Aliza T. Brown, PhD, Hongjiang Chen, MD, Joseph A

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Plasma homocysteine measurements after carotid artery manipulation and clamping in a rat CEA model Aliza T. Brown, PhD, Hongjiang Chen, MD, Joseph A. Davis, MD, Irfan Qureshi, Carlos P. Cruz, MD, Lionel A. Poirier, PhD, John F. Eidt, MD, Mohammed M. Moursi, MD Journal of Vascular Surgery Volume 40, Issue 4, Pages 796-802 (October 2004) DOI: 10.1016/j.jvs.2004.07.011 Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 1 Plasma homocysteine between groups over time. Homocysteine levels in no anesthesia (NA) compared with anesthesia only (AO) indicate low levels compatible with control rats and no differences between these groups. With the carotid endarterectomy (CEA) there was a significant increase in plasma homocysteine at P ± .01 compared with all groups, including NA, AO, skin incision groups open/close (OC) and open/expose carotid/close (O/E/C), rats that received a femoral endarterectomy (FEA), and a clamp-only (CO) group. The increase in homocysteine concentration that was observed with CEA remained at 4 and 6 weeks. The CO group had a significant increase over other non-CEA groups except for the NA and AO group. Means are ±SEM. *Indicates CEA group means P < .05 versus all other treatment groups. tIndicates CO group means P ≤ .05 versus O/C, O/E/C, and FEA. Journal of Vascular Surgery 2004 40, 796-802DOI: (10.1016/j.jvs.2004.07.011) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 2 Positive correlation of plasma homocysteine and red blood cell folate. Regression analysis between plasma homocysteine and corresponding red blood cells indicate a significant correlation. Journal of Vascular Surgery 2004 40, 796-802DOI: (10.1016/j.jvs.2004.07.011) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 3 Hepatic MTHFR enzyme activity compared between carotid endarterectomy (CEA) operated and anesthesia only (AO). The stimulative response of the CEA injury produced an overall increase in nmol/h of enzyme activity for MTHFR, indicating an increase in remethylation in the homocysteine metabolism pathway. Means are ±SEM. *Indicates P < .05. Journal of Vascular Surgery 2004 40, 796-802DOI: (10.1016/j.jvs.2004.07.011) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 4 Hepatic cystathionine β-synthase (CBS) enzyme activity compared between carotid endarterectomy (CEA) operated and anesthesia only (AO). The stimulative response of the CEA injury produced an overall increase in U/mg of enzyme activity for CBS, indicating an increase in the transsulfuration pathway in homocysteine metabolism. Means are ±SEM. *Indicates P < .05. Journal of Vascular Surgery 2004 40, 796-802DOI: (10.1016/j.jvs.2004.07.011) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions

Fig 5 Positive correlation of hepatic MTHFR and folate levels. Folate, a co-factor for MTHFR in the homocysteine metabolism pathway, was positively correlated with levels of MTHFR, indicating that endarterectomy surgical stress induced a hepatic change that altered metabolic enzymes as well as folate levels. Journal of Vascular Surgery 2004 40, 796-802DOI: (10.1016/j.jvs.2004.07.011) Copyright © 2004 The Society for Vascular Surgery Terms and Conditions