How we wish to be cited:
Neuman M. Homocysteine in moderation [editorial]. Rondel 2003; 17. URL: http://www.rondellen.net

Homocysteine in moderation

Monica Neuman was born in Poland 1965; she came to Sweden 1983. She was trained in chemistry and bacteriology in Gothenburg and defended her PhD thesis in 1995 – on antibacterial tensides, degradable by enzymes. A few years later, she turned from university research to communication and trading. She came to DPC Scandinavia in 2002 and is now product manager for diagnostics of diseases within vascular, immune and metabolic systems. In off-work hours, she shares the care of four children and a middle-aged house with her husband.

Homocysteine provides a superb marker for deficiency of cobalamin and/or folate. However, this marker has limitations. Elevated homocysteine levels without bearing on vitamin stores are common; impaired renal function is the most frequent cause of "false positives". In contrast, homocysteine levels below the decision range of 15 micromoles per liter are thought to exclude cobalamin/folate deficiency of clinical significance. It is essential to mind these basic guidelines in the interpretation of the conference Homocysteine Metabolism in Basle (cf 1-3).

The manufacturers of laboratory kits have a delicate quest – to translate the possibilities opened by basic research into clinical routine. We receive messages from basic scientists, from clinical chemists, from practitioners, and to some degree even from patients. The industrial large-scale production of equipment and kits is our primary task. Admittedly, we also send own messages back to the senders mentioned. It is not for us to decide the role of homocysteine in human metabolism – risk marker, risk determinant, or risk factor. Our mission is to provide cost-effective, standardized, sensitive, accurate and reliable assessments of factors essential for health and disease.

The interdisciplinary meeting of Homocysteine Metabolism in Basle provided me with ideas from epidemiologists and clinicians from many fields. I noted with deep satisfaction that homocysteine is about to be established as screening test for deficiency states of cobalamin and folate, with more specific but less sensitive "reflex tests" (S-folate, S-B12, S-MMA) in the subsequent process of verification or falsification. My personal conclusion is that the era of classical advertisement is ending. The future marketing belongs to professionals, who are prepared to listen and learn from each other. The realities will probably still be complex and confusing, but on a higher level.

Monika Neuman, PhD
DPC Scandinavia
Kärragatan 8
SE-431 53 Mölndal, Sweden
E-mail: monika.neuman@dpc.se

References

  1. Bolander-Gouaille C. Current state of homocysteine research [debate]. Rondel 2003; 16. URL: http://www.rondellen.net/debate16_eng.htm
  2. Norberg B. Painful sensory neuropathy [editorial]. Rondel 2003; 16. URL: http://www.rondellen.net/publisher16_eng.htm
  3. Nilsson M. Cobalamin communication – receivers and senders [editorial]. Rondel 2003; 15. URL: http://www.rondellen.net/publisher15_eng.htm

Published October 10, 2003