title: High- but not low-dose folic acid improves endothelial function in coronary artery disease.
abstract: BACKGROUND
  While folic acid (FA) reduces plasma homocysteine (Hcy), whether the simultaneous improvement in endothelial function is dependent on Hcy lowering per se is questionable. In the present study the relationship between FA dose, Hcy lowering and endothelial function in patients with coronary artery disease (CAD) was investigated.
  
  
  METHODS
  Eighty-four patients with CAD received either 400 microg FA or 5 mg placebo daily for a 6-week treatment period. A further 44 patients with CAD received either 100 mg kg(-1) day(-1) of betaine or placebo for a 6-week treatment period. Flow-mediated dilatation (FMD), a measure of endothelial function, was assessed before and after the 6-week periods. Isometric tension and Western blotting were used to investigate the effect of FA on endothelial function and endothelial nitric oxide synthase (eNOS) dimerization in isolated rabbit aortic rings and cultured porcine aortic endothelial cells (PAEC), respectively.
  
  
  RESULTS
  Both 400 micro g day(-1) and 5 mg day(-1) FA significantly increased plasma folate and decreased plasma Hcy. The FMD improved significantly after 6 weeks' treatment of 5 mg day(-1) FA but did not correlate with the reduction in Hcy. There was no change in FMD in either the 400 micro g FA or placebo group. In a subgroup analysis of 11 patients in the betaine group, despite a reduced Hcy, a significant impairment in FMD was observed. In the in vitro studies FA, but not betaine, reversed methionine-induced endothelial dysfunction. Moreover, the FA promoted eNOS dimerization in cultured PAEC.
  
  
  CONCLUSIONS
  These data suggest that FA dose-dependently improves endothelial function in CAD via a mechanism independently of Hcy lowering. It may involve promotion of eNOS dimerization.
authors.affiliation: Department of Medical Biochemistry, University Hospital of Wales, Cardiff, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Moat
authors.forename: A
authors.initials: A
authors.lastname: Madhavan
authors.forename: S Y
authors.initials: SY
authors.lastname: Taylor
authors.forename: N
authors.initials: N
authors.lastname: Payne
authors.forename: R H
authors.initials: RH
authors.lastname: Allen
authors.forename: S P
authors.initials: SP
authors.lastname: Stabler
authors.forename: J
authors.initials: J
authors.lastname: Goodfellow
authors.forename: I F W
authors.initials: IF
authors.lastname: McDowell
authors.forename: M J
authors.initials: MJ
authors.lastname: Lewis
authors.forename: D
authors.initials: D
authors.lastname: Lang
mesh_terms: D000368:Aged; D001622:Betaine / Q000097:blood / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage* / Q000097:blood; D006397:Hematinics / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D002316:Cardiotonic Agents; D006397:Hematinics; D001622:Betaine; D005492:Folic Acid