Homocysteine-Methionine (HM) cycle produces a universal methyl group donor S-adenosylmethionine (SAM), a competitive methylation inhibitor S-adenosylhomocysteine (SAH), and an intermediate amino acid product homocysteine (Hcy). Elevated plasma levels of Hcy is termed as hyperhomocycteinemia (HHcy) which is an established risk factor for cardiovascular disease (CVD) and neural degenerative disease. We were the first to describe methylation inhibition as a mediating biochemical mechanism for endothelial injury and inflammatory monocyte differentiation in HHcy-related CVD and diabetes. We proposed metabolism-associated danger signal (MADS) recognition as a novel mechanism for metabolic risk factor-induced inflammatory responses, independent from pattern recognition receptor (PRR)-mediated pathogen-associated molecular pattern (PAMP)/danger-associated molecular pattern (DAMP) recognition. In this study, we examined the relationship of HM cycle gene expression with methylation regulation in human disease. We selected 115 genes in the extended HM cycle, including 31 metabolic enzymes and 84 methyltransferases (MT), examined their mRNA levels in 35 human disease conditions using a set of public databases. We discovered that: 1) HM cycle senses metabolic risk factor and controls SAM/SAH-dependent methylation. 2) Most of metabolic enzymes in HM cycle (8/11) are located in cytosol, while most of the SAM-dependent MTs (61/84) are located in the nucleus, and Hcy metabolism is absent in the nucleus. 3) 11 up-regulated, 3 down-regulated and 24 differentially regulated SAM/SAH-responsive signal pathways are involved in 7 human disease categories. 4) 8 SAM/SAH-responsive H3/H4 hypomethylation sites are identified in 8 disease conditions. We conclude that HM cycle is a key metabolic sensor system which mediates receptor-independent MADS recognition and modulates SAM/SAH-dependent methylation in human disease. We propose that HM metabolism takes place in cytosol and that nuclear methylation equilibration requires nuclear-cytosol transfer of SAM, SAH and Hcy. CD40 is a cell surface molecule which is expressed on antigen presenting cells such as monocyte, macrophage, dendritic cells and neutrophils. The costimulatory pair, CD40 and CD40L, enhances T cell activation and induce chronic inflammatory disease. Also, DNA hypomethylation on CD40 promotor induces inflammatory monocyte differentiation in chronic kidney disease. In order to figure out if CD40 is a prototypic HM cycle regulated master gene, RNA-seq analysis were performed for CD40+ and CD40- monocytes from mouse peripheral blood and 1,093 differentially expressed genes (DEGs) were selected from those two groups. All the DEGs modulate as much as 15 functional gene groups such as cytokines, enzymes and transcriptional factors. Furthermore, CD40+ monocytes activated trained immunity pathways especially in Acetyl-CoA generation and mevalonate pathway. In HM cycle, CD40 is a prototypic HM cycle regulated master gene to induce the most of the Hcy metabolic enzymes as well as MT, which can further modulate the methylation-regulated pathological signaling. / Biomedical Sciences

L'hyperhomoscystéinémie (HHcy) est considérée comme un facteur indépendant de risque cardio-métabolique. Notre travail avait pour objectifs : 1) de déterminer la prévalence de l’HHcy au Bénin; 2) d’étudier sa relation avec les apports de vitamines B12, B9, B6 et B2, la consommation d’alcool, l’âge, le sexe et le niveau socioéconomique (NSE); 3) de vérifier son association avec les facteurs classiques de risque cardio-métabolique. Un total de 541 sujets apparemment en santé et vivant dans trois zones du Bénin ont été étudiés. L’Hcy sérique a été analysée par ELISA. Des rappels de 24h ont servi à évaluer les apports nutritifs. L’obésité et l’hypertension ont été définies selon l’OMS, la dyslipidémie et la dysglycémie selon la NCEP-ATPIII. Les autres données ont été récoltées par questionnaire. La prévalence de l’HHcy était élevée : 52,2% chez les hommes et de 24,7% chez les femmes. Dans les modèles multivariés, l’Hcy était positivement associée à la consommation de bière locale chez les hommes; chez les femmes, elle était associée négativement à l'apport de vitamine B12. L’Hcy était positivement associée à la tension artérielle, au taux de LDL-cholestérol et au cholestérol total chez les hommes, mais seulement avec le rapport cholestérol total/HDL-cholestérol (CT/HDL-c) chez les femmes. Les femmes présentant une HHcy étaient au moins deux fois plus susceptibles de présenter une hypertension ou un rapport CT/HDL-c élevé que celles dont l’Hcy était normale. Un apport suffisant en B12 ainsi qu’une consommation prudente de boissons alcoolisées pourraient réduire l'HHcy et donc contribuer à réduire le risque cardio-métabolique de cette population du sud du Bénin. / Hyperhomocysteinemia (HHcy) appears to be an independent risk factor for cardiovascular disease. This study aims to determine the prevalence of HHcy in Benin, to explore its relationship with intakes of folate, B12, B6 and B2, with alcohol consumption and with socioeconomic status (SES) and to verify whether it is associated with classical risk factors of cardiovascular diseases. 541 apparently healthy subjects were randomly selected in tree areas of Benin. Hcy was measured in serum using ELISA commercial kits. Nutrient intakes were assessed on the basis of three non-consecutive 24-hour recalls. Alcohol consumption, socio-demographics and SES were documented in personal interviews. Obesity, hypertension, dyslipidemia and hyperglycaemia were defined according to WHO and NCEP-ATPIII. HHcy (> 12 μmol/L) was detected in 52.2% of men and 24.7% of women. In multivariate models, Hcy in men was positively associated with alcohol intake, but only alcohol in beer. In women, Hcy was negatively related to vitamin B12 intake. HHcy was associated in women with more than twice the odds of hypertension and with the CT/HDL-c ratio. In men, Hcy was positively and independently associated with diastolic blood pressure and with LDL-cholesterol and total cholesterol. In this Beninese population, the prevalence of HHcy is particularly high among men, and it appears to be related to alcohol consumption. Inadequate intake of vitamin B12 may be a risk factor for HHcy which could be related to some of cardiovascular factors.

Galectina-1 (Gal-1) pertence à família de lectinas que reconhecem -galactosídeos e pode ser expressa em vários tipos celulares, incluindo as células endoteliais e músculo liso. Esta lectina endógena possui propriedades imunomodulatórias e antiinflamatórias, dependentes de processos celulares, essenciais incluindo ativação, diferenciação, sobrevivência, fagocitose e adesão celular. Os eventos iniciais da lesão vascular são pouco conhecidos e, na literatura, são escassos os dados sobre a participação da Gal-1 nesses eventos. Portanto, neste trabalho, pretendeu-se avaliar a participação dessa lectina nos eventos iniciais da lesão vascular por hiperhomocisteinemia moderada induzida em camundongos. A dose padrão de 0,4g/Kg/dia de homocisteína-tiolactona foi administrada oralmente a camundongos selvagens (Gal-1+/+) e destituídos do gene da Gal-1 (Gal-1-/-), por diferentes tempos, causando uma elevação da concentração plasmática de homocisteína total, Este fato provocou alterações na reatividade vascular de contração na artéria aorta e de rolamento e adesão de leucócitos em vênulas mesentéricas. Foi detectada a presença da Gal-1 nas aortas de animais Gal-1+/+ em todos tempos de tratamento e no controle, observando, porém, um aumento dela no grupo tratados por 15 dias e, mais expressa em 24 horas (expressão protéica por Western blot e imunofluorescência e, gênica por Real Time PCR). Neste tempo, houve maiores alterações metabólicas significativas como triglicérides, LDL, colesterol total, glicose e de homocisteína. A análise da expressão das óxido nítrico sintases revelou não haver alterações para NOS induzida (iNOS) entre os grupos de animais Gal-1+/+ controle e tratados, nem mesmo em relação aos animais controles Gal-1-/-. Entretanto, o tratamento modulou a expressão da NOS endotelial (eNOS) nos animais Gal-1+/+, havendo uma redução da proteína para os tempos de 48 horas e 7dias (expressão protéica por imunohistoquímica - peroxidade e, gênica por RT-PCR). O tratamento não alterou a concentração plasmática de óxido nítrico (NO) em camundongos Gal-1+/+, mas foi detectada redução dos valores basais para animais Gal-1-/- e, uma redução com o tratamento por 15 dias. Portanto, foi verificado que a expressão de Gal-1 foi aumentada com o tratamento de Hcy-Taq nos tempos de 24 horas e 15 dias, onde se observam significativas e maiores alterações biológicas dos parâmetros de lesão vascular induzida pela hiperhomocisteinemia moderada analisadas: reatividade vascular, rolamento e adesão de leucócitos em vênulas mesentéricas, concentração de homocisteína plasmática, perfil lipídico e expressão da óxido nítrico sintase endotelial. / Galectin-1 (Gal-1) belongs to the lectin family of -galactosides-binding proteins and can be expressed by several cell types, including endothelial cells and vascular smooth cells. This endogenous lectin has immunological and anti-inflammatory properties dependent of essential cellular processes, including activation, differentiation, survival, phagocytosis and cell adhesion. There are few and inconclusive studies about the engagement of Gal-1 in vascular injury initial processes. Thus, this work was conducted to evaluate the engagement of Gal-1 in hyperhomocysteinemia-induced vascular injury. Wild type (Gal-1+/+) and Gal-1-knockout (Gal-1-/-) mice were fed with 0,4g/Kg/day with thiolactone-homocysteine (D,L Hcy-T) for different times, provoking increased plasmatic total homocysteine levels. That has indicated alterations in aortic vasomotor responses and mesenteric venial leukocyte rolling and adhesion. Gal-1 was detected in aortic frozen section of Gal-1+/+ mice for all times of treatment with D,L Hcy-T, but more detected for aorta of 15 days treated animal group and, more expressed, for 24 hours ones (protein expression by Western blot and immunofluorescence and, genetic by Real Time PCR). Besides, at 24 hours of treatment, many metabolic alterations were observed: increased LDL, triglycerides, cholesterol, glucose and homocysteine levels. Expressions for nitric oxide sintases (NOS) showed no alteration for inducible NOS (iNOS) for Gal-1+/+ mice (treated or not), even for Gal-1-/- untreat mice. However, the treatment was able to modulate endothelial NOS (eNOS) decreasing the expression at 48 hours and 7 days treated animals group (protein expression by imunoperoxidase and, genetic by RT-PCR). Gal-1-/- mice have less circulating constitutive nitric oxide (NO) than Gal-1+/+ ones, and, the treatment has reduced these levels only for Gal-1-/- 15 days treated mice but not for Gal-1+/+ ones . This work, therefore, has shown that Gal-1 is always expressed by aortas. However, increased expression of Gal-1 at 24 hours and 15 days of treatment has been often correlated to biological alterations in the in hyperhomocysteinemia-induced vascular injury: aortic vasomotor responses, leukocyte rolling and adhesion in mesenteric venues, plasmatic homocysteine, lipid metabolites and NOS expression.

Nível elevado de homocisteína (Hcy) no plasma é considerado fator de risco de doença cardiovascular. Consumo reduzido de vitaminas B6, B12 e ácido fólico tem sido relacionado com hiperhomocisteinemia. O objetivo desse estudo foi verificar o consumo de vitaminas B6, B12 e ácido fólico nas populações urbana e rural, bem como a correlação dos níveis plasmáticos dessas vitaminas com os níveis plasmáticos de Hcy. Também determinamos os níveis séricos de lipídeos e avaliamos o risco cardiovascular das populações frente a hiperlipemia. O consumo de B6 e ácido fólico é maior na população urbana, com p=0,00 e p=0,04 respectivamente, sendo o consumo de B12 maior na população rural, com p=0,47. As correlações são significativamente negativa entre Hcy e as vitaminas B12 e ácido fólico . A população rural apresenta Hcy com valor médio de 16,5±9,2µmol/L, classificada como hiperhomocisteinemia moderada, e a população urbana 12,8±5,5 µmol/L, o qual está dentro da faixa de referência. O valor médio de LDL sérica é maior na população urbana (3,4±0,8mmoI/L) do que na população rural (2,8±0,9mmoI/L), com valor de p=0,00. Como fator de risco cardiovascular, consideramos Hcy plasmática >14µmol/L e LDL sérica >3,38mmol/L. Neste caso, 41,4% da população rural e 7,4% população urbana apresentam Hcy maior que 14µmol/L. O inverso ocorre em relação a LDL, onde 43,2% da população urbana e 11% na população rural apresentam níveis acima de 3,38mmol/L. Concluímos que o risco cardiovascular decorrente de hiperhomocisteinemia é maior na população rural que na urbana e este risco poderia reduzir mediante o consumo de vitaminas. / Elevated levels of plasma homocysteine (Hey) are considered a risk factor for cardiovascular diseases. Low intake of vitamins 86, 812 and folic acid have been related to hyperhomocysteinemia. The purpose of the present study is to determine the consumption of the vitamins B6, B12 and folic acid in two Brazilian urban and rural populations, along with the plasmatic levels of these vitamins and plasmatic homocysteine. In addition, the serum levels of lipids have been determined to evaluate the cardiovascular risk in the two populations regarding their hyperlipidemie comdition. The consumption of B6 and folic acid is higher in the urban population (p=0.00 and p=0.04 respective/y), while the consumption of B12 is not significantly different (p=0.47). There is a negative correlation between B12 and folic acid with Hcy. The rural population shows mean Hcy value of 16.5±9.2µmol/L and is classified as having moderate hyperhomocysteinemia, while for the urban population, the mean value is 12.8±5.5µmol/L and is well within the normal range. The mean value of the serum LDL is higher in the urban population (3.4±0.8mmol/L) compared to the rural population (2.8±0.9mmol/lL) with a significance of p=0.00. Plasma Hcy values >14µmol/L and serum LDL >3.38mmol/L were considered as the risk factors for cardiovascular disease. With in the reference values, 41.4% of the rural population and 7.4% of the urban population showa Hcy as a risk factor. For LDL, the inverse is true, i.e 43.2% of urban and 11% of the rural population are at risk. We conclude that the cardiovascular risk arising from hyperhomocysteinemia is higher in the rural population and that this can be reduced by increased consumption of vitamins.

L'hyperhomoscystéinémie (HHcy) est considérée comme un facteur indépendant de risque cardio-métabolique. Notre travail avait pour objectifs : 1) de déterminer la prévalence de l’HHcy au Bénin; 2) d’étudier sa relation avec les apports de vitamines B12, B9, B6 et B2, la consommation d’alcool, l’âge, le sexe et le niveau socioéconomique (NSE); 3) de vérifier son association avec les facteurs classiques de risque cardio-métabolique. Un total de 541 sujets apparemment en santé et vivant dans trois zones du Bénin ont été étudiés. L’Hcy sérique a été analysée par ELISA. Des rappels de 24h ont servi à évaluer les apports nutritifs. L’obésité et l’hypertension ont été définies selon l’OMS, la dyslipidémie et la dysglycémie selon la NCEP-ATPIII. Les autres données ont été récoltées par questionnaire. La prévalence de l’HHcy était élevée : 52,2% chez les hommes et de 24,7% chez les femmes. Dans les modèles multivariés, l’Hcy était positivement associée à la consommation de bière locale chez les hommes; chez les femmes, elle était associée négativement à l'apport de vitamine B12. L’Hcy était positivement associée à la tension artérielle, au taux de LDL-cholestérol et au cholestérol total chez les hommes, mais seulement avec le rapport cholestérol total/HDL-cholestérol (CT/HDL-c) chez les femmes. Les femmes présentant une HHcy étaient au moins deux fois plus susceptibles de présenter une hypertension ou un rapport CT/HDL-c élevé que celles dont l’Hcy était normale. Un apport suffisant en B12 ainsi qu’une consommation prudente de boissons alcoolisées pourraient réduire l'HHcy et donc contribuer à réduire le risque cardio-métabolique de cette population du sud du Bénin. / Hyperhomocysteinemia (HHcy) appears to be an independent risk factor for cardiovascular disease. This study aims to determine the prevalence of HHcy in Benin, to explore its relationship with intakes of folate, B12, B6 and B2, with alcohol consumption and with socioeconomic status (SES) and to verify whether it is associated with classical risk factors of cardiovascular diseases. 541 apparently healthy subjects were randomly selected in tree areas of Benin. Hcy was measured in serum using ELISA commercial kits. Nutrient intakes were assessed on the basis of three non-consecutive 24-hour recalls. Alcohol consumption, socio-demographics and SES were documented in personal interviews. Obesity, hypertension, dyslipidemia and hyperglycaemia were defined according to WHO and NCEP-ATPIII. HHcy (> 12 μmol/L) was detected in 52.2% of men and 24.7% of women. In multivariate models, Hcy in men was positively associated with alcohol intake, but only alcohol in beer. In women, Hcy was negatively related to vitamin B12 intake. HHcy was associated in women with more than twice the odds of hypertension and with the CT/HDL-c ratio. In men, Hcy was positively and independently associated with diastolic blood pressure and with LDL-cholesterol and total cholesterol. In this Beninese population, the prevalence of HHcy is particularly high among men, and it appears to be related to alcohol consumption. Inadequate intake of vitamin B12 may be a risk factor for HHcy which could be related to some of cardiovascular factors.

Galectina-1 (Gal-1) pertence à família de lectinas que reconhecem -galactosídeos e pode ser expressa em vários tipos celulares, incluindo as células endoteliais e músculo liso. Esta lectina endógena possui propriedades imunomodulatórias e antiinflamatórias, dependentes de processos celulares, essenciais incluindo ativação, diferenciação, sobrevivência, fagocitose e adesão celular. Os eventos iniciais da lesão vascular são pouco conhecidos e, na literatura, são escassos os dados sobre a participação da Gal-1 nesses eventos. Portanto, neste trabalho, pretendeu-se avaliar a participação dessa lectina nos eventos iniciais da lesão vascular por hiperhomocisteinemia moderada induzida em camundongos. A dose padrão de 0,4g/Kg/dia de homocisteína-tiolactona foi administrada oralmente a camundongos selvagens (Gal-1+/+) e destituídos do gene da Gal-1 (Gal-1-/-), por diferentes tempos, causando uma elevação da concentração plasmática de homocisteína total, Este fato provocou alterações na reatividade vascular de contração na artéria aorta e de rolamento e adesão de leucócitos em vênulas mesentéricas. Foi detectada a presença da Gal-1 nas aortas de animais Gal-1+/+ em todos tempos de tratamento e no controle, observando, porém, um aumento dela no grupo tratados por 15 dias e, mais expressa em 24 horas (expressão protéica por Western blot e imunofluorescência e, gênica por Real Time PCR). Neste tempo, houve maiores alterações metabólicas significativas como triglicérides, LDL, colesterol total, glicose e de homocisteína. A análise da expressão das óxido nítrico sintases revelou não haver alterações para NOS induzida (iNOS) entre os grupos de animais Gal-1+/+ controle e tratados, nem mesmo em relação aos animais controles Gal-1-/-. Entretanto, o tratamento modulou a expressão da NOS endotelial (eNOS) nos animais Gal-1+/+, havendo uma redução da proteína para os tempos de 48 horas e 7dias (expressão protéica por imunohistoquímica - peroxidade e, gênica por RT-PCR). O tratamento não alterou a concentração plasmática de óxido nítrico (NO) em camundongos Gal-1+/+, mas foi detectada redução dos valores basais para animais Gal-1-/- e, uma redução com o tratamento por 15 dias. Portanto, foi verificado que a expressão de Gal-1 foi aumentada com o tratamento de Hcy-Taq nos tempos de 24 horas e 15 dias, onde se observam significativas e maiores alterações biológicas dos parâmetros de lesão vascular induzida pela hiperhomocisteinemia moderada analisadas: reatividade vascular, rolamento e adesão de leucócitos em vênulas mesentéricas, concentração de homocisteína plasmática, perfil lipídico e expressão da óxido nítrico sintase endotelial. / Galectin-1 (Gal-1) belongs to the lectin family of -galactosides-binding proteins and can be expressed by several cell types, including endothelial cells and vascular smooth cells. This endogenous lectin has immunological and anti-inflammatory properties dependent of essential cellular processes, including activation, differentiation, survival, phagocytosis and cell adhesion. There are few and inconclusive studies about the engagement of Gal-1 in vascular injury initial processes. Thus, this work was conducted to evaluate the engagement of Gal-1 in hyperhomocysteinemia-induced vascular injury. Wild type (Gal-1+/+) and Gal-1-knockout (Gal-1-/-) mice were fed with 0,4g/Kg/day with thiolactone-homocysteine (D,L Hcy-T) for different times, provoking increased plasmatic total homocysteine levels. That has indicated alterations in aortic vasomotor responses and mesenteric venial leukocyte rolling and adhesion. Gal-1 was detected in aortic frozen section of Gal-1+/+ mice for all times of treatment with D,L Hcy-T, but more detected for aorta of 15 days treated animal group and, more expressed, for 24 hours ones (protein expression by Western blot and immunofluorescence and, genetic by Real Time PCR). Besides, at 24 hours of treatment, many metabolic alterations were observed: increased LDL, triglycerides, cholesterol, glucose and homocysteine levels. Expressions for nitric oxide sintases (NOS) showed no alteration for inducible NOS (iNOS) for Gal-1+/+ mice (treated or not), even for Gal-1-/- untreat mice. However, the treatment was able to modulate endothelial NOS (eNOS) decreasing the expression at 48 hours and 7 days treated animals group (protein expression by imunoperoxidase and, genetic by RT-PCR). Gal-1-/- mice have less circulating constitutive nitric oxide (NO) than Gal-1+/+ ones, and, the treatment has reduced these levels only for Gal-1-/- 15 days treated mice but not for Gal-1+/+ ones . This work, therefore, has shown that Gal-1 is always expressed by aortas. However, increased expression of Gal-1 at 24 hours and 15 days of treatment has been often correlated to biological alterations in the in hyperhomocysteinemia-induced vascular injury: aortic vasomotor responses, leukocyte rolling and adhesion in mesenteric venues, plasmatic homocysteine, lipid metabolites and NOS expression.

A Doença da Artéria Periférica (DAP) é o resultado do processo aterosclerótico das artérias dos membros superiores, inferiores, aorta abdominal e seus ramos viscerais. Nosso objetivo foi detectar a DAP correlacionando-a com fatores de risco (FR) e a filtração glomerular estimada (FGe) nos pacientes com ≥30 anos, assistidos na Unidade docente - assistencial de Angiologia (UDA) do Hospital Universitário Pedro Ernesto da Faculdade de Ciências Médicas - UERJ, com o intuito de descrever os FR e associação com doença renal crônica à DAP, a partir da aferição do índice tornozelo-braço (ITB); determinar a alteração da FGe por equações, relacionando-a à progressão da DAP. Foi usado um questionário padrão e o ITB para identificar os pacientes com e sem DAP. Correlacionou-se as variáveis laboratoriais, como os níveis séricos de colesterol, triglicerídeos, HDL-c, LDL-c, glicemia, homocisteína com a FGe e com o ITB. As análises estatísticas foram feitas pelo programa Statistical Package for the Social Sciences (SPSS) 16.0 Os resultados apontaram para a importância do ITB no diagnóstico da DAP, com configuração de graus de obstrução leve, discreta, moderada e grave para os sintomáticos, e a identificação dos assintomáticos, possibilitando intervenção nos fatores de risco demarcados e o controle de suas complicações. O tabagismo mostou-se como o FR com razão de risco mais importante para DAP. A hipertensão sistólica e a diastólica foram variáveis clínicas mais significativas que o diabetes mellitus. Os marcadores séricos tradicionais para DAP: colesterol total, triglicerídeos e glicemia mostraram significância estatística. A homocisteína foi o marcador mais significativo em relação à DAP. Ocorreu associação entre redução do ITB com a elevação dos níveis pressóricos, das glicemias, da homocisteína, assim como diminuição das médias da FGe. Foi conclído que nos pacientes com DAP a hiperhomocisteinemia está associada à diminuição da FGe, ambas passíveis de prevenção, contribuindo na redução da morbimortalidade da DAP. A estreita associação da DAP com a FGe diminuída representou relevante contribuição do estudo. / Peripheral Artery (DAP) is the result of the atherosclerotic process involving the arteries of the superior and inferior limbs, abdominal aorta and its visceral branches. The objective was detect PAD, using the ankle brachial index (ABI), in patients ≥ 30 years old attended in the Unidade Docente - Assistencial of Angiology (UDA), correlating it with risk factors (RF) and estimated glomerular filtration rate (eGFR), with intention to describe the RF and association with chronic kidney disease. It was used a standard questionnaire and the ABI to identify patients with and without PAD. Laboratorial tests, as total cholesterol, triglycerides, HDL-c, LDL-c, glycemia, creatinine and homocysteine were correlated to ABI. Statistical analyses were done using the Statistical Package for the Social Sciences (SPSS) 16.0 program. The results had pointed to the importance of the ABI in the diagnosis of PAD, with degrees of mild, discrete, moderate and serious stenosis for the symptomatic patients, and the identification of the asymptomatic ones, making possible intervention in the RF and control of their complications. Tabagism was confirmed as the RF with most important odds ratio for PAD. The systolic and diastolic hypertension showed to be more significant than diabetes mellitus, as diseases associated to PAD. In laboratorial evaluation, the traditional blood markers for PAD: total cholesterol, triglycerides and glucose had shown statistics significance. Homocysteine was the marker most significant in PAD. Association between reduction of ABI with systolic and diastolic hypertension and glycemias occurred, as well as reduction of the averages of the eGFR. The conclusion was, in patients with PAD, hyperhomocysteinemia and decrease of eGFR are possible of prevention, contributing in the reduction of the morbimortality of PAD. The narrow association of decrease eGFR in patients with PAD represented excellent contribution of this study.

Nível elevado de homocisteína (Hcy) no plasma é considerado fator de risco de doença cardiovascular. Consumo reduzido de vitaminas B6, B12 e ácido fólico tem sido relacionado com hiperhomocisteinemia. O objetivo desse estudo foi verificar o consumo de vitaminas B6, B12 e ácido fólico nas populações urbana e rural, bem como a correlação dos níveis plasmáticos dessas vitaminas com os níveis plasmáticos de Hcy. Também determinamos os níveis séricos de lipídeos e avaliamos o risco cardiovascular das populações frente a hiperlipemia. O consumo de B6 e ácido fólico é maior na população urbana, com p=0,00 e p=0,04 respectivamente, sendo o consumo de B12 maior na população rural, com p=0,47. As correlações são significativamente negativa entre Hcy e as vitaminas B12 e ácido fólico . A população rural apresenta Hcy com valor médio de 16,5±9,2µmol/L, classificada como hiperhomocisteinemia moderada, e a população urbana 12,8±5,5 µmol/L, o qual está dentro da faixa de referência. O valor médio de LDL sérica é maior na população urbana (3,4±0,8mmoI/L) do que na população rural (2,8±0,9mmoI/L), com valor de p=0,00. Como fator de risco cardiovascular, consideramos Hcy plasmática >14µmol/L e LDL sérica >3,38mmol/L. Neste caso, 41,4% da população rural e 7,4% população urbana apresentam Hcy maior que 14µmol/L. O inverso ocorre em relação a LDL, onde 43,2% da população urbana e 11% na população rural apresentam níveis acima de 3,38mmol/L. Concluímos que o risco cardiovascular decorrente de hiperhomocisteinemia é maior na população rural que na urbana e este risco poderia reduzir mediante o consumo de vitaminas. / Elevated levels of plasma homocysteine (Hey) are considered a risk factor for cardiovascular diseases. Low intake of vitamins 86, 812 and folic acid have been related to hyperhomocysteinemia. The purpose of the present study is to determine the consumption of the vitamins B6, B12 and folic acid in two Brazilian urban and rural populations, along with the plasmatic levels of these vitamins and plasmatic homocysteine. In addition, the serum levels of lipids have been determined to evaluate the cardiovascular risk in the two populations regarding their hyperlipidemie comdition. The consumption of B6 and folic acid is higher in the urban population (p=0.00 and p=0.04 respective/y), while the consumption of B12 is not significantly different (p=0.47). There is a negative correlation between B12 and folic acid with Hcy. The rural population shows mean Hcy value of 16.5±9.2µmol/L and is classified as having moderate hyperhomocysteinemia, while for the urban population, the mean value is 12.8±5.5µmol/L and is well within the normal range. The mean value of the serum LDL is higher in the urban population (3.4±0.8mmol/L) compared to the rural population (2.8±0.9mmol/lL) with a significance of p=0.00. Plasma Hcy values >14µmol/L and serum LDL >3.38mmol/L were considered as the risk factors for cardiovascular disease. With in the reference values, 41.4% of the rural population and 7.4% of the urban population showa Hcy as a risk factor. For LDL, the inverse is true, i.e 43.2% of urban and 11% of the rural population are at risk. We conclude that the cardiovascular risk arising from hyperhomocysteinemia is higher in the rural population and that this can be reduced by increased consumption of vitamins.

Made available in DSpace on 2014-12-17T14:13:32Z (GMT). No. of bitstreams: 1 MarcioLTA_Tese.pdf: 1453040 bytes, checksum: 7c0ed7c44a56eb54d2170012eedbfa04 (MD5) Previous issue date: 2009-11-27 / The imprecision of the frontier that separates those cognitive deficits inherent to the human physiological aging process from those which represent the early signs of nervous system degenerative pathologies ,very prevalent among the elderly, has brought attention to the need of studies aiming to establish clinical and/or laboratorial criteria to allow this differentiation. Elderly people living in poor and developing countries are frequently exposed to precarious socioeconomic conditions which facilitate the development of an array of pathologies which have metabolic and nutritional dysfunctions as the established or proposed etiological agents. The levels of certain micronutrients, such as the vitamins B12 and B9 (folic acid), and of some intermediary metabolites, such as homocysteine are being thought of as etiological factors and/or as biological markers of a group of alterations which affect the normal functioning of the nervous system with important reflexes upon cognitive performance. This study aims to investigate the influence of homocysteine, B12 vitamin and folic acid levels on the cognitive performance of the low income elderly population. This transversal study took place in Natal, Rio Grande do Norte State, Brazil, and involved 205 dwelling elderly people, users of the Programa de Sa?de da Fam?lia, a public healthcare program, maintained by the city s health authorities. A multidimensional questionnaire was used to assess the socio-demographic aspects and the overall health and nutrition conditions. The cognitive performance was measured by the use of the Portuguese version of the Mini Mental State Exam (MMSE). The serum levels of homocysteine, B12 vitamin and folic acid were determined by chemiluminescence. The association between the socio-demographic and serum levels of Hcy, B12 vitamin and folic acid was determined by multiple linear regression. Serum levels higher than 13.5 &#956;mol/l, indicative of hyperhomocysteinemia (HHcy), were found on 25.4% of the sample, being more prevalent in men (p<0.05). Deficitary levels of folic acid (<5ng/mol) and of B12 vitamin (<193 pg/ml) were found on 3.9% and 10.2% of the sample respectively. A negative correlation was found between cognitive performance with both age and HHcy and a positive correlation was found between cognitive performance and schooling. The isolated HHcy R2 values were an explanation to only 4% of the variance of the MMSE scores. However, when associated with schooling and age, this model explains about 25% of this association / A imprecis?o da fronteira que separa os d?ficits pr?prios do processo de envelhecimento fisiol?gico humano daqueles que representam os sinais precoces das patologias degenerativas de grande preval?ncia entre idosos, tem chamado a aten??o para a necessidade da produ??o de estudos voltados para o estabelecimento crit?rios cl?nicos e/ou laboratoriais que permitam essa diferencia??o. Idosos de popula??es de pa?ses pobres e/ou em desenvolvimento s?o freq?entemente expostos a condi??es socioecon?micas prec?rias prop?cias ao desenvolvimento de um conjunto de patologias, disfun??es metab?licas e nutricionais. Os n?veis de determinados micronutrientes e de alguns metab?litos intermedi?rios v?m sendo vistos como fatores etiol?gicos e como marcadores biol?gicos de um conjunto de altera??es que afetam a fun??o normal do sistema nervoso com reflexos importantes sobre o desempenho cognitivo. N?veis elevados de homociste?na (Hcy) e d?ficits nutricionais e /ou metab?licos da vitamina B12 e B9 (?cido f?lico) t?m sido apontados como preditores e/ou como fatores etiol?gicos de altera??es cognitivas. O objetivo desse estudo foi avaliar a influ?ncia dos n?veis de homociste?na, Vitamina B12 e ?cido f?lico no desempenho cognitivo de idosos de baixa renda. Este estudo transversal desenvolvido em Natal, Rio Grande do Norte, Brasil, incluiu 205 idosos n?o institucionalizados atendidos pelo Programa de Sa?de da Fam?lia da Secretaria Municipal de Sa?de do munic?pio. Um question?rio multidimensional foi utilizado para avaliar os aspectos sociodemogr?ficos e as condi??es gerais de sa?de e nutri??o. O desempenho cognitivo foi aferido utilizando-se a vers?o em portugu?s do Mini-Exame do Estado Mental (MEEM). Os n?veis s?ricos de homociste?na, Vitamina B12 e ?cido f?lico foram determinados por quimioluminesc?ncia. A associa??o entre as vari?veis sociodemogr?ficas e os n?veis s?ricos de Hcy Vitamina B12 e ?cido f?lico foi determinada atrav?s de regress?o linear m?ltipla. Valores s?ricos acima de 13,5 &#956;mol/l indicativos de hiperhomocisteinemia (HHcy) foram encontrados em 25,4% da amostra sendo mais prevalente em homens (p<0,05). N?veis deficit?rios de ?cido f?lico (<5ng/ml) e de Vitamina B12 (<193 pg/ml) foram encontrados em 3,9% e 10,2% dos indiv?duos respectivamente. O desempenho cognitivo mostrou uma correla??o negativa com a idade e a HHcy e positiva com a escolaridade. Os valores R2 da HHcy isolada explicaram apenas 4% da vari?ncia da pontua??o do MEEM. Contudo, quando associada escolaridade e idade, este modelo explica aproximadamente 25% desta associa??o.

A Doença da Artéria Periférica (DAP) é o resultado do processo aterosclerótico das artérias dos membros superiores, inferiores, aorta abdominal e seus ramos viscerais. Nosso objetivo foi detectar a DAP correlacionando-a com fatores de risco (FR) e a filtração glomerular estimada (FGe) nos pacientes com &#8805;30 anos, assistidos na Unidade docente - assistencial de Angiologia (UDA) do Hospital Universitário Pedro Ernesto da Faculdade de Ciências Médicas - UERJ, com o intuito de descrever os FR e associação com doença renal crônica à DAP, a partir da aferição do índice tornozelo-braço (ITB); determinar a alteração da FGe por equações, relacionando-a à progressão da DAP. Foi usado um questionário padrão e o ITB para identificar os pacientes com e sem DAP. Correlacionou-se as variáveis laboratoriais, como os níveis séricos de colesterol, triglicerídeos, HDL-c, LDL-c, glicemia, homocisteína com a FGe e com o ITB. As análises estatísticas foram feitas pelo programa Statistical Package for the Social Sciences (SPSS) 16.0 Os resultados apontaram para a importância do ITB no diagnóstico da DAP, com configuração de graus de obstrução leve, discreta, moderada e grave para os sintomáticos, e a identificação dos assintomáticos, possibilitando intervenção nos fatores de risco demarcados e o controle de suas complicações. O tabagismo mostou-se como o FR com razão de risco mais importante para DAP. A hipertensão sistólica e a diastólica foram variáveis clínicas mais significativas que o diabetes mellitus. Os marcadores séricos tradicionais para DAP: colesterol total, triglicerídeos e glicemia mostraram significância estatística. A homocisteína foi o marcador mais significativo em relação à DAP. Ocorreu associação entre redução do ITB com a elevação dos níveis pressóricos, das glicemias, da homocisteína, assim como diminuição das médias da FGe. Foi conclído que nos pacientes com DAP a hiperhomocisteinemia está associada à diminuição da FGe, ambas passíveis de prevenção, contribuindo na redução da morbimortalidade da DAP. A estreita associação da DAP com a FGe diminuída representou relevante contribuição do estudo. / Peripheral Artery (DAP) is the result of the atherosclerotic process involving the arteries of the superior and inferior limbs, abdominal aorta and its visceral branches. The objective was detect PAD, using the ankle brachial index (ABI), in patients &#8805; 30 years old attended in the Unidade Docente - Assistencial of Angiology (UDA), correlating it with risk factors (RF) and estimated glomerular filtration rate (eGFR), with intention to describe the RF and association with chronic kidney disease. It was used a standard questionnaire and the ABI to identify patients with and without PAD. Laboratorial tests, as total cholesterol, triglycerides, HDL-c, LDL-c, glycemia, creatinine and homocysteine were correlated to ABI. Statistical analyses were done using the Statistical Package for the Social Sciences (SPSS) 16.0 program. The results had pointed to the importance of the ABI in the diagnosis of PAD, with degrees of mild, discrete, moderate and serious stenosis for the symptomatic patients, and the identification of the asymptomatic ones, making possible intervention in the RF and control of their complications. Tabagism was confirmed as the RF with most important odds ratio for PAD. The systolic and diastolic hypertension showed to be more significant than diabetes mellitus, as diseases associated to PAD. In laboratorial evaluation, the traditional blood markers for PAD: total cholesterol, triglycerides and glucose had shown statistics significance. Homocysteine was the marker most significant in PAD. Association between reduction of ABI with systolic and diastolic hypertension and glycemias occurred, as well as reduction of the averages of the eGFR. The conclusion was, in patients with PAD, hyperhomocysteinemia and decrease of eGFR are possible of prevention, contributing in the reduction of the morbimortality of PAD. The narrow association of decrease eGFR in patients with PAD represented excellent contribution of this study.