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Effects of Folic Acid Before and After Vitamin B₁₂ on Plasma Homocysteine Concentrations in Hemodialysis Patients with Known MTHFR Genotypes

Anna Pastore¹, Sandro De Angelis³, Stefania Casciani², Rosalba Ruggia², Gianna Di Giovamberardino¹, Annalisa Noce³, Giorgio Splendiani³, Claudio Cortese², Giorgio Federici² and Mariarita Dess'^2,a

¹ Biochemistry Laboratory, Children’s Hospital and Research Institute "Bambino Gesù", Rome, Italy² Department of Laboratory Medicine and the³ Nephrology and Dialysis Unit, University Hospital "Tor Vergata", Rome, Italy;

^aaddress correspondence to this author at: Department of Laboratory Medicine, University Hospital Tor Vergata", Viale Oxford 81, 00133 Rome, Italy; fax 39-06-20902357, e-mail mariarita.dessi{at}ptvonline.it)

Abstract

Background: Treatment with folic acid and vitamin B₁₂ appears to be effective in lowering total plasma homocysteine (tHcy) concentrations, but whether vitamin B₁₂ alone lowers tHcy in patients with normal vitamin B₁₂ status is unknown. The aims of the present study were to explore the effect of individual supplementation with folic acid or vitamin B₁₂ on tHcy concentrations in hemodialysis (HD) patients and to compare changes in tHcy concentrations with MTHFR genotype.

Methods: We recruited 200 HD patients (119 men) from the "Umberto I" Hospital (Frosinone, Italy) and the Dialysis Unit of University Hospital "Tor Vergata". These patients were randomized blindly into 2 groups of 100 each. Unfortunately, during the study, 36 patients in the first group and 16 in the second group died. The first group was treated initially with vitamin B₁₂ for 2 months and with folic acid for a following 2 months. The second group was treated initially with folic acid and then with vitamin B₁₂. Samples were drawn before administration of either, after the first and second periods, and again 2 months after treatment.

Results: The concentrations of tHcy decreased in both groups after the consecutive vitamin therapies, and the decrease was genotype-dependent. The decrease was greater for the T/T genotype (P <0.05) and was more significant when the treatment was started with folic acid (P <0.01).

Conclusion: The alternating vitamin treatment demonstrated for the first time the importance of folate therapy and the secondary contribution of vitamin B₁₂in lowering tHcy in HD patients.

The following articles in journals at HighWire Press have cited this article:

				J. Golledge, L. Jones, L. Oliver, F. Quigley, and M. Karan Folic Acid, Vitamin B12, MTHFR Genotypes, and Plasma Homocysteine. Clin. Chem., June 1, 2006; 52(6): 1205 - 1206. [Full Text] [PDF]