Ovlivnění plazmatické hladiny homocysteinu u pacientů s Parkinsonovou chorobou terapií L-DOPA a entacaponem

Introduction: Homocysteine (HCY) is a risk factor for vascular diseases, cognitive impairment and dementia. Peripheral metabolism of L-DOPA via enzyme catechol-O-methyltransferase (COMT) is one of the possible sources of HCY. Some retrospective studies showed increased plasma HCY concentrations in patients suffering from Parkinson's disease (PD) and long-term treatment with L-DOPA. The aim of the study was to assess association between regular L-DOPA treatment and plasma HCY levels in Parkinson's disease patients and the impact of additional treatment by the COMT inhibitor (entacapone). Methods: Patients were divided into 3 groups: 1 - patients who received long-term treatment with L-DOPA with added entacapone (30 patients, aged 50-82 years, mean 68,5 ± 8,5); 2 - L-DOPA naive patients newly treated with L-DOPA and entacapone (10 patients, aged 56-74 years, mean 67,7 ± 6,6); 3 - control group of subjects without any neurodegenerative disease who were not treated with L-DOPA and entacapone (21 patients, aged 38-78 years, mean 51,7 ± 11,1). Results: In Group 1 the mean plasma HCY concentration was 17,6 ± 6,6 (9,2-44,4) μmol/l and 8 weeks after adding entacapone it reached 16,4 ± 5,5 (7,4-31,1) μmol/l. In Group 2 the mean plasma HCY level was 14,6 ± 4,7 (8,9-22,1) μmol/l and 8 weeks after combined therapy of L-DOPA and entacapone it reached 15,1 ± 7,3 (8,1-31,1) μmol/l. In control group the mean plasma HCY level was 9,7 ± ± 2,8 (6,6-16,5) μmol/l. Discussion: Results of this study confirm, that patients with long-term treatment with L-DOPA have increased plasma HCY concentrations. The combined treatment with L-DOPA and entacapone, however, do not significantly decrease HCY plasma levels.