Armando D'Angelo, MD; Isabella Fermo, PhD; Silvana Vigano'D'Angelo, MD
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D'Angelo A, Fermo I, Vigano'D'Angelo S. Methionine Loading, Vitamin B6 Status, and Premature Thromboembolic Disease. Ann Intern Med. 1996;125:419-420. doi: 10.7326/0003-4819-125-5-199609010-00013
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Published: Ann Intern Med. 1996;125(5):419-420.
As suggested by Dr. Bostom, we reevaluated the PML total homocysteine data in our patients as the net increase above fasting levels (change in PML). Determinations of PML total homocysteine levels were available in 19 of the 23 hyperhomocysteinemic patients, 10 with normal and 9 with elevated fasting total homocysteine levels (14.3 ± 3.2 µmol/L compared with 36 ± 25.6 µmol/L; P = 0.001; Mann-Whitney rank test). Change in PML was 40.5 ± 6.8 µmol/L in patients with normal fasting homocysteine levels and 34.1 ± 21.1 µmol/L in those with elevated levels (P = 0.061). Changes in PML exceeding the 95th percentile of the distribution in control men (36.4 µmol/L) and women (30.0 µmol/L) were, by definition, seen in all patients with normal fasting homocysteine levels but in only 3 of the 9 patients with elevated fasting levels (P = 0.0031; Fisher exact test). A family history of hyperhomocysteinemia was investigated in 10 patients (6 with elevated fasting total homocysteine levels) and confirmed in 8 (5 with elevated fasting total homocysteine levels). Because we did not determine pyridoxal 5′-phosphate levels, deficiency of this substance cannot be ruled out as the pathogenic mechanism of methionine intolerance in the four families with potential trans-sulfuration defects.
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