Various forms of homocysteine and oxidative status in the plasma of ischemic-stroke patients as compared to healthy controls

Objectives: We compared various forms of plasma homocysteine (Hcy) including total Hcy (tHcy), free reduced Hcy (reHcy), free oxidized Hcy (oxHcy) and reHcy plus oxHcy between patients with acute/subacute-ischemic stroke and healthy controls. We also investigated whether the patients have increased oxidative stress. Design and methods: Using an in-tube derivatization method, we measured plasma levels of tHcy, reHcy and oxHcy in 55 ischemic-stroke patients (14 females and 41 males, median age 64) and 52 age-matched healthy subjects (15 females and 37 males, median age 60). We also measured plasma malondialdehyde (MDA, as lipid peroxidation marker) and oxygen-radical absorbance capacity (ORAC, as total antioxidant activity). Results: The plasma levels of reHcy and reHcy plus oxHcy and the ratio of reHcy to oxHcy were significantly higher in the patients than in the age-matched controls, whereas tHcy and oxHcy levels were not significantly different. The patients had a significantly higher level of MDA but a lower value of ORAC than that of controls. A significantly positive correlation was found in the levels of reHcy vs. MDA (r = 0.19, P< 0.03), whereas significant negative correlations were found for reHcy vs. ORAC (r = −0.30, P< 0.001) and free Hcy vs. ORAC (r = −0.30, P< 0.001). Conclusions: reHcy and reHcy plus oxHcy Hcy, rather than tHcy, are significantly elevated in patients with acute/subacute ischemic stroke. The elevated reHcy along with elevated MDA level and lowered ORAC value in the plasma of the stroke patients indicates an imbalance of antioxidant–prooxidant status in acute ischemic stroke