title: Homocysteine plasma concentration is related to severity of lung impairment in scleroderma.
abstract: OBJECTIVE
  To investigate the correlation between plasma concentration of total homocysteine and pulmonary involvement in patients with limited or diffuse scleroderma (systemic sclerosis, SSc).
  
  
  METHODS
  Seventy-one patients with scleroderma were divided into 3 groups based on pulmonary involvement: Group A comprised patients without lung involvement (9 cases); Group B patients with lung involvement of mild and moderate stages (44 cases); and Group C patients with lung involvement of severe stage and endstage (18 cases). At the time of evaluation of lung involvement all patients underwent determination of plasma homocysteine concentration. Homocysteine concentration was also measured in 30 healthy controls homogeneous for sex and age.
  
  
  RESULTS
  In patients with scleroderma the homocysteine concentration was significantly higher than in controls (11.1 and 6.9 micromol/l, respectively; p < 0.001). We found a significant association between plasma homocysteine concentration and severity of lung involvement that was not modified by correction for age, time from the diagnosis, type of scleroderma pattern, and serum creatinine and folate levels. Homocysteine concentration progressively increases in scleroderma patients with more severe pulmonary involvement. Subjects with high homocysteine concentration (i.e., > or = 75th percentile of homocysteine concentration in patients with scleroderma without lung involvement) were mostly present in the group with the greatest lung involvement.
  
  
  CONCLUSIONS
  High level of homocysteinemia is associated with an increased risk of pulmonary disease in patients with scleroderma. We hypothesize that hyperhomocysteinemia may worsen injury of the endothelium, a key lesion in scleroderma disease, favoring the development of lung involvement. Our data support the hypothesis that homocysteine could be involved in the pathogenetic process of scleroderma pulmonary involvement.
authors.affiliation: Dipartmento di Medicina Clinica e Sperimentale, Policlinico GB Rossi, Verona, Italy. caramaschi@cmib.univr.it
authors.forename: Paola
authors.initials: P
authors.lastname: Caramaschi
authors.forename: Nicola
authors.initials: N
authors.lastname: Martinelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Biasi
authors.forename: Antonio
authors.initials: A
authors.lastname: Carletto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Faccini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: Marcello
authors.initials: M
authors.lastname: Ferrari
authors.forename: Cinzia
authors.initials: C
authors.lastname: Scambi
authors.forename: Lisa Maria
authors.initials: LM
authors.lastname: Bambara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008171:Lung Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D012720:Severity of Illness Index
chemical_list: D006710:Homocysteine