Diseases of sulphur metabolism: implications for the methionine-homocysteine cycle, and vitamin responsiveness.

Sixteen inherited human diseases are now recognized, affecting most of the major steps in sulphur metabolism. Studies of patients with three types of homocystinuria have demonstrated unequivocally the major role of cystathionine formation in degradation of homocysteine, and the importance of homocysteine remethylation. Methionine balance studies of normal subjects and of a sarcosine oxidase-deficient subject have shown the predominant role of creatine synthesis in methionine utilization and permitted assessment of the rate of oxidation of the methyl group of methionine. Together, the results demonstrate that once regulatory adjustments have been made the rate of methylneogensis is nicely controlled so that labile methyl groups are made available in amounts just sufficient to meet the needs for methionine. When excess methionine is ingested the four-carbon moiety is diverted into cystathionine, the methyl group is oxidized via sarcosine and the flow of partially oxidized one-carbon units is diverted away from 5-methyltetrahydrofolate toward CO2. Studies of cystathionine synthase-deficient patients demonstrate that the capacity to respond or not to respond to pyridoxine administration is genetically controlled, probably through structural differences in mutant cystathionine synthases. However, the properties of the enzyme crucial in conferring responsiveness have not yet been identified.