Key result
High levels of homocysteine induce mitochondrial permeability transition and reactive oxygen species generation, leading to matrix metalloproteinase activation and myocardial matrix remodeling.
Hyperhomocysteinemia contributes to cardiovascular pathology by inducing mitochondrial dysfunction, ROS generation, and matrix metalloproteinase activation, leading to adverse myocardial remodeling.
Hyperhomocysteinemia may drive adverse remodeling via mitochondrial pathways; leaves open whether targeted lowering alters clinical outcomes.
High levels of homocysteine (Hcy), known as hyperhomocysteinmia (HHcy), are correlated with an increase in extracellular matrix remodelling (ECM) via the matrix metalloproteinases (MMPs) and plasminogen/plasmin system. This results in an increase deposition of collagen that leads to endothelial-myocyte (EM) and myocyte-myocyte (MM) uncoupling; the physiological consequences are a plethora of cardiovascular pathologies. Homocysteine-induced increase in intracellular and mitochondrial Ca(2+) plays an important role in increasing reactive oxygen species (ROS) within mitochondria and instigating mitophagy within the cell. This occurs via several Hcy-mitigated processes: agonizing N-methyl-d-aspartate receptor-1 (NMDA-R1), decreasing expression of peroxisome proliferator activator receptor (PPAR) [thereby increasing oxidation], impairing Ca(2+) handling via Na(+)/Ca(2+) exchanger (NCX1) and Sarco endoplasmic reticulum Ca(2+) ATPase (SERCA-2a). The end result is an increase in ROS that directly or indirectly lead to MMP activation within mitochondria or the cytoplasm. Hcy induces a mitochondrial permeability transition that allows MMPs to be released from mitochondria thereby metabolizing matrix and impairing cardiac function. Further work remains to be elucidated concerning the specific mitochondrial mitophagic mechanisms under which matrix metabolism and remodelling occurs. Moreover, the therapeutic implications of NMDA and PPAR ligands are some promise to patient.
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Vacek et al. (2011) conducted a review in Hyperhomocysteinemia and cardiovascular pathologies. Homocysteine (hyperhomocysteinemia) was evaluated. High levels of homocysteine induce mitochondrial permeability transition and reactive oxygen species generation, leading to matrix metalloproteinase activation and myocardial matrix remodeling.
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