Vascular and cellular stress in inflammatory bowel disease: revisiting the role of homocysteine.
Moderate hyperhomocysteinemia is a complex trait commonly associated with inflammatory bowel disease (IBD). Nutritional deficiencies and genetic determinants have been identified as risk factors for moderate hyperhomocysteinemia, such as folate and vitamin B(12) deprivation and polymorphisms in the 5,10 methylenetetrahydrofolate reductase (MTHFR) encoding gene, respectively. Homocysteine has a crucial role in cellular stress, epigenetic events, inflammatory processes, and host-microbial interactions. Hyperhomocysteinemia might therefore influence the clinical history of IBD, including disease severity, susceptibility to particular enteric infections, and the risk for the development of colorectal cancer. In contrast, homocysteine metabolism does not seem to contribute to the greater risk of thrombosis in IBD subjects. Herein, we review the evidence linking homocysteine metabolism to the pathophysiology of IBD. Furthermore, we discuss the relevance of screening and treating folate and vitamin B(12) deficiencies in IBD subjects. Given the peculiar frequency of such deficiencies in IBD, normalizing vitamin levels should be an integral part of the management of these patients, especially those with active disease, history of intestinal resection, and/or treated with methotrexate.
Peyrin-Biroulet
Laurent
L
Inserm, U724, Laboratory of Cellular and Molecular Pathology in Nutrition, Faculty of Medicine, Nancy-Universitè Vandoeuvre-les-Nancy, F-54511, France.
Rodriguez-Guéant
Rosa-Maria
RM
Chamaillard
Mathias
M
Desreumaux
Pierre
P
Xia
Bing
B
Bronowicki
Jean-Pierre
JP
Bigard
Marc-André
MA
Guéant
Jean-Louis
JL
D000818:Animals; D005494:Folic Acid Deficiency / Q000150:complications; D006710:Homocysteine / Q000502:physiology*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications* / Q000209:etiology / Q000235:genetics; D015212:Inflammatory Bowel Diseases / Q000209:etiology*; D018384:Oxidative Stress; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology*; D014806:Vitamin B 12 Deficiency / Q000150:complications
D006710:Homocysteine