Involvements of Hyperhomocysteinemia in Neurological Disorders
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H OH metabolites OH Review Involvements of Hyperhomocysteinemia in Neurological Disorders Marika Cordaro 1,† , Rosalba Siracusa 2,† , Roberta Fusco 2 , Salvatore Cuzzocrea 2,3,* , Rosanna Di Paola 2,* and Daniela Impellizzeri 2 1 Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; [email protected] 2 Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy; [email protected] (R.S.); [email protected] (R.F.); [email protected] (D.I.) 3 Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA * Correspondence: [email protected] (S.C.); [email protected] (R.D.P.); Tel.: +39-090-6765208 (S.C. & R.D.P.) † The authors equally contributed to the review. Abstract: Homocysteine (HCY), a physiological amino acid formed when proteins break down, leads to a pathological condition called hyperhomocysteinemia (HHCY), when it is over a definite limit. It is well known that an increase in HCY levels in blood, can contribute to arterial damage and several cardiovascular disease, but the knowledge about the relationship between HCY and brain disorders is very poor. Recent studies demonstrated that an alteration in HCY metabolism or a deficiency in folate or vitamin B12 can cause altered methylation and/or redox potentials, that leads to a modification on calcium influx in cells, or into an accumulation in amyloid and/or tau protein involving a cascade of events that culminate in apoptosis, and, in the worst conditions, neuronal death. The present review will thus summarize how much is known about the possible role of HHCY in neurodegenerative disease. Citation: Cordaro, M.; Siracusa, R.; Keywords: homocysteine; hyperhomocysteinemia; target; physiology; pathology Fusco, R.; Cuzzocrea, S.; Di Paola, R.; Impellizzeri, D. Involvements of Hyperhomocysteinemia in Neurological Disorders. Metabolites 1. Introduction 2021, 11, 37. https://doi.org/ Homocysteine (HCY) is a sulfhydryl-containing amino acid produced following the 10.3390/metabo11010037 demethylation of methionine, an amino acid contained primarily in animal protein. To recondition methionine, HCY is recuperated using a pathway that requires folic acid and Received: 27 November 2020 vitamins B6/B12 [1]. Pathologically high blood levels of HCY, indicated as hyperhomocys- Accepted: 1 January 2021 teinemia (HHCY), signal a breakdown in this biochemical process, resulting in biochemical Published: 6 January 2021 and life consequences [2]. Variations in HCY metabolism can also be developed with certain dietary and lifestyle modifications such as increased coffee drinking, cigarette smoking, and Publisher’s Note: MDPI stays neu- tral with regard to jurisdictional clai- alcohol abuse, as these interfere with methionine synthase activity [2]. Until today, HHCY ms in published maps and institutio- has been epidemiologically and clinically correlated in a variety of pathological conditions nal affiliations. and was confirmed also as an independent risk factor for many different pathologies such as cardiovascular disease, neural tube defects, osteoporosis, neuropsychiatric disorders and many, many, others [3–23]. Recent evidence, additionally, related high levels of HCY as a factor that contributes to the development of certain cancers [24–26]. Considering the Copyright: © 2021 by the authors. Li- literature, most of the information of HHCY-related pathologies were focused on cardio- censee MDPI, Basel, Switzerland. vascular disease but less was analyzed for brain disorder. With these aims in mind, we This article is an open access article studied the recent literature of HHCY and brain disorders. distributed under the terms and con- ditions of the Creative Commons At- tribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Metabolites 2021, 11, 37. https://doi.org/10.3390/metabo11010037 https://www.mdpi.com/journal/metabolites Metabolites 2021, 11, x FOR PEER REVIEW 2 of 20 2. Physiological Role of Homocysteine 2.1. Cycle HCY is a physiological metabolite of the essential amino acid methionine (Figure 1). Considering that nutriment contains little or no HCY, nearly all of the HCY in the body is derived from the methionine contained in animal and plant proteins [27,28]. Metabolites 2021, 11, 37x FOR PEER REVIEW 2 2of of 20 19 2.2. Physiological Physiological Role Role of of Homocysteine Homocysteine 2.1.2.1. Cycle Cycle HCYHCY is is a a physiological metabolite metabolite of of the the essential essential amino amino acid acid methionine methionine (Figure (Figure 11).). ConsideringConsidering that nutriment contains little or no HCY, nearly all of the HCY in the body is derivedderived from the methionine contained in animal and plant proteins [[27,28].27,28]. Methionine Homocysteine Figure 1. Chemical structure of methionine and homocysteine. The cycle of HCY is composed by two different pathways that intersect with each other in two points during transsulfuration (Figure 2) and remethylation (Figure 3). During the transsulfuration pathway, HCY condenses with serine to form cystathionine in a non-reversible reaction catalyzed by the pyridoxal-5′-phosphate (PLP)- containing enzyme, cystathionine β-synthase. In the next step, cystathionine is γ α hydrolyzedMethionine by a second PLP-containing Homocysteine enzyme, -cystathionase, to form cysteine and - ketobutyrate. Cysteine, in surplus, is oxidized to taurine or inorganic sulfates or is FigureFigure 1. ChemicalChemical structure structure of methionine and homocysteine. excreted in the urine. Consequently, in addition to the physiological synthesis of cysteine, this transsulfurationTheThe cycle of pathway HCY is effectivelycomposed bycatabolizes two differentdiffer excessent pathways HCY, which that is intersect not required with each for methylotherother in transfer. two points during transsulfuration (Figure 2 2)) andand remethylationremethylation (Figure(Figure3 ).3). During the transsulfuration pathway, HCY condenses with serine to form cystathionine in a non-reversible reaction catalyzed by the pyridoxal-5′-phosphate (PLP)- containing enzyme, cystathionine β-synthase. In the next step, cystathionine is hydrolyzed by a second PLP-containing enzyme, γ-cystathionase, to form cysteine and α- ketobutyrate. Cysteine, in surplus, is oxidized to taurine or inorganic sulfates or is excreted in the urine. Consequently, in addition to the physiological synthesis of cysteine, this transsulfuration pathway effectively catabolizes excess HCY, which is not required for methyl transfer. FigureFigure 2. Transsulfuration 2. Transsulfuration cycle. The cycle. metabolism The metabolism of HCY (homocysteine) of HCY (homocysteine) is composed is composed by two by two differentdifferent steps. steps. MS—methionine MS—methionine synthase; synthase; MTHFR—methylene MTHFR—methylene tetrahydrofolate tetrahydrofolate reductase; reductase; BHMT— BHMT—betaine HCY methyltransferase; DMG—dimethylglycine; B2—riboflavin; THF— betaine HCY methyltransferase; DMG—dimethylglycine; B2—riboflavin; THF—thetrahydrofolate; thetrahydrofolate; SAM S—adenosyl methionine; SAH S—adenosyl homocysteine. SAM S—adenosyl methionine; SAH S—adenosyl homocysteine. On theDuring other the hand, transsulfuration during remethylation, pathway, HCY HCY, condenses to form with methionine, serine to formacquires cystathion- a methyline group in a non-reversible from N-5-methyltetrahydrofolate reaction catalyzed by or the from pyridoxal-5 betaine.0 -phosphateThis metabolic (PLP)-containing reaction with N-5-methyltetrahydrofolate happens in all tissues and is vitamin B12 dependent; enzyme, cystathionine β-synthase. In the next step, cystathionine is hydrolyzed by a however,second the PLP-containing reaction with betaine enzyme, is restriγ-cystathionase,cted mainly to to the form liver cysteine and is andnot dependentα-ketobutyrate. Figure 2. Transsulfuration cycle. The metabolism of HCY (homocysteine) is composed by two by vitaminCysteine, B12. in The surplus, most ispart oxidized of methionine to taurine is orsuccessively inorganic sulfatesactivated or by is excretedATP to form in the S- urine. adenosylmethioninedifferent steps. MS—methionine (SAM). SAM synthase;have a key MT roHFR—methylenele to donate a tetrahydrofolatemethyl group toreductase; different BHMT—betaineConsequently, inHCY addition methyltransferase; to the physiological DMG—dimethylglycine; synthesis of cysteine, B2—riboflavin; this transsulfuration THF— thetrahydrofolate;pathway effectively SAM catabolizes S—adenosyl excess methionine; HCY, whichSAH S—adenos is not requiredyl homocysteine. for methyl transfer. On the other hand, during remethylation, HCY, to form methionine, acquires a methyl groupOn from the N-5-methyltetrahydrofolateother hand, during remethylation, or from betaine. HCY, Thisto form metabolic methionine, reaction acquires with N-5- a methylmethyltetrahydrofolate group from N-5-methyltetrahydrofolate happens in all tissues and or is from vitamin betaine. B12 dependent; This metabolic however, reaction the withreaction N-5-methyltetrahydrofolate with betaine is restricted mainlyhappens to in the all liver tissues and isand not is dependent vitamin B12 by vitamindependent; B12. however,The most partthe reaction of methionine with betaine is successively is restri activatedcted mainly by ATP to the to formliver S-adenosylmethionineand is not dependent by(SAM). vitamin SAM B12.