid chromatography, and serum folate was measured by chemiluminescent immunoassay. Known genotypes were detected by PCR-RFLP methods. The results showed that the MTHFR C677T mutation was related a decreased serum AST level (r520.11, p50.026), whereas the MTHFR A1298C mutation elevated serum AST level (r50.11, p50.032). Furthermore, multiple regression analysis showed that folate deficiency was associated with higher serum ALT (b (SE): 0.13 (0.06), p50.031) and GGT level (b (SE): 0.18 (0.07), p50.011). However, serum Hcy level may not affect the hepatic functions. Our data suggested that hepatic func- tions were affected by MTHFR gene polymorphisms and serum folate level. Further studies are needed to confirm these correlations in a larger population. Key Words folate deficiency, MTHFR gene polymorphisms, alanine aminotransferase, aspartate transaminase, glutamyl transpeptidase Fatty liver disease (FLD), including primary non-alco- closely related to many important biochemical processes holic fatty liver disease (NAFLD) and the severe form, in vivo. A mouse experiment suggested that maternal non-alcoholic steatohepatitis (NASH) is the most com- low folate and selenium diet altered liver gene expression mon form of liver disease and is increasing through- patterns in the offspring after weaning (5). And a previ- out the world (1). In Western adults, the prevalence of ous study showed that folate supplementation reduced NAFLD assessed by ultrasound is 20–30% and the prev- the serum ALT level in high baseline ALT (.40 IU/L) alence of NASH is 3–16% (2). Alanine aminotransfer- individuals (6). In addition, a higher serum homocys- ase (ALT), aspartate transaminase (AST) and glutamyl teine (Hcy) level also showed strongly correlation with transpeptidase (GGT) are three key enzymes in the liver liver disease (7, 8). metabolism. Studies showed that high levels of ALT, AST Methylenetetrahydrofolate reductase (MTHFR), and GGT were associated with liver disease (3). Further- methionine synthase (MTR) and methionine synthase more, serum ALT and AST levels showed relevance with reductase (MTRR) are three key regulatory enzymes in the histopathological changes in liver biopsies of hepa- the folate and Hcy metabolisms (9). MTHFR catalyses titis C patients (4). In one carbon metabolism, folate is the reduction of 5,10-methylenetetrahydrofolate (5,10- MTHF) to 5-methyltetrahydrofolate (5-MTHF) and * To whom correspondence should be addressed. 5-MTHF is a cofactor for Hcy methylation to methionine E-mail: [email protected] when catalyzed by the MTR-cobalamin complex (10, 265 266 LI W-X et al. 11). Over time, the cobalamin(I) cofactor of MTR is oxi- Table 1. Clinical and epidemiologic characteristics of dized to form cobalamin(II), leading to inactivation of the study population. MTR. Thus, MTRR is required for reversion of oxidized cobalamin(II) to CH3-cobalamin(III) to maintain the Characteristic n Value/Percentage activity of MTR (12). MTHFR C677T and A1298C are two common muta- Age, y 480 56.8610.0 tions in the MTHFR enzyme. A study carried out in Height, cm 480 162.768.1 Weight, kg 480 68.4611.0 Turkey showed both 677C/T and 1298A/C mutations BMI, kg/m2 480 25.863.4 were more common in NAFLD groups compared with SBP, mmHg 480 154.3611.7 the controls (13). However, another study in a Brazil- DBP, mmHg 480 93.368.5 ian population showed that the MTHFR C677T and Folate, nmol/L 479 12.6 (9.7–15.7) A1298C polymorphisms are not genetic risk factors for Hcy, mmol/L 480 13.2 (9.9–15.9) the development of NAFLD whereas higher Hcy level ALT, IU/L 435 22.7 (16.0–32.6) was related the incidence of NAFLD (14). The effect if AST, IU/L 377 24.4 (20.0–31.0) polymorphisms of MTR A2756G and MTRR A66G on GGT, IU/L 412 21.2 (14.0–30.0) the hepatic functions have not been adequately studied. Sex Our previous studies found that the mutations of Male 208 43.3% MTHFR C677T, MTHFR A1298C, MTR A2756G and Female 272 56.7% MTRR A66G jointly elevate the folate deficiency risk Clinical Centers Ha’rbin 60 12.5% (15). Further, the combination effects of genotypes and Shanghai 64 13.3% low folate increased the dyslipidemia risk (16). Based on Shenyang 79 16.5% the metabolism connections between folate and these Beijing 120 25.0% hepatic enzymes, we hypothesized that these four gene Xi’an 78 16.3% polymorphisms in combination with Hcy/folate may Nanjing 79 16.5% affect the hepatic functions. The aim of the present MTHFR C677T study was to investigate the effects of serum folate and CC 118 24.6% Hcy and genotypes on the hepatic functions in Chinese CT 242 50.4% hypertensive patients. TT 120 25.0% MTHFR A1298C MATERIALS AND METHODS AA 332 69.9% AC 127 26.7% This study was conducted using data collected in a CC 16 3.4% previous study (16). This was a multicenter, randomized, MTR A2756G double-blind controlled trial in hypertensive Chinese AA 393 81.9% adults. Details regarding “Study subjects,” “Randomiza- AG 83 17.3% tion and double blinding,” “Data collection procedures,” GG 4 0.8% and “Laboratory tests” have been previously described MTRR A66G (16, 17). In total, 480 patients with mild or moderate AA 155 32.7% hypertension were recruited from six hospitals in differ- AG 240 50.6% GG 79 16.7% ent Chinese regions (Ha’rbin, Shanghai, Shenyang, Bei- jing, Xi’an, and Nanjing) from September to December BMI: body mass index, SBP: systolic blood pressure, DBP: 2005. All six hospitals were certified as clinical phar- diastolic blood pressure, Hcy: homocysteine, ALT: alanine macology centers by the State Food and Drug Adminis- aminotransferase, AST: aspartate transaminase, GGT: tration in China. This study was approved by the Ethics glutamyl transpeptidase, MTHFR: methylenetetrahy- Committee of Peking University First Hospital, Beijing, drofolate reductase, MTR: methionine synthase, MTRR: China. All procedures followed were in accordance with methionine synthase reductase. the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in were 3.5% and 4.2%, respectively (16). Serum folate 2000(5) (18). The purpose and procedures of the study was determined by chemiluminescent immunoassay were carefully explained to all participants, and written using a Beckman Coulter ACCESS Immunoassay System informed consent was obtained from each participant. (Beckman-Coulter Canada Inc., Mississauga, Canada). Demographic and clinical information was obtained The intra- and inter-assay coefficients of variation were at baseline. Blood samples collected at baseline were 2.3% and 3.7%, respectively (16). The polymerase chain used for the measurement of serum Hcy, folate, ALT, reaction-restriction fragment length polymorphism AST and GGT levels. All these tests were performed in (PCR-RFLP) method was applied to detect the MTHFR the six study center laboratories; serum ALT, AST and C677T, MTHFR A1298C, MTR A2756G, and MTRR GGT were measured by using an automatic biochem- A66G genotypes. Each genotyping reaction mixture istry analyzer (17). Hcy concentration was determined contained 4 ng dried DNA, 0.08 mL 40 assay locus-spe- in duplicate by high-performance liquid chromatogra- cific probe, and 2.0 mL TaqMan universal polymerase phy. The intra- and inter-assay coefficients of variation chain reaction (PCR) master mix in a final volume of Low Folate Elevate Serum ALT and GGT 267 Table 2. Associations of gene polymorphisms and measure of hepatic function. Genotypes ALT AST GGT MTHFR C677T CC 23.0 (17.8–32.0) 25.6 (21.3–31.0) 20.4 (14.0–28.8) CT 23.1 (16.0–33.4) 24.6 (20.0–31.0) 21.9 (15.0–30.8) TT 21.7 (16.0–32.8) 22.8 (18.0–29.3) 20.9 (13.0–30.7) r 20.04 20.11
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