Since the 1960s, it has been known that elevated levels of homocysteine (Hcy), 1 resulting from mutations in genes encoding Hcy-metabolizing enzymes, are harmful to humans (1, 2). During the past decade it has been established that even a mild increase in Hcy level is a risk factor for cardiovascular disease and stroke in humans (3, 4) and predicts mortality independently of traditional risk factors in patients with coronary artery disease (5). Plasma Hcy is also a risk factor for neurodegenerative disorders, such as dementia and Alzheimer's disease (6). In tissue cultures, Hcy does not support growth and induces apoptotic death in human endothelial cells (7). Animal and cell culture studies have shown that Hcy induces cell death and potentiates amyloid -peptide toxicity in neurons (8).In humans, Hcy, formed from dietary methionine as a byproduct of cellular methylation reactions, is detoxified by folic acid-and vitamin B 12 -dependent re-methylation to methionine (2) or vitamin B 6 -dependent trans-sulfuration to cysteine (1). Whereas Hcy is formed in all human organs, most of its detoxification occurs in the liver and kidneys. Detoxification of Hcy in human vascular tissues and skin occurs only by re-methylation; enzymes of the trans-sulfuration pathway are not expressed in these tissues (9).Hcy is perhaps the most reactive amino acid in biological systems (1, 2). In addition to re-methylation to methionine or trans-sulfuration to cysteine (via cystathionine), Hcy is also metabolically converted to Hcy-thiolactone, S-nitroso-Hcy, AdoHcy, Hcy-containing disulfides, or homocysteic acid, each of which has been implicated in the pathology of hyperhomocystinemia (1, 10).Because of its similarity to the protein amino acid methionine, Hcy can exert its biological effects by interfering with protein biosynthesis (10 -18). For example, Hcy is metabolized to Hcy-thiolactone by methionyl-tRNA synthetase in a two-step reaction (19,20). In the first step (Reaction 1), methionyl-tRNA synthetase catalyzes activation of Hcy with ATP, which yields methionyl-tRNA synthetase (MetRS)-bound homocysteinyl adenylate.The second step (Reaction 2), in which the side chain thiolate of Hcy reacts with the activated carboxyl group of Hcy, yields Hcy-thiolactone.The energy of the anhydride bond in HcyϳAMP is conserved in the thioester bond in Hcy-thiolactone. Because of this, Hcythiolactone reacts with proteins, forming Hcy-containing adducts, in which the carboxyl group of Hcy is linked by an amide bond with ⑀-amino group of a protein lysine residue (21-23).Originally discovered in cultured cells (21-23), protein Nhomocysteinylation is now known to occur in humans (10,(12)(13)(14)(15)(16)(17)(18). Both Hcy-thiolactone (13,24,25) and N-linked proteinHcy (12,16,26,27) have been demonstrated in human blood. About 70% of circulating Hcy is N-linked to blood proteins, mostly hemoglobin and albumin (26). A protective mechanism against protein N-homocysteinylation appears to exist in humans (28,29).Two major forms of albumin exist in circulatio...