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Luckschander-Zeller N, Giani B, Doulidis PG, Plickert HD, Tichy A, Marculescu R, Schwendenwein I, Burgener IA. Implications of hypocobalaminemia as a negative prognostic marker in juvenile dogs with parvovirus enteritis. Front Vet Sci 2024; 11:1426664. [PMID: 39086759 PMCID: PMC11289667 DOI: 10.3389/fvets.2024.1426664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Canine Parvovirus 2 (CPV-2) infection poses a significant global health risk to susceptible dogs. Hypocobalaminemia, defined as reduced serum cobalamin (CBL) concentrations, is a recognized complication in chronic enteropathies in adult dogs but remains poorly understood in the context of acute enteropathies, especially in young dogs. The aim of this study was to investigate the frequency and severity of hypocobalaminemia in young dogs with parvovirus enteritis and evaluation of CBL as a predictor of outcome. Materials and methods Thirty client-owned dogs diagnosed with parvovirus infection and thirty healthy controls were enrolled. Clinical, hematological, and biochemical tests, including CBL and serum methylmalonic acid (MMA) concentrations, were assessed. Results Results indicated a significantly higher prevalence of hypocobalaminemia in dogs with parvovirus enteritis compared to healthy controls, as well as a significant correlation with a disease severity score. Moreover, survivors demonstrated higher CBL concentrations than non-survivors, suggesting an eventual prognostic value of CBL status. However, parenteral CBL supplementation showed no significant effect on serum CBL or MMA concentrations, highlighting potential challenges in CBL uptake at the cellular level. Discussion Hypocobalaminemia in this population is caused by multiple factors such as reduced nutritional absorption, gastrointestinal losses, and increased metabolic demands. Further research is needed to develop tailored management strategies, evaluate the effectiveness of CBL supplementation, and understand the mechanisms behind hypocobalaminemia in parvovirus infection.
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Affiliation(s)
- Nicole Luckschander-Zeller
- Department for Companion Animals and Horses, Division of Small Animal Internal Medicine, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Bettina Giani
- Department for Companion Animals and Horses, Division of Small Animal Internal Medicine, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Pavlos G. Doulidis
- Department for Companion Animals and Horses, Division of Small Animal Internal Medicine, University of Veterinary Medicine of Vienna, Vienna, Austria
| | | | - Alexander Tichy
- Department for Biomedical Sciences, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Clinical Institute for Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ilse Schwendenwein
- Central Laboratory, Department for Pathobiology, University of Veterinary Medicine of Vienna, Vienna, Austria
| | - Iwan A. Burgener
- Department for Companion Animals and Horses, Division of Small Animal Internal Medicine, University of Veterinary Medicine of Vienna, Vienna, Austria
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Knöpfli S, Goeschl B, Zeyda M, Baghdasaryan A, Baumgartner-Kaut M, Baumgartner MR, Herle M, Margreitter J, Poms M, Wortmann SB, Konstantopoulou V, Huemer M. The Benefit of Detecting Reduced Intracellular B12 Activity through Newborn Screening Remains Unclear. Int J Neonatal Screen 2024; 10:40. [PMID: 38920847 PMCID: PMC11203543 DOI: 10.3390/ijns10020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
Vitamin B12 (B12) deficiency (B12D) can have detrimental effects on early growth and development. The Austrian newborn screening (NBS) program targets inborn errors of cobalamin metabolism and also detects B12D. Of 59 included neonates with B12D suspected by NBS, B12D was not further investigated in 16 (27%) retrospectively identified cases, not confirmed in 28 (48%), and confirmed in 15 (25%) cases. NBS and recall biomarkers were recorded. Age at sampling of the dried blood spots for NBS and the 1st-tier methionine/phenylalanine ratio were the strongest parameters to predict B12D (67.4% correct allocations). No differences between cases with confirmed, unconfirmed, or unknown B12D or differences to norms were observed for growth and psychomotor development (Vineland III scales, phone interviews with parents of children between months 10 and 14 of life). B12 intake was below recommendations in most mothers. NBS can detect reduced intracellular B12 activity. No advantage of NBS detection and treatment regarding infant cognitive development or growth could be proven. Since conspicuous NBS findings cannot be ignored, and to prevent exposing newborns to invasive diagnostics, assessment of maternal B12 status during pregnancy seems advisable.
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Affiliation(s)
- Stella Knöpfli
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
| | - Bernadette Goeschl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Maximilian Zeyda
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Anna Baghdasaryan
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Margot Baumgartner-Kaut
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias R. Baumgartner
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
- Newborn Screening Switzerland, Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Julian Margreitter
- Department of Child and Adolescent Health, Division of Pediatrics I—Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Poms
- Newborn Screening Switzerland, Division of Clinical Chemistry and Biochemistry, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Division of Clinical Chemistry and Biochemistry, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland
| | - Saskia B. Wortmann
- University Children’s Hospital, Salzburger Landeskliniken and Paracelsus Medical University, 5020 Salzburg, Austria
| | - Vassiliki Konstantopoulou
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Austrian Newborn Screening, Medical University of Vienna, 1090 Vienna, Austria
| | - Martina Huemer
- Division of Metabolism and Children’s Research Center, University Children’s Hospital of Zurich, University of Zurich, 8032 Zurich, Switzerland; (S.K.)
- Department of Pediatrics, LKH Bregenz, 6900 Bregenz, Austria
- Vorarlberg University of Applied Sciences, Competence Area Healthcare and Nursing, 6850 Dornbirn, Austria
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3
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Nexo E, Parkner T. Vitamin B12-Related Biomarkers. Food Nutr Bull 2024; 45:S28-S33. [PMID: 38987873 DOI: 10.1177/03795721241227114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Adult vitamin B12 (B12) deficiency may present itself with nonspecific mainly neurological symptoms, and thus plasma biomarkers are often judged to be of major importance in the further diagnostic process. Four biomarkers are of special relevance: total B12, holotranscobalamin (the part of B12 bound to the active transport protein, transcobalamin, also named holoTC or active B12) and the 2 so-called metabolic markers that accumulate if B12 is lacking, methylmalonic acid (MMA) and homocysteine. OBJECTIVE This article briefly reviews the inherent limitation of biomarkers, discusses its use in establishing the diagnosis and cause of B12 deficiency, and when following or discontinuing treatment with B12. METHODS The review is based on published papers, but also on knowledge gained from working within the area. CONCLUSION It is concluded that a combination of a B12 and a metabolic marker, for example, total B12 and MMA, may prove most useful in daily practice. An unexpectedly high level of total B12 is most often of no clinical importance, though sometimes related to the presence of underlying cancer. Measurement of total B12 is of limited value in patients on treatment with pharmacological doses of B12 but may be helpful if B12 treatment is discontinued.
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Affiliation(s)
- Ebba Nexo
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
| | - Tina Parkner
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Aarhus University, Aarhus, Denmark
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4
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Ridefelt P, Saldeen J, Vogel M, Ceglarek U, Kiess W, Larsson A. Pediatric reference intervals for serum folate and cobalamin based on a European population without exposure to folic acid fortification. Scand J Clin Lab Invest 2024; 84:104-108. [PMID: 38511974 DOI: 10.1080/00365513.2024.2330918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
The aim of the present study was to define pediatric reference intervals for serum cobalamin and folate utilizing data generated from a population not exposed to food fortified with folic acid. Folate and cobalamin results analyzed by electrochemiluminescence immunoassay (Roche Cobas) were obtained from 2375 children (2 months to 17.99 years of age). The serum samples were collected between 2011 and 2015 as part of the LIFE (Leipzig Research Centre for Civilization Diseases) Child cohort study in Germany, where folic acid fortification of food is not mandated. These results were used to generate age- and gender-specific reference intervals presented as non-parametric 2.5 and 97.5 percentiles. Because of a subsequent restandardisation of the Roche folate assay in 2016, folate values were recalculated accordingly for adaptation to results obtained using the present calibration. In both genders, folate concentrations decreased continuously with age, whereas cobalamin concentrations peaked at five years of age and then declined. Teenage females had higher concentrations of cobalamin in the age group 12-17.99 years.
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Affiliation(s)
- Peter Ridefelt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Johan Saldeen
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, Leipzig, Germany
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
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5
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Fedosov SN, Nexo E. Macro-B12 and Unexpectedly High Levels of Plasma B12: A Critical Review. Nutrients 2024; 16:648. [PMID: 38474776 DOI: 10.3390/nu16050648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
A low total plasma vitamin B12 supports a clinical suspicion of B12 deficiency, while the interpretation of an unexpectedly normal/high level is marred by controversies. Here, we critically review current knowledge on B12 in blood plasma, including the presence of the so-called "macro-B12". The latter form is most often defined as the fraction of B12 that can be removed by precipitation with polyethylene glycol (PEG), a nonspecific procedure that also removes protein polymers and antibody-bound analytes. Plasma B12 includes B12 attached to transcobalamin and haptocorrin, and an increased concentration of one or both proteins almost always causes an elevation of B12. The total plasma B12 is measured by automated competitive binding assays, often incorrectly referred to as immunoassays, since the binding protein is intrinsic factor and not an antibody. An unexpectedly high level of B12 may be further explored using immunological measurements of haptocorrin and transcobalamin (optionally combined with e.g., size-exclusion chromatography). Nonspecific methods, such as PEG precipitation, are likely to give misleading results and cannot be recommended. Currently, the need for evaluation of a high B12 of unknown etiology is limited since other tests (such as measurements of methylmalonic acid) may better guide the diagnosis of B12 deficiency.
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Affiliation(s)
- Sergey N Fedosov
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
- Department of Clinical Medicine/Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ebba Nexo
- Department of Clinical Medicine/Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Wirthensohn M, Wehrli S, Ljungblad UW, Huemer M. Biochemical, Nutritional, and Clinical Parameters of Vitamin B12 Deficiency in Infants: A Systematic Review and Analysis of 292 Cases Published between 1962 and 2022. Nutrients 2023; 15:4960. [PMID: 38068819 PMCID: PMC10708449 DOI: 10.3390/nu15234960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Pooled data from published reports on infants with clinically diagnosed vitamin B12 (B12) deficiency were analyzed with the purpose of describing the presentation, diagnostic approaches, and risk factors for the condition to inform prevention strategies. An electronic (PubMed database) and manual literature search following the PRISMA approach was conducted (preregistration with the Open Science Framework, accessed on 15 February 2023). Data were described and analyzed using correlation analyses, Chi-square tests, ANOVAs, and regression analyses, and 102 publications (292 cases) were analyzed. The mean age at first symptoms (anemia, various neurological symptoms) was four months; the mean time to diagnosis was 2.6 months. Maternal B12 at diagnosis, exclusive breastfeeding, and a maternal diet low in B12 predicted infant B12, methylmalonic acid, and total homocysteine. Infant B12 deficiency is still not easily diagnosed. Methylmalonic acid and total homocysteine are useful diagnostic parameters in addition to B12 levels. Since maternal B12 status predicts infant B12 status, it would probably be advantageous to target women in early pregnancy or even preconceptionally to prevent infant B12 deficiency, rather than to rely on newborn screening that often does not reliably identify high-risk children.
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Affiliation(s)
- Miriam Wirthensohn
- Department of Pediatrics, Landeskrankenhaus Bregenz, 6900 Bregenz, Austria
| | - Susanne Wehrli
- Department of Psychosomatics and Psychiatry, University Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- University Research Priority Program “ITINERARE—Innovative Therapies in Rare Diseases”, University of Zurich, 8032 Zurich, Switzerland
| | - Ulf Wike Ljungblad
- Department of Pediatrics, Vestfold Hospital Trust, NO-3168 Tønsberg, Norway
| | - Martina Huemer
- Department of Pediatrics, Landeskrankenhaus Bregenz, 6900 Bregenz, Austria
- Division of Metabolism and Children’s Research Center, University Children’s Hospital Zurich, University of Zurich, 8032 Zurich, Switzerland
- Vorarlberg University of Applied Sciences, Competence Area Healthcare and Nursing, 6850 Dornbirn, Austria
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Aureli A, Recupero R, Mariani M, Manco M, Carlomagno F, Bocchini S, Nicodemo M, Marchili MR, Cianfarani S, Cappa M, Fintini D. Low Levels of Serum Total Vitamin B12 Are Associated with Worse Metabolic Phenotype in a Large Population of Children, Adolescents and Young Adults, from Underweight to Severe Obesity. Int J Mol Sci 2023; 24:16588. [PMID: 38068910 PMCID: PMC10706451 DOI: 10.3390/ijms242316588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/19/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
Vitamin B12 (or cobalamin) is an essential vitamin for DNA synthesis, fatty acid and protein metabolism as well as other metabolic pathways fundamental to the integrity of cells and tissues in humans. It is derived from the diet and mostly stored in the liver. Its deficiency has been associated with metabolic derangements, i.e., obesity, glucose intolerance, increased lipogenesis and metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH). However, data with regard to body weight across the whole spectrum (from underweight to severe obesity) in children and young individuals are scarce. The present study aims to describe the association between serum total vitamin B12 and body mass index (BMI) ranging from underweight to severe obesity in a large population of children, adolescents and young adults. This study also investigates associations with visceral adiposity, glucose and lipid metabolism and liver dysfunction. A cross-sectional, single-centre study was conducted at the Paediatrics and Endocrinology units of the "Bambino Gesù Children Hospital", a tertiary referral institution for eating disorders. Clinical charts were reviewed and 601 patients aged from 5 to 25 years were enrolled in order to analyse anthropometric, auxological, clinical, biochemical and liver ultrasound data using robust statistical approaches. Analyses were adjusted for potential confounders. A reduction in serum total B12 levels was associated with a linear increase in body weight, as expressed by WHO BMI SDS (r = -0.31, p < 0.001, BCa 95% -0.38, -0.24). Lower B12 levels were associated with higher waist circumference but only in pubertal girls (r = -0.33, p = 0.008, BCa 95% -0.53, -0.11). Hepatic insulin resistance was higher in males with lower B12 levels (B = -0.003 (-0.007, -0.0001), p = 0.039), but not in females, whereas whole-body insulin resistance was unaffected. Serum lipid profiles (total, HDL and LDL cholesterol and triglycerides) were not influenced by serum cobalamin levels. However, lower cobalamin levels were associated with higher grading of ultrasound-scored hepatic steatosis (ptrend = 0.035). Lastly, both AST and ALT showed a significant and direct correlation with total B12 levels in underweight (r = 0.22 and 0.24, p = 0.002 and <0.001, respectively) and severely obese subjects (r = 0.24 and 0.32, p = 0.002 and <0.001). In conclusion lower vitamin B12 levels are associated with higher body weight, adiposity and with worse metabolic health in a large population of children, adolescents and young adults.
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Affiliation(s)
- Alessia Aureli
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Rosanna Recupero
- Pediatric Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy;
- Pediatrics Department, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michela Mariani
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Melania Manco
- Research Area for Foetal Neonatal and Cardiological Sciences, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy
| | - Francesco Carlomagno
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Sarah Bocchini
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Mirella Nicodemo
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
| | - Maria Rosaria Marchili
- Department of Emergency Admission and General Pediatrics, “Bambino Gesù” Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Stefano Cianfarani
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Marco Cappa
- Research Area of Innovative Therapies in Endocrinopathies, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy;
| | - Danilo Fintini
- Endocrinology and Diabetology Unit, “Bambino Gesù” Children’s Hospital, IRCCS, 00146 Rome, Italy; (A.A.); (M.M.); (S.B.); (M.N.); (S.C.); (D.F.)
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Jassam N, Bancroft T, Luvai A, Mbagaya W, Barth JH. Vitamin B12 reference intervals on Beckman, Roche and Siemens analytical platforms. Ann Clin Biochem 2023; 60:417-422. [PMID: 37669635 DOI: 10.1177/00045632231202211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Vitamin B12 status is assessed primarily by measuring total serum B12 using competitive binding methods. The lack of availability of a standard material and high-level reference measurement procedure affect the trueness of B12 results; this results in variation between methods. This study aimed to determine the reference intervals for vitamin B12 on three routine analytical platforms. METHOD A prospective reference population of healthy individuals was recruited according to the IFCC CRIDL criteria. Vitamin B12 samples were measured on Roche, Beckman and Siemens analytical platforms. RESULTS In total, 300 adult subjects were recruited; the central 95th centile values for B12 for Roche (190-678 ng/mL) and Siemens (181-562 ng/mL) analytical platforms were in a close agreement. Beckman DXi, however, showed a significantly lower reference limit (110-562 ng/mL). All reference intervals are in keeping with previously published data but some are not in agreement with manufacturer provided reference interval. CONCLUSION As the quality of the reference intervals plays a significant role in clinical outcome, it is of great importance that laboratories use a method-specific reference interval and if possible, locally derived reference intervals until further method standardization occurs.
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Affiliation(s)
- Nuthar Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - Thomas Bancroft
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - Ahai Luvai
- Specialist Laboratory Medicine, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Wycliffe Mbagaya
- Specialist Laboratory Medicine, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Julian H Barth
- Specialist Laboratory Medicine, St James Hospital, Leeds Teaching Hospitals, Leeds, UK
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Schleicher E, Didangelos T, Kotzakioulafi E, Cegan A, Peter A, Kantartzis K. Clinical Pathobiochemistry of Vitamin B 12 Deficiency: Improving Our Understanding by Exploring Novel Mechanisms with a Focus on Diabetic Neuropathy. Nutrients 2023; 15:nu15112597. [PMID: 37299560 DOI: 10.3390/nu15112597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Vitamin B12 (B12) is an essential cofactor of two important biochemical pathways, the degradation of methylmalonic acid and the synthesis of methionine from homocysteine. Methionine is an important donor of methyl groups for numerous biochemical reactions, including DNA synthesis and gene regulation. Besides hematological abnormalities (megaloblastic anemia or even pancytopenia), a deficiency in B12 may cause neurological symptoms, including symptoms resembling diabetic neuropathy. Although extensively studied, the underlining molecular mechanism for the development of diabetic peripheral neuropathy (DPN) is still unclear. Most studies have found a contribution of oxidative stress in the development of DPN. Detailed immunohistochemical investigations in sural nerve biopsies obtained from diabetic patients with DPN point to an activation of inflammatory pathways induced via elevated advanced glycation end products (AGE), ultimately resulting in increased oxidative stress. Similar results have been found in patients with B12 deficiency, indicating that the observed neural changes in patients with DPN might be caused by cellular B12 deficiency. Since novel results show that B12 exerts intrinsic antioxidative activity in vitro and in vivo, B12 may act as an intracellular, particularly as an intramitochondrial, antioxidant, independent from its classical, well-known cofactor function. These novel findings may provide a rationale for the use of B12 for the treatment of DPN, even in subclinical early states.
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Affiliation(s)
- Erwin Schleicher
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, 72076 Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, German Center for Diabetes Research (DZD), 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), 85764 Neuherberg, Germany
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Evangelia Kotzakioulafi
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Alexander Cegan
- Department of Biological and Biochemical Sciences, Faculty of Chemical Technology, University of Pardubice, 53210 Pardubice, Czech Republic
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, 72076 Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, German Center for Diabetes Research (DZD), 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), 85764 Neuherberg, Germany
| | - Konstantinos Kantartzis
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, German Center for Diabetes Research (DZD), 72076 Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), 85764 Neuherberg, Germany
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, 72076 Tübingen, Germany
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10
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Knudsen CS, Parkner T, Hoffmann-Lücke E, Abildgaard A, Greibe E. Reference intervals and stability of haptocorrin and holotranscobalamin in Danish children and elderly. Clin Chim Acta 2023; 546:117394. [PMID: 37209861 DOI: 10.1016/j.cca.2023.117394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Haptocorrin (HC) and holotranscobalamin (holoTC) carry vitamin B12 (B12) in the circulation and can be useful biomarkers for evaluating B12 status. The concentration of both proteins depends on age, but data on reference intervals for children and the elderly are sparse. Similarly, not much is known about the effect of preanalytical factors. METHODS HC plasma samples from healthy elderly > 65 years (n = 124) were analysed, and both HC and holoTC were analysed in paediatric serum samples ≤ 18 years (n = 400). Furthermore, we investigated assay precision and stability. RESULTS HC and holoTC were effected by age. We established reference intervals for HC: 2-10 years, 369-1237 pmol/L; 11-18 years, 314-1128 pmol/L; 65-82 years, 242-680 pmol/L and for holoTC: 2-10 years, 46-206 pmol/L; 11-18 years, 30-178 pmol/L. Analytical coefficients of variations of 6.0-6.8% and 7.9-15.7% were found for HC and holoTC, respectively. HC were affected when stored at room temperature and by freeze/thaw. HoloTC was stable at room temperature and after delayed centrifugation. CONCLUSION We present novel 95% age-related reference limits for HC and HoloTC in children, and for HC both in children and elderly. Moreover, we found HoloTC to be fairly stable when stored, whereas HC was more vulnerable to preanalytical factors.
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Affiliation(s)
- Cindy S Knudsen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
| | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; Institute for Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Elke Hoffmann-Lücke
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; Institute for Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Anders Abildgaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; Institute for Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Antonio Delgado J, Pastor García MI, Márquez Jiménez N, Costa Petit G, Regís Perelló A, Robles J, Miquel Bauça J. FUNCTIONAL VITAMIN B12 DEFICIENCY: IMPROVING METHYLMALONIC ACID REFERENCE INTERVALS IN URINE. Clin Chim Acta 2023; 544:117334. [PMID: 37031782 DOI: 10.1016/j.cca.2023.117334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND AIM Most laboratory requests focus on the detection of possible vitamin B12 deficiency. In this context, methylmalonic acid (MMA) is reported as the best biomarker. The aim of our study was to establish the biological reference interval for MMA in urine, and assess the influence of age, sex, and vitamin B12 status on MMA concentrations. METHODS This is a prospective observational study considering individuals with normal results for blood count and liver and kidney function. Individuals who presented supplementation, any pathology or treatment that could cause cobalamin metabolism disorders, and pregnant women were excluded. Likewise, individuals whose vitamin B12 result presented antibody-mediated interference were excluded. Individuals were grouped by age-group and sex. Reference intervals were determined by non-parametric calculation (percentiles 1-99). RESULTS It was established a single reference interval [0.52 (CI90%: 0.50-0.54) - 5.75 (CI90%: 5.57-6.17) mmolMMA/mol creatinine], with 100% of individuals with MMA above the upper limit of reference presenting a total vitamin B12 concentration ≤238pmol/L. CONCLUSION The establishment of optimal reference intervals for methylmalonic acid excretion in urine is crucial in individuals with a suspicion of functional vitamin B12 deficiency. However, the possibility of establishing a cut-off value for total vitamin B12 suggesting subclinical deficiency remains a challenge for this magnitude.
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Affiliation(s)
- Jose Antonio Delgado
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain.
| | | | | | - Gemma Costa Petit
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | | | - Juan Robles
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - Josep Miquel Bauça
- Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain; Institut d́Investigació Sanitària de les Illes Balears (IdISBa), Spain
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12
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Tomasiuk R, Zubrzycki IZ, Wiacek M. Age-dependent changes in fat- and water-soluble vitamins—National Health and Nutrition Examination Surveys study. Front Med (Lausanne) 2022; 9:907067. [PMID: 36388949 PMCID: PMC9641218 DOI: 10.3389/fmed.2022.907067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Aging is an independent risk factor for the development of various diseases associated, among others, with detrimental blood levels of fat- and water-soluble vitamins. Thus, the objective of this study is to investigate age-related changes in blood levels of vitamin A, B12, C, D, and E. Subject serum vitamin levels were obtained from the combined National Health and Nutrition Examination Surveys (NHANES). NHANESIII and NHANES 1999–2000, 2001–2002, 2003–2004, and 2005–2006. The raw data set was stratified into five age groups G1- G5: 20 ≤ G1 < 30, 30 ≤ G2 < 40, 40 ≤ G3 < 50, 50 ≤ G4 < 60, and 60 ≤ G5 < 70 years of age. Age stratified data was cleaned using the modified Horn algorithm. The reference range for the vitamin level of a specific age group was defined as data between the first and third quartile of the subject defined by normal blood pressure and normal bone density. Age-dependent changes in serum/plasma vitamin levels were assessed using the bootstrap technique with 10,000 repeats and Bonferroni adjustment. There was a continuous increase in vitamin A, B12, D, and E levels in the blood. However, the vitamin C concentration remained virtually constant in all age groups. There was a lack of cross-correlations between lipid and water-soluble vitamin levels and blood pressure and bone health. The following reference levels for vitamin A, B12, C, D, and E in subjects older than 20 years of age were established: vitamin A: 1.32–2.8 mmol/L, vitamin B12: 257.94–498.33 pmol/L, vitamin C: 38.18–79.2 mmol/L, vitamin D: 76.33–199.36 nmol/L and vitamin E: 3.65–41.12 μmol/L.
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Affiliation(s)
- Ryszard Tomasiuk
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
| | - Igor Z. Zubrzycki
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
- Department of Biometry and Mathematics, Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Magdalena Wiacek
- Faculty of Medical and Health Sciences, Kazimierz Pułaski University of Technology and Humanities in Radom, Radom, Poland
- *Correspondence: Magdalena Wiacek,
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