Hydrogen sulfide (H2S) is receiving increasing interest, as much as nitric oxide (NO) and carbon monoxide have received previously, to understand its physiological functions as it meets all the criteria to define as a third gasotransmitter. Endogenous synthesis from L-cysteine via cystathionine-γ-lyase (CSE) and cystathionine-β-synthase (CBS) and the function of H2S as an inhibitor of smooth muscle contraction in gastrointestinal tract are known. However, the loci of generation and action of H2S, and the mechanism of inhibition of contraction are unknown. Hence, my aims in the present study are to: i) identify the expression of enzymes in smooth muscle, ii) determine the effects of endogenously released and exogenously applied H2S on smooth muscle function; and iii) identify the targets and mechanism involved in mediating the effects of H2S using isolated smooth muscle cells from rabbit colon. I have identified the expression of CSE, but not CBS, in smooth muscle and demonstrated that L-cysteine (an activator of CSE) and NaHS (H2S donor): 1) inhibited carbachol-induced contraction in muscle strips and isolated muscle cells that was independent of KATP channels, a known S-sulfhydration target of H2S; 2) induced S-sulfhydration of small G protein, RhoA leading to inhibition of RhoA and Rho kinase activities, a key pathway in the sustained smooth muscle contraction; and 3) inhibited PDE5 activity leading to augmentation NO-induced cGMP formation and muscle relaxation. Sodium nitroprusside (an NO donor) induced an increase in H2S production via PKG-dependent phosphorylation and activation of CSE. We conclude that smooth muscle cells selectively express CSE, and endogenous generation of H2S via activation of CSE inhibits muscle contraction and augments muscle relaxation. Inhibition of contraction is mediated via S-sulfhydration of RhoA and suppression of RhoA/Rho kinase pathway. Augmentation of relaxation is mediated via inhibition of PDE5 activity and stimulation of cGMP/PKG pathway, which in addition initiates generation of H2S via PKG-mediated phosphorylation and activation of CSE. The findings are important in providing the underlying mechanisms involved in the regulation of smooth muscle function by H2S and could offer insights for the development of therapeutic agents that may act on smooth muscle in the gut to treat motility disorders.

No description available.

H2S é um gasotransmissor com atua regulando processos fisiológicos e fisiopatológicos. É sintetizado principalmente pelas enzimas cistationinagama-liase (CSE) e cistationina beta-sintase (CBS), ambas dependentes do co-fator 5-fosfato de pirodoxal, e que utilizam o L-cisteína como substrato. Essas enzimas estão presentes no fígado. O camundongo knockout para CBS (CBS KO) apresenta fenótipo de homocistinúria, ou seja, além da homocisteinemia apresenta estresse oxidativo, fibrose e esteatose hepática. Ademais, há estudos in vitro sugerindo um papel desse gás reduzindo a captação de glicose hepática. A hipótese desse projeto é que haja redução precoce da produção de H2S pelo fígado de camundongos alimentados com dieta hiperlipídica (DHL) e esse seja um evento anterior à instalação do fígado gorduroso ou DGHNA associada à obesidade induzida pela DHL, DIO. Para isso, avaliamos a evolução ponderal, consumo alimentar e calórico diários, a tolerância a glicose e a insulina (GTT, ITT e Kitt), a morfohistologia hepática com corantes HE e picrocirius red, expressão proteica e gênica das enzimas CBS e CSE, a quantificação do conteúdo de triglicérides, a deteção de F4/80 e a atividade de enzimas antioxidantes (catalase, GPx e arginase) em amostras de fígado de camundongos machos C57Bl6 alimentados com a DHL por 5 períodos distintos (10, 20, 40, 60 e 80 dias de dieta). Detectamos aumento da massa corporal final a partir de 20 dias de DHL. O consumo alimentar diário foi menor nos animais com a DHL, porém com maior consumo calório do que os respectivos controles. A glicemia basal foi maior nos animais com DHL desde os 10 dias, com exceção o grupo com 40 dias. Houve maior intolerância à glicose desde 10 dias de DHL seguida de resistência à insulina a partir de 20 dias de DHL. Foi detectada presença de vacúolos intracelular nos hepatócitos a partir de 20 dias de DHL, no entanto, a presença de hepatócitos comprometidos foi de aproximadamente 2% aos 20 dias da DHL, cerca de 5% aos 40 dias da DHL e aproximadamente 60% com 60 e 80 dias da DHL. Aos 80 dias de DHL foi detectada balonização de hepatócitos, presença de infiltrado inflamatório identificado pelo aumento da marcação com F4/80, maior detecção de fibras colágenas nos espaços vasculares e aumento da atividade da enzima sérica AST. Houve redução para aproximadamente 50% da produção do H2S nas amostras de fígado dos animais a partir de 40 dias da DHL, porém sem relação clara com as modificações detectadas na expressão das enzimas CBS e CSE. Diante desses dados, concluímos que a DHL leva à intolerância à glicose, seguida de aumento da massa corporal e resistência ao efeito hipoglicemiante da insulina e que o desenvolvimento de fígado gorduroso é um evento mais tardio. Vimos que o espectro da DGHNA desenvolvida apresenta características de esteato-hepatite incipiente, com balonização dos hepatócitos, infiltrado inflamatório presente, discreto aumento de deposição de fibras colágenas e aumento da enzima hepática circulante AST. A redução da produção do gás apareceu após a instalação da resistência à insulina, mas anterior ao estabelecimento da DGHNA. Portanto, concluímos que a alteração na produção hepática do H2S pode ser um evento precoce associado ao desenvolvimento da DGHNA e que merece ser investigado seu potencial papel na progressão de estatose a EHNA com fibrose e cirrose. No entanto, será importante buscar um outro modelo animal para estudo dessa evolução. / Hydrogen sulfide (H2S) is a gaseous signaling molecule that regulates a variety of physiological and pathophysiological processes. It is primarily synthesized by cystathionine-gamma-lyase (CSE) and cystathionine beta-synthase (CBS), which are expressed in the liver, require 5\'-pyrodoxal phosphate as a co-factor, and use L-cysteine as a substrate. Interestingly, CBS knockout (CBS KO) mice present homocystinuria and associated homocysteinemia, as well as oxidative stress, fibrosis and hepatic steatosis. Furthermore, in vitro studies suggest that this gas reduces hepatic glucose uptake. It was hypothesized that mice fed a high fat diet (HFD) would display an early reduction H2S production by the liver and that this event would occur prior to the establishment of fatty liver or NAFLD, which is associated with diet induced obesity (DIO). Towards the goal of gaining a better understanding of H2S production during the onset and progression of DIO, male C57B16 mice were fed a HFD for 10, 20, 40, 60 or 80 days. During the experimental period, weight evolution, daily food and caloric intake, as well as glucose and insulin tolerance (GTT, ITT and Kitt) were evalauted. At the end of each time period hepatocyte morphology was assessed by HE and picrocirius red staining, CBS and CSE gene and protein expression were evaluated, triglyceride content was quantified, F4/80 antigen was detected and antioxidant enzyme (catalase, GPx and arginase) activites were determined. The results showed that mice fed a HFD for 20 days or longer presented an increase in final body weight. All of the HFD groups presented reduced daily food intake, but higher caloric intake, when compared to their respective controls. All of the animals fed a HFD had increased basal glycemia levels, with the exception of the group fed the diet for 40 days. Reduced glucose tolerance and insulin resistance were observed after consuming the HFD for 10 and 20 days, respectively. Intracellular vacuoles were detected in the hepatocytes after 20 days of the HFD. The amount of compromised hepatocytes increased from 2% after 20 days of the HFD, to about 5% after 40 days, to approximately 60% after 60 and 80 days. After consuming the HFD for 80 days, there was an observed ballooning of hepatocytes, increased F4/80 detection indicating the presence of inflammatory infiltrates, increased collagen fiber detection in the vascular spaces, and increased serum AST activity. There was a ~50% reduction in H2S production in the liver samples from animals fed a HFD for 40 days; however, there was no clear relationship with the alterations detected in CBS and CSE gene or protein expression. Based on the results, it was concluded that an HFD promotes glucose intolerance, followed by increased body mass and insulin resistance and that the development of fatty liver occurs later. Additionally, the spectrum of the developed NAFLD presented incipient steatohepatitis characteristics, such as: hepatocyte ballooning, inflammatory infiltrate, a slight increase in collagen fiber deposition, and an increase in circulating liver AST levels. The reduction in H2S gas production appeared after the installation of insulin resistance, but prior to the establishment of NAFLD. Therefore, we conclude that alterations in hepatic H2S production may be an early event associated with the onset of NAFLD and that its potential role in the progression of steatosis and NASH with fibrosis and cirrhosis deserves to be investigated. However, it will be important to evaluate this evolution in other animal models.

Introdução: A homocistinúria clássica é um erro inato do metabolismo causado pela atividade deficiente da cistationina β-sintase (CβS). É caracterizada pela elevação sérica de homocisteína e metionina e redução dos níveis de cisteína. As manifestações clínicas clássicas envolvem os sistemas ocular, vascular, nervoso central e ósseo. Entretanto, observações recentes sugerem que alterações na composição corporal, especialmente a redução de tecido adiposo, também pode ser uma manifestação frequente e clinicamente relevante nesta doença. Além disso, a gravidade do fenótipo clínico parece ser influenciada por outros genes além do CβS. O objetivo deste estudo foi investigar alterações na composição corporal e detectar mutações comuns nos genes CβS, MTHFR e F5 em pacientes com homocistinúria clássica; relacionando dados clínicos, bioquímicos e genéticos. Métodos: Realizada avaliação da composição corporal em 8 pacientes através de duas técnicas: antropometria (aferição das dobras cutâneas triciptal, biciptal, subescapular e suprailíaca) e bioimpedância elétrica (BIA). A partir dos resultados obtidos, calculou-se o percentual de gordura pelas fórmulas de Siri (antropometria) e Kushner (BIA). O índice de massa corporal (IMC) também foi calculado. Os níveis de metionina, homocisteína e cisteína foram mensurados por HPLC. A avaliação genotípica foi realizada em 11 pacientes através de PCR-RFLP. Pesquisadas as mutações p.I278T, p.T191M, p.G307S e c.844ins68 no gene CβS; c.677TC>T e c.1298A>C no gene MTHFR; e p.R506Q no gene F5 (Fator V de Leiden). Resultados: Cinco pacientes apresentaram baixo percentual de gordura por pelo menos um dos métodos; o restante apresentou percentual médio. De acordo com o IMC, apenas dois pacientes foram classificados em baixo peso. O percentual de gordura total não se relacionou com os achados bioquímicos ou ósseos, mas medida isolada da dobra cutânea triciptal correlacionou-se positivamente com os níveis de cisteína (p=0,03) Além disso, os níveis de homocisteína e metionina correlacionaram-se negativamente com o IMC, enquanto que a cisteína teve associação positiva (p<0.05). Houve tendência do escore T de fêmur associar-se negativamente com homocisteína e positivamente com cisteína (p=0,09). Entre as mutações do gene CβS, a p.1278T foi a única encontrada (n= 3/9 famílias); entretanto, em 2/3 famílias estava em cis com a c.844ins68. Assim, em apenas um caso tinha caráter patogênico. Não foi possível estabelecer associação entre mutações em MTHFR e F5 e a gravidade do fenótipo. Conclusões: Os resultados sugerem que deficiência de CβS gera alterações significativas na composição corporal – observou-se redução do percentual de gordura independentemente do IMC. Este pode ser um mecanismo patogênico importante envolvido na etiologia da 2 osteoporose na homocistinúria clássica, mas estudos adicionais são necessários para demonstrar esta relação. Os achados sugerem que as mutações patogênicas no gene CBS sejam raras ou privadas nesta amostra, e não corroboram a ação dos genes MTHFR e F5 como modificadores da doença. / Introduction: Classical homocystinuria is an inborn error of metabolism caused by the deficient activity of cystathionine β-synthase (CβS). It is characterized by plasma increase in homocysteine and methionine and a decrease in cysteine levels. Its classical clinical manifestations involve the following systems: ocular, vascular, central nervous, and skeletal. However, recent observations have suggested that changes in the body composition, especially a reduction of the adipose tissue, may also be a frequent manifestation of the disease and clinically relevant to it. Moreover, the severity of its clinical phenotype may be influenced by other genes besides CβS. The objective of the present study was to investigate alterations in the body composition and to detect common mutations in CβS, MTHFR and F5 genes in patients with classical homocystinuria and to correlate them to the clinical, biochemical, and genetic data. Methods: Body composition was assessed in 8 patients using the techniques of anthropometry (measurement of the following skinfolds: triciptal, biciptal, subscapular, and suprailiac) and electrical bioimpedance (BIA). Based on the results obtained, the percentage of body fat was calculated using the formulas of Siri (anthropometry) and Kushner (BIA). The body mass index (BMI) was also calculated. The levels of methionine, homocysteine, and cysteine were measured by HPLC. The genotypic evaluation was done in 11 patients by PCR-RFLP. The following mutations were investigated: p.I278T, p.T191M, p.G307S, and c.844ins68 in the CβS gene; c.677TC>T and c.1298A>C in the MTHFR gene; and p.R506Q in the F5 gene (Factor V Leiden). Results: Five patients presented low percentage of body fat by at least one of the methods; the other patients presented a medium percentage. According to the BMI, only 2 patients were classified as being underweight. The percentage of total body fat was not related to either bone or biochemical findings, but the isolate measurement of the triciptal skinfold was positively correlated to the levels of cysteine (p=0.03). Also, the levels of homocysteine and methionine were negatively correlated to the BMI, while cysteine had a positive association (p<0.05). The T score of the femur tended to associate negatively with homocysteine and positively with cysteine (p=0.09). The genetic evaluation revealed only one pathogenic mutation in CβS (p.I278T). An association between mutations in MTHFR and F5 and phenotype severity could not be established. Conclusions: The present results suggest that the deficiency of CβS causes significant alterations in the body composition; a reduction of the percentage of body fat was observed independently from the BMI. This may be an important pathogenic mechanism involved in the etiology of osteoporosis in classical homocystinuria. The present findings suggest that in this sample the 4 pathogenic mutations in the CBS gene are rare or private and do not corroborate with the action of the MTHFR and F5 genes as disease modifiers. Further studies are needed.

Cell replication and division are central to the proliferation of life, and have implications for normal growth and development as well as disease state. Assembly of a complete picture of the systems which control this process requires identification of individual genetic components, but the identity and complete sequence of events that trigger initiation of cell division, at a point called START in yeast, remain unknown. Here, we evaluated panels of non-essential single gene deletion strains and tested the effects of FDA-approved drugs on cell-cycle progression, using flow cytometry to detect altered DNA content. Previous studies relied mainly on cell size changes to systematically identify genes required for the timely completion of START. This analysis revealed that most gene deletions that altered cell-cycle progression did not change cell size. Our results highlight a strong requirement for ribosomal biogenesis and protein synthesis for initiation of cell division. We also identified numerous factors that have not been previously implicated in cell-cycle control mechanisms. We found that cystathionine-beta-synthase (CBS) advances START in two ways: by promoting cell growth, which requires CBS's catalytic activity, and by a separate function which does not require that activity. CBS defects cause disease in humans, and in animals CBS has vital, non-catalytic, unknown roles. Hence, our results may be relevant for human biology. Screening chemical libraries to identify compounds that affect overall cell proliferation is common. However, it is generally not known whether the compounds tested alter the timing of particular cell-cycle transitions. Our approach revealed strong cell-cycle effects of several commonly used pharmaceuticals. We show that the antilipemic gemfibrozil delays initiation of DNA replication, while cells treated with the antidepressant fluoxetine severely delay progression through mitosis. We discovered a strong suppressive interaction between gemfibrozil and fluoxetine. The novel interaction between gemfibrozil and fluoxetine suggests that identifying and combining drugs that show cell-cycle effects might streamline identification of drug combinations with a pronounced impact on cell proliferation. Our studies not only transform our view of START, but also expand the repertoire of genetic and chemical means to modulate the eukaryotic cell cycle.

Introdução: A homocistinúria clássica é um erro inato do metabolismo causado pela atividade deficiente da cistationina β-sintase (CβS). É caracterizada pela elevação sérica de homocisteína e metionina e redução dos níveis de cisteína. As manifestações clínicas clássicas envolvem os sistemas ocular, vascular, nervoso central e ósseo. Entretanto, observações recentes sugerem que alterações na composição corporal, especialmente a redução de tecido adiposo, também pode ser uma manifestação frequente e clinicamente relevante nesta doença. Além disso, a gravidade do fenótipo clínico parece ser influenciada por outros genes além do CβS. O objetivo deste estudo foi investigar alterações na composição corporal e detectar mutações comuns nos genes CβS, MTHFR e F5 em pacientes com homocistinúria clássica; relacionando dados clínicos, bioquímicos e genéticos. Métodos: Realizada avaliação da composição corporal em 8 pacientes através de duas técnicas: antropometria (aferição das dobras cutâneas triciptal, biciptal, subescapular e suprailíaca) e bioimpedância elétrica (BIA). A partir dos resultados obtidos, calculou-se o percentual de gordura pelas fórmulas de Siri (antropometria) e Kushner (BIA). O índice de massa corporal (IMC) também foi calculado. Os níveis de metionina, homocisteína e cisteína foram mensurados por HPLC. A avaliação genotípica foi realizada em 11 pacientes através de PCR-RFLP. Pesquisadas as mutações p.I278T, p.T191M, p.G307S e c.844ins68 no gene CβS; c.677TC>T e c.1298A>C no gene MTHFR; e p.R506Q no gene F5 (Fator V de Leiden). Resultados: Cinco pacientes apresentaram baixo percentual de gordura por pelo menos um dos métodos; o restante apresentou percentual médio. De acordo com o IMC, apenas dois pacientes foram classificados em baixo peso. O percentual de gordura total não se relacionou com os achados bioquímicos ou ósseos, mas medida isolada da dobra cutânea triciptal correlacionou-se positivamente com os níveis de cisteína (p=0,03) Além disso, os níveis de homocisteína e metionina correlacionaram-se negativamente com o IMC, enquanto que a cisteína teve associação positiva (p<0.05). Houve tendência do escore T de fêmur associar-se negativamente com homocisteína e positivamente com cisteína (p=0,09). Entre as mutações do gene CβS, a p.1278T foi a única encontrada (n= 3/9 famílias); entretanto, em 2/3 famílias estava em cis com a c.844ins68. Assim, em apenas um caso tinha caráter patogênico. Não foi possível estabelecer associação entre mutações em MTHFR e F5 e a gravidade do fenótipo. Conclusões: Os resultados sugerem que deficiência de CβS gera alterações significativas na composição corporal – observou-se redução do percentual de gordura independentemente do IMC. Este pode ser um mecanismo patogênico importante envolvido na etiologia da 2 osteoporose na homocistinúria clássica, mas estudos adicionais são necessários para demonstrar esta relação. Os achados sugerem que as mutações patogênicas no gene CBS sejam raras ou privadas nesta amostra, e não corroboram a ação dos genes MTHFR e F5 como modificadores da doença. / Introduction: Classical homocystinuria is an inborn error of metabolism caused by the deficient activity of cystathionine β-synthase (CβS). It is characterized by plasma increase in homocysteine and methionine and a decrease in cysteine levels. Its classical clinical manifestations involve the following systems: ocular, vascular, central nervous, and skeletal. However, recent observations have suggested that changes in the body composition, especially a reduction of the adipose tissue, may also be a frequent manifestation of the disease and clinically relevant to it. Moreover, the severity of its clinical phenotype may be influenced by other genes besides CβS. The objective of the present study was to investigate alterations in the body composition and to detect common mutations in CβS, MTHFR and F5 genes in patients with classical homocystinuria and to correlate them to the clinical, biochemical, and genetic data. Methods: Body composition was assessed in 8 patients using the techniques of anthropometry (measurement of the following skinfolds: triciptal, biciptal, subscapular, and suprailiac) and electrical bioimpedance (BIA). Based on the results obtained, the percentage of body fat was calculated using the formulas of Siri (anthropometry) and Kushner (BIA). The body mass index (BMI) was also calculated. The levels of methionine, homocysteine, and cysteine were measured by HPLC. The genotypic evaluation was done in 11 patients by PCR-RFLP. The following mutations were investigated: p.I278T, p.T191M, p.G307S, and c.844ins68 in the CβS gene; c.677TC>T and c.1298A>C in the MTHFR gene; and p.R506Q in the F5 gene (Factor V Leiden). Results: Five patients presented low percentage of body fat by at least one of the methods; the other patients presented a medium percentage. According to the BMI, only 2 patients were classified as being underweight. The percentage of total body fat was not related to either bone or biochemical findings, but the isolate measurement of the triciptal skinfold was positively correlated to the levels of cysteine (p=0.03). Also, the levels of homocysteine and methionine were negatively correlated to the BMI, while cysteine had a positive association (p<0.05). The T score of the femur tended to associate negatively with homocysteine and positively with cysteine (p=0.09). The genetic evaluation revealed only one pathogenic mutation in CβS (p.I278T). An association between mutations in MTHFR and F5 and phenotype severity could not be established. Conclusions: The present results suggest that the deficiency of CβS causes significant alterations in the body composition; a reduction of the percentage of body fat was observed independently from the BMI. This may be an important pathogenic mechanism involved in the etiology of osteoporosis in classical homocystinuria. The present findings suggest that in this sample the 4 pathogenic mutations in the CBS gene are rare or private and do not corroborate with the action of the MTHFR and F5 genes as disease modifiers. Further studies are needed.

In advanced stages, cardiac disease causes millions of deaths each year. Superoxide anions (O₂^.-) and their derivative peroxynitrite (ONOO^-) contribute to cardiac disease pathogenesis, yet strategies to reduces these reactive oxygen species through antioxidants in large scale clinical trials have largely been unsuccessful. Better understanding of pathways regulating enzymatic sources of O₂^.- like NADPH oxidases, uncoupled nitric oxide synthases (NOSs) and mitochondrial oxidases are required to regulate myocardial oxidative stress in patients with advanced stages of cardiac disease. Hydrogen sulfide (H2S) is a gaseous signalling molecule generated by transsulfuration pathway enzymes cystathionine γ-lyase (CSE), cystathionine β-synthase (CBS), and 3-mercaptopyruvate sulfurtransferase (MST). H₂S regulates oxidative stress in animal models and shows promise for cardiovascular therapeutic strategy. This thesis investigates whether H₂S/CSE biology is related to human myocardial redox state in a cohort of individuals with advanced cardiac disease (Oxford Heart, Fat, Vessels Cohort; Ox-HVF). Individuals with varying levels of myocardial oxidative stress and function were extensively phenotyped for H₂S biology. Individuals with high myocardial oxidative stress from NADPH oxidases and NOSs were found to have high expression of myocardial CSE. To examine first the positive association with NADPH oxidase activity, CSE expression was examined after myocardial oxidative injury and CSE was found to be redox-sensitive. Furthermore, direct effects of two exogenous H₂S donors (NaHS and GYY4137) demonstrated a direct regulation of O₂^.- from NOSs in myocardium from individuals with advanced cardiac disease, further supporting H₂S's direct role in the regulation of NOS biology. Finally, identification of a SNP in CSE further demonstrated CSE's causal role in the regulation of O2.- generation from mitochondrial oxidases. Taken together, we demonstrate for the first time that H₂S and CSE biology are linked to human myocardial redox state and have a causal role in redox regulation in the human heart. These findings suggest H₂S/CSE biology are important endogenous regulators of myocardial redox state in humans and continued exploration of these pathways may develop novel therapeutic strategies against myocardial oxidative stress in cardiac disease.

Hydrogen sulfide (H2S) is a toxic gas that causes respiratory failure and death at high concentrations, but at low concentrations, it functions as a signaling molecule in vasodilation and neuromodulation, and it protects cells and tissues from reperfusion injury, hypoxia, hyperglycemia and endothelial dysfunction. Several model organisms have been used to study the physiological roles and signaling pathways of H2S. The roundworm Caenorhabditis elegans is a remarkable model for studying the physiology, developmental biology and signaling of H2S; however, the metabolism of H2S in this animal is largely unknown. Cystathionine beta-synthase (CBS) is one of three H2S-producing enzymes in mammals. Notably, C. elegans possesses 6 genes that encode proteins homologous to CBS, namely cbs- 1, cbs-2, cysl-1, cysl-2, cysl-3 and cysl-4. In this thesis we studied the roles of these genes in H2S metabolism and signaling. First, we identified cbs-1 as the gene encoding CBS in C. elegans; the recombinant purified CBS-1 protein exhibited canonical CBS activity, and RNA interference-mediated silencing of cbs-1 resulted in decreased CBS activity and increased homocysteine levels in worm extracts, recapitulating the phenotypes of CBS deficiency in mammals. Notably, the nematode and human enzymes differ in their domain...

Introdução: A homocistinúria clássica é um erro inato do metabolismo causado pela atividade deficiente da cistationina β-sintase (CβS). É caracterizada pela elevação sérica de homocisteína e metionina e redução dos níveis de cisteína. As manifestações clínicas clássicas envolvem os sistemas ocular, vascular, nervoso central e ósseo. Entretanto, observações recentes sugerem que alterações na composição corporal, especialmente a redução de tecido adiposo, também pode ser uma manifestação frequente e clinicamente relevante nesta doença. Além disso, a gravidade do fenótipo clínico parece ser influenciada por outros genes além do CβS. O objetivo deste estudo foi investigar alterações na composição corporal e detectar mutações comuns nos genes CβS, MTHFR e F5 em pacientes com homocistinúria clássica; relacionando dados clínicos, bioquímicos e genéticos. Métodos: Realizada avaliação da composição corporal em 8 pacientes através de duas técnicas: antropometria (aferição das dobras cutâneas triciptal, biciptal, subescapular e suprailíaca) e bioimpedância elétrica (BIA). A partir dos resultados obtidos, calculou-se o percentual de gordura pelas fórmulas de Siri (antropometria) e Kushner (BIA). O índice de massa corporal (IMC) também foi calculado. Os níveis de metionina, homocisteína e cisteína foram mensurados por HPLC. A avaliação genotípica foi realizada em 11 pacientes através de PCR-RFLP. Pesquisadas as mutações p.I278T, p.T191M, p.G307S e c.844ins68 no gene CβS; c.677TC>T e c.1298A>C no gene MTHFR; e p.R506Q no gene F5 (Fator V de Leiden). Resultados: Cinco pacientes apresentaram baixo percentual de gordura por pelo menos um dos métodos; o restante apresentou percentual médio. De acordo com o IMC, apenas dois pacientes foram classificados em baixo peso. O percentual de gordura total não se relacionou com os achados bioquímicos ou ósseos, mas medida isolada da dobra cutânea triciptal correlacionou-se positivamente com os níveis de cisteína (p=0,03) Além disso, os níveis de homocisteína e metionina correlacionaram-se negativamente com o IMC, enquanto que a cisteína teve associação positiva (p<0.05). Houve tendência do escore T de fêmur associar-se negativamente com homocisteína e positivamente com cisteína (p=0,09). Entre as mutações do gene CβS, a p.1278T foi a única encontrada (n= 3/9 famílias); entretanto, em 2/3 famílias estava em cis com a c.844ins68. Assim, em apenas um caso tinha caráter patogênico. Não foi possível estabelecer associação entre mutações em MTHFR e F5 e a gravidade do fenótipo. Conclusões: Os resultados sugerem que deficiência de CβS gera alterações significativas na composição corporal – observou-se redução do percentual de gordura independentemente do IMC. Este pode ser um mecanismo patogênico importante envolvido na etiologia da 2 osteoporose na homocistinúria clássica, mas estudos adicionais são necessários para demonstrar esta relação. Os achados sugerem que as mutações patogênicas no gene CBS sejam raras ou privadas nesta amostra, e não corroboram a ação dos genes MTHFR e F5 como modificadores da doença. / Introduction: Classical homocystinuria is an inborn error of metabolism caused by the deficient activity of cystathionine β-synthase (CβS). It is characterized by plasma increase in homocysteine and methionine and a decrease in cysteine levels. Its classical clinical manifestations involve the following systems: ocular, vascular, central nervous, and skeletal. However, recent observations have suggested that changes in the body composition, especially a reduction of the adipose tissue, may also be a frequent manifestation of the disease and clinically relevant to it. Moreover, the severity of its clinical phenotype may be influenced by other genes besides CβS. The objective of the present study was to investigate alterations in the body composition and to detect common mutations in CβS, MTHFR and F5 genes in patients with classical homocystinuria and to correlate them to the clinical, biochemical, and genetic data. Methods: Body composition was assessed in 8 patients using the techniques of anthropometry (measurement of the following skinfolds: triciptal, biciptal, subscapular, and suprailiac) and electrical bioimpedance (BIA). Based on the results obtained, the percentage of body fat was calculated using the formulas of Siri (anthropometry) and Kushner (BIA). The body mass index (BMI) was also calculated. The levels of methionine, homocysteine, and cysteine were measured by HPLC. The genotypic evaluation was done in 11 patients by PCR-RFLP. The following mutations were investigated: p.I278T, p.T191M, p.G307S, and c.844ins68 in the CβS gene; c.677TC>T and c.1298A>C in the MTHFR gene; and p.R506Q in the F5 gene (Factor V Leiden). Results: Five patients presented low percentage of body fat by at least one of the methods; the other patients presented a medium percentage. According to the BMI, only 2 patients were classified as being underweight. The percentage of total body fat was not related to either bone or biochemical findings, but the isolate measurement of the triciptal skinfold was positively correlated to the levels of cysteine (p=0.03). Also, the levels of homocysteine and methionine were negatively correlated to the BMI, while cysteine had a positive association (p<0.05). The T score of the femur tended to associate negatively with homocysteine and positively with cysteine (p=0.09). The genetic evaluation revealed only one pathogenic mutation in CβS (p.I278T). An association between mutations in MTHFR and F5 and phenotype severity could not be established. Conclusions: The present results suggest that the deficiency of CβS causes significant alterations in the body composition; a reduction of the percentage of body fat was observed independently from the BMI. This may be an important pathogenic mechanism involved in the etiology of osteoporosis in classical homocystinuria. The present findings suggest that in this sample the 4 pathogenic mutations in the CBS gene are rare or private and do not corroborate with the action of the MTHFR and F5 genes as disease modifiers. Further studies are needed.

Protein misfolding is considered to be the major pathogenic mechanism in homocystinuria due to cystathionine beta-synthase (CBS) deficiency. The aim of this work was to study molecular mechanisms underlying protein misfolding of CBS mutants. Firstly, we studied spatial arrangement of normal human CBS protein. Using data from differential covalent labeling of solvent-exposed aminoacid residues, we identified interdomain contact area between the catalytic core and the regulatory domain in human CBS, and we subsequently generated the structural model of the full-length CBS. In the next step, we studied evolutionary divergence of CBS protein structures. We performed phylogenetic analysis that revealed unique spatial arrangement of CBS enzyme in nematodes; the domain architecture of CBS in Caenorhabditis elegans was studied experimentally in more detail. Finally, we determined conformational properties of a representative set of human CBS mutants that exhibited in various extent affected formation of tetramers and decreased catalytic activity. Using thermolysin-based proteolytic techniques for analysis of nine mutants expressed in E.coli, we found that an unfolded structure is a common intermediate occurring in CBS misfolding. The importance of protein unfolding for pathogenesis of CBS deficiency was...