Metabolomic Evaluation of the Consequences of Plasma Cystathionine Elevation in Adults with Stable Angina Pectoris

J Nutr. 2017 Sep;147(9):1658-1668. doi: 10.3945/jn.117.254029. Epub 2017 Aug 9.


Background: An elevated circulating cystathionine concentration, which arises in part from insufficiencies of vitamin B-6, B-12, or folate, has been shown to be associated with cardiovascular disease (CVD) risk. Hydrogen sulfide (H2S) is a gasotransmitter involved in vasodilation, neuromodulation, and inflammation. Most endogenously produced H2S is formed by pyridoxal phosphate (PLP)-dependent enzymes by noncanonical reactions of the transsulfuration pathway that yield H2S concurrently form lanthionine and homolanthionine. Thus, plasma lanthionine and homolanthionine concentrations can provide relative information about H2S production in vivo.Objective: To determine the metabolic consequences of an elevated plasma cystathionine concentration in adults with stable angina pectoris (SAP), we conducted both targeted and untargeted metabolomic analyses.Methods: We conducted NMR and LC-mass spectrometry (MS) metabolomic analyses on a subset of 80 plasma samples from the Western Norway Coronary Angiography Cohort and selected, based on plasma cystathionine concentrations, a group with high cystathionine concentrations [1.32 ± 0.60 μmol/L (mean ± SD); n = 40] and a group with low cystathionine concentrations [0.137 ± 0.011 μmol/L (mean ± SD); n = 40]. Targeted and untargeted metabolomic analyses were performed and assessed with the use of Student's t tests corrected for multiple testing. Overall differences between the cystathionine groups were assessed by untargeted NMR and LC-MS metabolomic methods and evaluated by partial least squares discriminant analysis (PLS-DA) with significant discriminating metabolites identified with 99% confidence.Results: Subjects with high cystathionine concentrations had 75% higher plasma lanthionine concentrations (0.12 ± 0.044 μmol/L) than subjects with low cystathionine concentrations [0.032 ± 0.013 μmol/L (P < 0.001)]. Although plasma homolanthionine concentrations were notably higher than lanthionine concentrations, they were not different between the groups (P = 0.47). PLS-DA results showed that a high plasma cystathionine concentration in SAP was associated with higher glucose, branched-chain amino acids, and phenylalanine concentrations, lower kidney function, and lower glutathione and plasma PLP concentrations due to greater catabolism. The high-cystathionine group had a greater proportion of subjects in the postprandial state.Conclusion: These data suggest that metabolic perturbations consistent with higher CVD risk exist in SAP patients with elevated plasma cystathionine concentrations.

Keywords: LC-MS; NMR; cardiovascular disease; cystathionine; hydrogen sulfide; metabolomics; vitamin B-6.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Alanine / analogs & derivatives
  • Alanine / blood
  • Amino Acids, Branched-Chain / blood
  • Angina, Stable / blood
  • Angina, Stable / etiology*
  • Blood Glucose / metabolism
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Cystathionine / blood*
  • Female
  • Glutathione / blood
  • Homocysteine / blood
  • Humans
  • Hydrogen Sulfide / blood
  • Kidney / metabolism
  • Male
  • Mass Spectrometry
  • Metabolic Networks and Pathways*
  • Metabolome
  • Middle Aged
  • Nutritional Status
  • Phenylalanine / blood
  • Pyridoxal Phosphate / blood
  • Risk
  • Sulfides / blood
  • Vitamin B Complex / blood
  • Vitamin B Deficiency / blood
  • Vitamin B Deficiency / complications


  • Amino Acids, Branched-Chain
  • Blood Glucose
  • Sulfides
  • Homocysteine
  • Vitamin B Complex
  • Cystathionine
  • Phenylalanine
  • Pyridoxal Phosphate
  • Glutathione
  • lanthionine
  • Alanine
  • Hydrogen Sulfide