Contribution of the Cystathionine β-Synthase Gene (844ins68) Polymorphism to the Risk of Early-onset Venous and Arterial Occlusive Disease and of Fasting Hyperhomocysteinemia

Raffaella de Franchis; Isabella Fermo; Giuseppina Mazzola; Gianfranco Sebastio; Giovanni Di Minno; Antonio Coppola; Generoso Andria; Armando D’Angelo

doi:10.1055/s-0037-1614070

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2000; 84(04): 576-582
DOI: 10.1055/s-0037-1614070

Review Article

Schattauer GmbH

Contribution of the Cystathionine β-Synthase Gene (844ins68) Polymorphism to the Risk of Early-onset Venous and Arterial Occlusive Disease and of Fasting Hyperhomocysteinemia

Raffaella de Franchis

¹From the Department of Pediatrics, University “Federico II”, Naples, Italy

,

Isabella Fermo

²Department of Laboratory Medicine, Istituto Scientifico IRCCS H S. Raffaele, Milano, Italy

,

Giuseppina Mazzola

³Coagulation Service and Thrombosis Research Unit, Istituto Scientifico IRCCS H S. Raffaele, Milano, Italy

,

Gianfranco Sebastio

¹From the Department of Pediatrics, University “Federico II”, Naples, Italy

,

Giovanni Di Minno

⁴Department of Clinical and Experimental Medicine, University “Federico II”, Naples, Italy

,

Antonio Coppola

⁴Department of Clinical and Experimental Medicine, University “Federico II”, Naples, Italy

,

Generoso Andria

¹From the Department of Pediatrics, University “Federico II”, Naples, Italy

,

Armando D’Angelo

³Coagulation Service and Thrombosis Research Unit, Istituto Scientifico IRCCS H S. Raffaele, Milano, Italy

› Author Affiliations

Abstract

Summary

The frequency of the heterozygous 844ins68 mutation of the cystathionine β-synthase (CBS) gene and of its association with the homozygous C677T transition of the methylenetetrahydrofolate reductase (MTHFR) gene, plasma fasting tHcy, folate and vitamin B₁₂ levels were evaluated in 309 consecutive patients with objectively diagnosed early-onset venous (n = 200) or arterial thromboembolic disease (n = 109) recruited over 25 months in Milan (North Italy) and Naples (South Italy). The above gene polymorphisms were also evaluated in a population of 787 unmatched controls, 204 of whom – similar to patients for age- and sex-distribution – had fasting tHcy, vitamins and activated protein C resistance measured in their plasma.

Moderate fasting hyperhomocysteinemia was detected in 15.5% of patients and in 5.9% of 204 controls (Mantel-Haenszel OR after stratification for type of occlusive disease and gender: 2.88; 1.48–5.32). The frequencies of the 677TT mutation of the MTHFR gene and of the heterozygous 844ins68 insertion of the CBS gene were not significantly different in the patient (19.4% and 6.9%) and the control population (16.5% and 7.8%), but the association of the two gene polymorphisms – found in 3.9% of patients and in 1.1% of controls – was significantly associated with an increased risk of venous or arterial occlusive diseases (RR = 3.63; 1.48–8.91). The MTHFR 677TT mutation (RR: 6.92; 3.86–12.4) and its association with the 844ins68 insertion (RR: 21.9; 8.35–57.4), but not the isolated insertion (RR: 0.71), were more frequent in patients and controls with fasting hyperhomocysteinemia than in normohomocysteinemic subjects, irrespective of the type of occlusive disease (venous or arterial). When adjusted for determinants of hyperhomocysteinemia in the patient and the control populations (generalized linear model), fasting tHcy levels were significantly higher in subjects with association of the two gene abnormalities (24.2 ± 3.8 µmol/L) than in subjects with the MTHFR 677TT mutation only (14.0 ± 5.8 µmol/L, p = 0.004). Activated protein C resistance was significantly more prevalent in venous patients (9.9%) than in controls (3.9%, OR = 2.69; 1.08–6.88). Six of 21 venous patients with APCresistance also had hyperhomocysteinemia (RR = 5.04; 0.68–37.6), but isolated fasting hyperhomocysteinemia retained statistical significance for the association with venous occlusive disease (RR = 2.84; 1.34–6.01).

Heterozygosity for the 844ins68 mutation of the CBS gene is not per se a risk factor for premature arterial and/or venous occlusive diseases. However, when detected in combination with thermolabile MTHFR, it increases by almost 4-fold the risk of occlusive diseases (arterial and/or venous), by increasing the risk and the degree of fasting hyperhomocysteinemia.

Key words

Vascular occlusive disease - thrombosis - APC-resistance - hyperhomocysteinemia - methylenetetrahydrofolate reductase - cystathionine β-synthase

Full Text

References

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