Book review of Homocysteine in Health & Disease

Book review of:"Homocysteine in Health and Disease," Eds: Ralph Carmel and Donald W. Jacobsen. New York, NY: Cambridge University Press, 2001, 510 pp., $150. ISBN 0521653193.

Hyperhomocysteinemia promotes hypercoagulation, and, as a vasculotoxin and neurotoxin, is a significant risk factor for cardiovascular, cerebrovascular, peripheral vascular, neuropsychiatric, and fetal morbidity and mortality. These conditions are usually preventable and treatable, according to cause, by vitamins B₁₂ and/or B₆ and/or folate. The chapters in this excellent, comprehensive book are authored by some of the leading homocysteine researchers and clinicians from all over the world.

After a preface by coeditors Carmel and Jacobsen, and a ìHistorical Overview and Recent Perspectivesî by Bridget and David Wilcker of Australia, the 40 chapters of the book are divided into seven outstanding sections: ìChemistryî; ìBiochemistry and Metabolismî; ìPhysiology"; "Clinical Chemistry"; "Genetic Disordersî; ìAcquired Disordersî; and ìClinical Consequences in Hyperhomocysteinemia.î

Of the 40 chapters, only two appeared less than fully up to date. The cobalamin chapter fails to discuss the diagnostic value of measuring serum holotranscobalamin, a commercially available clinical chemistry test that is not only a surrogate Schilling test, but can be the first laboratory indicator of negative vitamin B₁₂ balance years before total serum cobalamin becomes low, and of early B₁₂ deficiency sufficient to produce mild cognitive impairment correctable by B₁₂ therapy. The chapter on folate deficiency claims that the ìdefinition of folate deficiency is surprisingly elusive and susceptible to subjective interpretation.î In fact, it is neither when one has adequately reviewed the pertinent literature and applies the four stages of negative balance for any nutrient to folate deficiency, and the progression of clinical chemistry abnormalities which define each (see ìFolic Acidî chapter in ìModern Nutrition in Health and Disease, Ninth Ed.,î Eds. M. Shils et al., Philadelphia, Williams & Wilkins, 1999). Otherwise this text is up to date to June 2001. The only ìbookî with newer material is the Abstracts Book of the 3^rd International Conference on Homocysteine Metabolism, held in Sorrento, Italy, in August 2001.

Prof. Victor Herbert, M.D., J.D., M.A.C.P., F.R.S.M. (London)

V.H. CV #843BR. Herbert V. Book Review. "Homocysteine in Health and Disease," edited by Ralph Carmel and Donald W. Jacobsen. Cambridge University Press, New York, NY, Clin Chem 2002; 48 (6).