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From Northwest Territories, Canada:

I have type 1 diabetes, and recently my doctor ordered that my homocystine level be measured. What is homocystine? How will the test results be used?


It's rather a long and complicated story, but very briefly, homocystine is a normal amino acid. However, raised blood levels, particularly in people with type 2 diabetes has, in the last few years, come to be regarded as a reliable index of inflammation and particularly of incipient blood vessel complications in the eye, the kidney and the heart. It has not achieved quite the emphasis in this country that it has in Europe in part because simpler tests like that for C-reactive protein or LDL cholesterol seemed to give the same information rather more easily. There was a possibility however that hyperhomocysteinemia was a cause of vascular complications as well as an index of it. See Guilland JC, Favier A, Potier de Courcy G, Galan P, Hercberg S. Hyperhomocysteinemia: an independent risk factor or a simple marker of vascular disease? Pathol Biol (Paris). 2003 Mar;51(2):101-10.

One of the reasons for this suspicion came from the observation that children with a rare inborn metabolic disease called homocystinuria were especially susceptible to strokes. To make the story even more complex, one of the enzymes that is responsible for the initial breakdown of homocysteine in the liver is folic acid dependent which explains the growing vogue in Britain to give folic acid supplements to all people with type 2 diabetes prophylactically. You can even take the argument a step further by supposing that the vascular complications of diabetes are in part due to malnutrition for which there is indeed some other evidence.


[Editor's comment: Homocystine and homocysteine are very closely related compounds. Although technically they are different, for the purposes of this discussion they can be considered interchangeable. WWQ]

Original posting 3 Aug 2003
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