Inherited defects of B12 metabolism

DNA and other strands: the making of a human geneticist

This article--a mini-memoir--focuses on the first half of my half-century-long career as a human geneticist: its accidental beginnings; its early bad and then good fortunes at the National Institutes of Health; its serendipitous successes and career-making scientific productivity at Yale; and its incalculable fortuity in the form of the large number of talented and resourceful mentors, colleagues, postdoctoral fellows, graduate students, and technicians who worked with me. These years acted as a launchpad for positions of visibility and leadership that followed them. My personal odyssey, which began in Madison, Wisconsin, and meandered with no fixed plan to New York, Bethesda, New Haven, and Princeton, has offered me life views as a human and medical geneticist that are panoramic, splendid, and indelible. I doubt that many people have been as fortunate as I have been in the professional life I have lived--and continue to live.

Are neuropsychiatric manifestations of folate, cobalamin and pyridoxine deficiency mediated through imbalances in excitatory sulfur amino acids?

Folate, cobalamin and pyridoxine deficiency are associated with psychiatric or neurological symptomatology. Disturbances in sulfur amino acid metabolism leading to accumulation of homocysteine occurs in all three conditions as the metabolism of homocysteine depends on enzymes requiring these vitamins as cofactors. Oxidation products of homocysteine (homocysteine sulfinic acid and homocysteic acid) and cysteine (cysteine sulfinic acid and cysteic acid) are excitatory sulfur amino acids and may act as excitatory neurotransmitters, whereas taurine and hypotaurine (decarboxylation products of cysteic acid and cysteine sulfinic acid) may act as inhibitory transmitters. Homocysteic acid and cysteine sulfinic acid have been considered as endogenous ligands for the N-methyl-D-aspartate (NMDA) type of glutamate receptors. The profile of these sulfur amino acid neurotransmitters could be altered in a similar fashion in states of decreased availability of folate, cobalamin or pyridoxine. It is proposed that the mechanism of neuropsychiatric manifestations in all three conditions result from a combination of two insults to homocysteine catabolism in the brain.

Improved distribution analysis of cobalamins and cobalamin analogues in human plasma in which the use of thiol-blocking agents is a prerequisite

In this paper the quantitative analysis of cobalamins and cobalamin analogues in human plasma by means of high performance liquid chromatography (HPLC) and radioisotope dilution assay (RIDA) is described. Current methods for the extraction of cobalamins from plasma proved impracticable due to the selective loss of hydroxo- and sulphitocobalamin, caused by concomitant reduction to the Co2+ form and tight binding to thiol groups of denatured plasma proteins. Although this process can be prevented by exchange of the hydroxyl group with sulphite, azide or nitrite ions, further separation of the respective cobalamin forms from the other endogenous cobalamins by HPLC proved to be impossible. Efficient extraction of hydroxo- and sulphitocobalamin has been obtained in the presence of the thiol-blocking agent N-ethylmaleimide, which does not interfere with the subsequent chromatographic separation of any of the plasma cobalamin forms. The use of R-binder free Intrinsic Factor and salivary R-binder separately as binding substances in RIDA made it possible to analyse the distribution of biologically active cobalamins as well as cobalamin analogues over the various HPLC fractions. Analyses are reported of 15 normal human plasma samples, in which the major components were found to be methylcobalamin (46.9 +/- 4.5%, mean +/- SD) and hydroxocobalamin (40.4 +/- 7.1%, mean +/- SD). Analyses of plasma extracts in the absence of N-ethylmaleimide showed a gross relative overestimation of the amount of methylcobalamin, due to loss of hydroxocobalamin during the extraction procedure. Cobalamin analogues appeared to be evenly distributed over the cobalamin fractions in a pattern almost similar to that of the biologically active forms.

[Vitamin B12 as a biologically active model compound]

A critical review on corrinoid biochemistry and physiology is presented. This includes: chemical synthesis of biologically important organocorrinoids and the correlation between their structures and coenzymatic activity; forms, distribution and transport of physiologically active corrinoids; methylcobalamin- and adenosylcobalamin-dependent enzymatic reactions and their physiological functions; and steric course of the adenosylcobalamin-dependent enzymatic rearrangements. Special attention is paid to the mechanisms of adenosylcobalamin-dependent enzymatic reactions.

Cycloleucine-induced vacuolation of myelin is associated with inhibition of protein methylation

Chickens injected with cycloleucine developed vacuolation of myelin similar to that seen in humans with vitamin B12 deficiency. Cycloleucine, an inhibitor of the formation of S-adenosylmethionine, decreased the incorporation of methyl groups into methylarginine in myelin basic protein in vivo. The need for methylcobalamin for the conversion of homocysteine to methionine and the requirement that myelin basic protein may be methylated, offer a rational explanation for the myelin lesions observed in cases of vitamin B12 deficiency where there is increasing evidence that methyl-, rather than adenosylcobalamin is required to prevent dysmyelination.

Newer aspects of pernicious anemia

Although readily treatable with vitamin B12, pernicious anemia continues to captivate investigative endeavors of those interested in the pathophysiology and pathogenesis of this disorder. Notable advances have been made in understanding properties of intrinsic factor, vitamin B12-binding proteins, structure and de novo synthesis of vitamin B12, mechanism of action of vitamin B12-dependent enzymes in man, and metabolic consequences of reduced activities of these enzymes in pernicious anemia. Similarly, newer morphological observations have given information regarding pathogenesis of some of the cytological abnormalities found in megaloblasts, and recent cytochemical studies have shed light on abnormalities of nuclear and cytoplasmic constituents in vitamin B12-deficient cells. Both cellular and humoral factors may contribute to immune-mediated processes in pernicious anemia, although as yet, it has not been established with certainty that pernicious anemia is an autoimmune disorder. As we look ahead, it will be important to define the process or processes responsible for atrophic gastritis, which is the pathophysiological basis of pernicious anemia. Likewise, advances in biophysics used in the study of cell membranes, cell surface phenomena, and metallic ion transport may find applicability in the study of pernicious anemia and perhaps provide further insights into metabolic abnormalities responsible for the development of megaloblastosis.

Deficient cytochrome b5 reductase activity in nontoxic goiter with iodide organification defect

A 37-yr-old woman with nontoxic goiter is presented. The thyroid 131I uptake at 3 and 24 hr were, respectively, 77.1% and 81.4% dose. Thiocyanate discharged 65.5% of the accumulated 131I in 30 min. In vitro organification of iodine in the thyroid homogenate from the patient was impaired and it was restored to normal by the addition of H2O2, glucose, and glucose oxidase system, FAD, or reduced cytochrome b5. Riboflavin, FMN, oxidized cytochrome b5, oxidized or reduced cytochrome c, NAD(H), and NADP(H) were ineffective in the reaction. The microsomal NADH-cytochrome b5 reductase activity was definitely low in the patient's thyroid. It was augmented to a normal level by incubation of the microsomes with FAD for 30 min or more. The activities of thyroid peroxidase, G6-PD, 6-PGD, catalase, protease, and NADPH-cytochrome c reductase were within normal limits. The major thyroid protein was normal thyroglobulin which could be readily iodinated in the presence of H2O2 and horse radish peroxidase. These findings suggest the correlation of an iodide organification defect with a cytochrome b5 reductase deficiency. Administration of high doses of FAD led to the restoration of thyroidal iodide organification mechanism associated with an increased thyroid hormone production and to a marked decrease of the goiter. Riboflavin was given without effect even at a high dosage level. Consequently, it seems likely that the deficient cytochrome b5 reductase activity in this patient is due to a defect in the biosynthesis of FAD, the coenzyme of the reductase, from riboflavin.

Vitamin B12 and the megaloblastic development

In patients with vitamin B(12) deficiency, phytohemagglutinin-stimulated cultured lymphocytes had little or no thymidylate synthetase activity. Ample activity was found in such lymphocytes from normal individuals and patients with folic acid deficiency or pernicious anemia in remission. It therefore appears that the megaloblastosis that is associated with vitamin B(12) deficiency is related to low thymidylate synthetase activity.