The role of homocysteine in the development of diabetic polyneuropathy and endothelial dysfunction

• Alexander S. Ametov
• Anyuta A. Kosyan

Abstract

According to the WHO, there are currently about 422 million people worldwide have diabetes mellitus. The rapid increase in the incidence of diabetes has led to an increase in the number of people with disabilities. In 2016 1.6 million deaths were caused by diabetes. This increase in disability and mortality is associated with complications of diabetes mellitus.

According to modern concepts, hyperglycemia plays an important role in the pathogenesis of diabetic polyneuropathy. However, the mechanisms of development of diabetic polyneuropathy are not fully revealed. It is known that not all cases of the onset and progression of diabetic polyneuropathy can be explained by traditional risk factors. Consequently, the search for the missing pathogenesis links that can cause progression of diabetic polyneuropathy remains an actual problem.

In recent years, accumulated data suggest an increased level of homocysteine (hyperhomocysteinemia) as a new risk factor aggravating the occurrence of diabetic complications. Many researchers in their observations showed a correlation between hyperhomocysteinemia and the severity of diabetic polyneuropathy. According to the researchers, cobalamin metabolism disorder in type 2 diabetes mellitus leads to an increase in homocysteine levels. Discruption of cobalamin metabolism is the result of taking a hypoglycemic medication, such as metformin. The role of hyperhomocysteinemia in the development of diabetic complications, including diabetic polyneuropathy, is to activate an oxidative stress. In addition, endothelium function is impaired under the influence of elevated homocysteine levels. Oxidative stress and endothelial dysfunction are the main interrelated mechanisms in the development of diabetic polyneuropathy. The review describes pathogenetic processes during which hyperhomocysteinemia disrupts the redox reaction and endothelium function, worsening the course of diabetic polyneuropathy.

Keywords:hyperhomocysteinemia, diabetic polyneuropathy, endothelial dysfunction, oxidative stress

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)