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Vitamin B Therapy, Methionine Synthase and Cystathionine Beta-Synthase (CBS) Gene Polymorphisms, and Their Impact on
Neetu Kataria1, Vasantha C Kalyani2, Shashi Ranjan Mani Yadav3
1Nursing, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Insights
Vitamin B therapy significantly lowered homocysteine levels in ischemic stroke patients. This treatment also improved clinical outcomes and addressed vitamin deficiencies, aiding in faster recovery.
Area of Science:
- Neurology
- Genetics
- Nutritional Science
Background:
- Hyperhomocysteinemia is more prevalent in hilly regions, potentially linked to high altitude and dehydration.
- Limited research exists on methionine synthase (MS) and cystathionine beta-synthase (CBS) gene polymorphisms in Southeast Asian stroke patients.
- Investigating genetic factors and homocysteine levels is crucial for understanding stroke in diverse populations.
Purpose of the Study:
- To evaluate the efficacy of vitamin B therapy in reducing homocysteine levels in ischemic stroke patients.
- To determine the prevalence and impact of MS and CBS gene polymorphisms on treatment outcomes and cardiovascular events.
- To explore the relationship between vitamin deficiencies, dietary habits, and hyperhomocysteinemia.
Main Methods:
- A randomized controlled trial involving 90 ischemic stroke patients receiving either vitamin B therapy (B6, B9, B12) or standard care for four months.
- Assessment of genetic polymorphisms using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).
- Monitoring of National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) scores, homocysteine, vitamin B12, and folate levels.
Main Results:
- The vitamin B group showed a significant reduction in homocysteine levels (8.6 vs. 19 µmol/L) compared to the standard therapy group (p < 0.001).
- Improved mRS scores and elevated vitamin B12 and folate levels were observed in the vitamin B group.
- Vitamin B12 deficiency and low green vegetable intake were identified as key predictors of hyperhomocysteinemia.
Conclusions:
- Vitamin B therapy is effective in reducing homocysteine levels and addressing deficiencies in ischemic stroke patients.
- Genetic polymorphisms (MS-AG and CBS-TT) were found to be less prevalent in this specific hilly region population.
- Vitamin B therapy contributes to reduced stroke severity, functional disability, and rehospitalization, promoting faster patient recovery.
Background:
Hyperhomocysteinemia cases were found to be higher in hilly regions due to factors such as high altitude and dehydration. There is limited research on methionine synthase (MS) and cystathionine beta-synthase (CBS) gene polymorphisms among stroke patients in Southeast Asia. The primary objective of the study was to determine the efficacy of vitamin B therapy in lowering homocysteine levels, and the secondary objective was to investigate the prevalence and impact of MS and CBS gene polymorphisms on treatment outcomes and cardiovascular events.
Methods:
A randomized controlled trial was conducted on 90 ischemic stroke patients at a tertiary care hospital, Rishikesh, India. Participants received either vitamin B therapy (B6, B9, B12) or standard therapy for four months. Tools were genetic polymorphisms (polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)) testing, National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores, mean homocysteine, mean vitamin B12, and mean folate levels.
Results:
The prevalence of MS-AG and CBS-TT polymorphism frequencies was 6% and 12%, respectively. At four months, the vitamin group showed a significant reduction in homocysteine as 8.6 vs. 19 µmol/L in standard therapy, improved mRS scores, and improved vitamin B12 and folate levels with p < 0.001. Vitamin B12 deficiencies and green vegetable intake were key predictors of hyperhomocysteinemia. Clinical outcomes included one recurrent stroke, eight cardiovascular events, and six vascular deaths.
Conclusion:
Our observations indicated that vitamin B therapy effectively reduced homocysteine and addressed deficiencies in ischemic stroke patients. However, genetic polymorphism was found to be less prevalent in this hilly region. Combining the role of vitamin B on homocysteine, along with reducing stroke severity and functional disability, leads to early recovery of the stroke patient and reduces rehospitalisation.
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