1
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Wolffenbuttel BHR, McCaddon A, Ahmadi KR, Green R. A Brief Overview of the Diagnosis and Treatment of Cobalamin (B12) Deficiency. Food Nutr Bull 2024; 45:S40-S49. [PMID: 38987879 DOI: 10.1177/03795721241229500] [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 An increasing number of adult individuals are at risk of vitamin B12 deficiency, either from reduced nutritional intake or impaired gastrointestinal B12 absorption. OBJECTIVE This study aims to review the current best practices for the diagnosis and treatment of individuals with vitamin B12 deficiency. METHODS A narrative literature review of the diagnosis and treatment of vitamin B12 deficiency. RESULTS Prevention and early treatment of B12 deficiency is essential to avoid irreversible neurological consequences. Diagnosis is often difficult due to diverse symptoms, marked differences in diagnostic assays' performance and the unreliability of second-line biomarkers, including holo-transcobalamin, methylmalonic acid and total homocysteine. Reduced dietary intake of B12 requires oral supplementation. In B12 malabsorption, oral supplementation is likely insufficient, and parenteral (i.e. intramuscular) supplementation is preferred. There is no consensus on the optimal long-term management of B12 deficiency with intramuscular therapy. According to the British National Formulary guidelines, many individuals with B12 deficiency due to malabsorption can be managed with 1000 µg intramuscular hydroxocobalamin once every two months after the initial loading. Long-term B12 supplementation is effective and safe, but responses to treatment may vary considerably. Clinical and patient experience strongly suggests that up to 50% of individuals require individualized injection regimens with more frequent administration, ranging from daily or twice weekly to every 2-4 weeks, to remain symptom-free and maintain a normal quality of life. 'Titration' of injection frequency based on measuring biomarkers such as serum B12 or MMA should not be practiced. There is currently no evidence to support that oral/sublingual supplementation can safely and effectively replace injections. CONCLUSIONS This study highlights the interindividual differences in symptomatology and treatment of people with B12 deficiency. Treatment follows an individualized approach, based on the cause of the deficiency, and tailored to help someone to become and remain symptom-free.
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Affiliation(s)
| | - Andrew McCaddon
- Faculty of Social and Life Sciences, Wrexham University, Wrexham, United Kingdom
| | - Kourosh R Ahmadi
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Ralph Green
- University of California Davis, Sacramento, CA, USA
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2
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Kohlmeier M, Baah E, Washko M, Adams K. Genotype-informed nutrition counselling in clinical practice. BMJ Nutr Prev Health 2023; 6:407-412. [PMID: 38618528 PMCID: PMC11009529 DOI: 10.1136/bmjnph-2023-000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Martin Kohlmeier
- University of North Carolina at Chapel Hill, School of Medicine and Gillings School of Global Public Health, and UNC Nutrition Research Institute, Chapel Hill, NC, USA
| | - Emmanuel Baah
- University of North Carolina at Chapel Hill, School of Medicine and Gillings School of Global Public Health, and UNC Nutrition Research Institute, Chapel Hill, NC, USA
| | - Matthew Washko
- University of North Carolina at Chapel Hill, School of Medicine and Gillings School of Global Public Health, and UNC Nutrition Research Institute, Chapel Hill, NC, USA
| | - Kelly Adams
- University of North Carolina at Chapel Hill, School of Medicine and Gillings School of Global Public Health, and UNC Nutrition Research Institute, Chapel Hill, NC, USA
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3
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Wolffenbuttel BH, Owen PJ, Ward M, Green R. Vitamin B 12. BMJ 2023; 383:e071725. [PMID: 37984968 PMCID: PMC10658777 DOI: 10.1136/bmj-2022-071725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
| | - P Julian Owen
- Department of Trauma and Orthopaedics, Addenbrooke's, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health, School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA
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4
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Swaby C, Yeung-Luk B, Thapa S, Nishida K, Wally A, Ghosh B, Niederkofler A, Luk S, Girgis M, Keller A, Cortez C, Ramaswamy S, Wilmsen K, Bouché L, Dell A, Drummond MB, Putcha N, Haslam SM, Mathias R, Hansel NN, Sheng J, Sidhaye V. Decreased fucosylation impacts epithelial integrity and increases risk for COPD. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.31.564805. [PMID: 37961411 PMCID: PMC10635007 DOI: 10.1101/2023.10.31.564805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
COPD causes significant morbidity and mortality worldwide. Epithelial damage is fundamental to disease pathogenesis, although the mechanisms driving disease remain undefined. Published evidence from a COPD cohort (SPIROMICS) and confirmed in a second cohort (COPDgene) demonstrate a polymorphism in Fucosyltransferese-2 (FUT2) is a trans-pQTL for E-cadherin, which is critical in COPD pathogenesis. We found by MALDI-TOF analysis that FUT2 increased terminal fucosylation of E-cadherin. Using atomic force microscopy, we found that FUT2-dependent fucosylation enhanced E-cadherin-E-cadherin bond strength, mediating the improvement in monolayer integrity. Tracheal epithelial cells from Fut2-/- mice have reduced epithelial integrity, which is recovered with reconstitution of Fut2. Overexpression of FUT2 in COPD derived epithelia rescues barrier function. Fut2-/- mice show increased susceptibility in an elastase model of disease developing both emphysema and fibrosis. We propose this is due to the role of FUT2 in proliferation and cell differentiation. Overexpression of FUT2 significantly increased proliferation. Loss of Fut2 results in accumulation of Spc+ cells suggesting a failure of alveolar type 2 cells to undergo transdifferentiation to alveolar type 1. Using a combination of population data, genetically manipulated mouse models, and patient-derived cells, we present a novel mechanism by which post-translational modifications modulate tissue pathology and serve as a proof of concept for the development of a disease-modifying target in COPD.
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Affiliation(s)
- Carter Swaby
- Department of Chemical and Biomolecular Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, 21218, USA
| | - Bonnie Yeung-Luk
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Shreeti Thapa
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Kristine Nishida
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Arabelis Wally
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Baishakhi Ghosh
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Austin Niederkofler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Sean Luk
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Mirit Girgis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Allison Keller
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Cecilia Cortez
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Sahana Ramaswamy
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Kai Wilmsen
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Laura Bouché
- Department of Life Sciences, Imperial College London, London, SW7 2AZ, UK
| | - Anne Dell
- Department of Life Sciences, Imperial College London, London, SW7 2AZ, UK
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, 27514, USA
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Stuart M. Haslam
- Department of Life Sciences, Imperial College London, London, SW7 2AZ, UK
| | - Rasika Mathias
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Nadia N. Hansel
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
| | - Jian Sheng
- Department of Engineering, Texas A&M University Corpus Christi, Corpus Christi, TX 78412, USA
| | - Venkataramana Sidhaye
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, 21224, Maryland, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, 21224, USA
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5
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McCaddon A, Carr DF, Peter H, Moat SJ, Quadros EV. Transcobalamin receptor gene polymorphisms and mutation in an elderly population. Clin Nutr ESPEN 2023; 55:425-427. [PMID: 37202078 DOI: 10.1016/j.clnesp.2023.04.023] [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: 11/03/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS Cellular uptake of the essential nutrient vitamin B12 (cobalamin) occurs via the transcobalamin receptor (TCblR/CD320), a ubiquitous membrane receptor. Polymorphisms in the receptor exist, though the effect of such variants across patient populations is unknown. METHODS We determined CD320 genotype in 377 randomly selected elderly individuals. RESULTS Three polymorphisms and a codon deletion were identified in the exon 2 region. Haplotype variants had significantly higher holotranscobalamin (holo-TC) values and a higher holo-TC/total cobalamin ratio. TCblR haplotype explained 46% of the variability in holo-TC values. CONCLUSIONS This has significant implications for the clinical utility of the 'combined indicator' of B12 status since it is based on a standard rate of intracellular flux via the TC-Cbl receptor. Modification of the model may be required to account for CD320 haplotype.
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Affiliation(s)
- Andrew McCaddon
- Faculty of Social and Life Sciences, Wrexham Glyndwr University, Wrexham, UK.
| | - Daniel F Carr
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | | | - Stuart J Moat
- School of Medicine and Department of Medical Biochemistry, Cardiff University, UK
| | - Edward V Quadros
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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6
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Sobczyńska-Malefora A, Katayev A, Steed D, O'Logbon J, Crook M, Harrington DJ. Age- and ethnicity-related reference intervals for serum vitamin B 12. Clin Biochem 2023; 111:66-71. [PMID: 36261053 DOI: 10.1016/j.clinbiochem.2022.10.007] [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: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Age and ethnicity are known to influence serum vitamin B12 (B12) concentration, yet universal reference intervals (RIs) are typically applied by laboratories. Both lower and upper RI limits for B12 are clinically relevant. Low values suggest deficiency leading to anemia and/or neurological impairment, while high values are not always an innocuous consequence of high B12 intake but are associated with some cancers, autoimmune, liver, and renal diseases. This work aimed to establish age- and ethnicity-related RIs for B12 using a modified indirect method based on Hoffmann's approach. METHODS A total of 72,091 anonymized B12 results (Jan 2018-Nov 2019) were analyzed from an ethnically-diverse South-East London general practice patient population. Patients belonged to five ethnic groups: Asian, Black, White, Mixed, or Other. Multiple records for the same patient and results with missing ethnicity were excluded from the analysis of adult RIs. B12 analyses were performed using ARCHITECT® (Abbott Diagnostics). RESULTS B12 was significantly higher in Black compared with Asian and White adults. There were no differences in B12 between Asian and White adults. Children (all ethnicities) between 2 and 5 years old had the highest B12. Because of the small number of children (up to the age of 13) in each ethnic-related age category, all ethnic groups were combined to obtain age-related RIs. The children's RIs ranged from 159 to 1025 pmol/L for 0-1-year-olds to 276-1102 pmol/L for 2-5-year-olds. The RIs for Black and White/Asian people >13 years of age were 166-805 pmol/L and 134-511 pmol/L respectively. CONCLUSIONS The application of age- and ethnicity-appropriate RIs into diagnostic practice will provide a more accurate evaluation of B12 status when using the B12 test alone or in combination with other markers.
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Affiliation(s)
- Agata Sobczyńska-Malefora
- Nutristasis Unit, Viapath, Guy's and St. Thomas' Hospital NHS Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom.
| | | | | | - Jessica O'Logbon
- Faculty of Life Sciences and Medicine, King's College London, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Martin Crook
- Biochemical Medicine, King's College London, United Kingdom; Guy's and St. Thomas' Hospital NHS Trust and Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Dominic J Harrington
- Nutristasis Unit, Viapath, Guy's and St. Thomas' Hospital NHS Trust, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom
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7
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Kozyraki R, Verroust P, Cases O. Cubilin, the intrinsic factor-vitamin B12 receptor. VITAMINS AND HORMONES 2022; 119:65-119. [PMID: 35337634 DOI: 10.1016/bs.vh.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cubilin (CUBN), the intrinsic factor-vitamin B12 receptor is a large endocytic protein involved in various physiological functions: vitamin B12 uptake in the gut; reabsorption of albumin and maturation of vitamin D in the kidney; nutrient delivery during embryonic development. Cubilin is an atypical receptor, peripherally associated to the plasma membrane. The transmembrane proteins amnionless (AMN) and Lrp2/Megalin are the currently known molecular partners contributing to plasma membrane transport and internalization of Cubilin. The role of Cubilin/Amn complex in the handling of vitamin B12 in health and disease has extensively been studied and so is the role of the Cubilin-Lrp2 tandem in renal pathophysiology. Accumulating evidence strongly supports a role of Cubilin in some developmental defects including impaired closure of the neural tube. Are these defects primarily caused by the dysfunction of a specific Cubilin ligand or are they secondary to impaired vitamin B12 or protein uptake? We will present the established Cubilin functions, discuss the developmental data and provide an overview of the emerging implications of Cubilin in the field of cardiovascular disease and cancer pathogenesis.
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Affiliation(s)
- Renata Kozyraki
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France.
| | - Pierre Verroust
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
| | - Olivier Cases
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université de Paris, Paris, France
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8
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Pangilinan F, Watkins D, Bernard D, Chen Y, Dong N, Wu Q, Ozel-Abaan H, Kaur M, Caggana M, Morrissey M, Browne ML, Mills JL, Van Ryzin C, Shchelochkov O, Sloan J, Venditti CP, Sarafoglou K, Rosenblatt DS, Kay DM, Brody LC. Probing the functional consequence and clinical relevance of CD320 p.E88del, a variant in the transcobalamin receptor gene. Am J Med Genet A 2022; 188:1124-1141. [PMID: 35107211 DOI: 10.1002/ajmg.a.62627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 11/06/2022]
Abstract
The biological and clinical significance of the p.E88del variant in the transcobalamin receptor, CD320, is unknown. This allele is annotated in ClinVar as likely benign, pathogenic, and of uncertain significance. To determine functional consequence and clinical relevance of this allele, we employed cell culture and genetic association studies. Fibroblasts from 16 CD320 p.E88del homozygotes exhibited reduced binding and uptake of cobalamin. Complete ascertainment of newborns with transiently elevated C3 (propionylcarnitine) in New York State demonstrated that homozygosity for CD320 p.E88del was over-represented (7/348, p < 6 × 10-5 ). Using population data, we estimate that ~85% of the p.E88del homozygotes born in the same period did not have elevated C3, suggesting that cobalamin metabolism in the majority of these infants with this genotype is unaffected. Clinical follow-up of 4/9 homozygous individuals uncovered neuropsychological findings, mostly in speech and language development. None of these nine individuals exhibited perturbation of cobalamin metabolism beyond the newborn stage even during periods of acute illness. Newborns homozygous for this allele in the absence of other factors are at low risk of requiring clinical intervention, although more studies are required to clarify the natural history of various CD320 variants across patient populations.
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Affiliation(s)
- Faith Pangilinan
- Genetics and Environment Interaction Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - David Watkins
- Department of Human Genetics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - David Bernard
- Genetics and Environment Interaction Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Yue Chen
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China
| | - Ningzheng Dong
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China.,MOH Key Laboratory of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qingyu Wu
- Cyrus Tang Hematology Center, Collaborative Innovation Center of Hematology, State Key Laboratory of Radiation Medicine and Prevention, Soochow University, Suzhou, China
| | - Hatice Ozel-Abaan
- Genetics and Environment Interaction Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Manjit Kaur
- Genetics and Environment Interaction Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Michele Caggana
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Mark Morrissey
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Marilyn L Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York and University at Albany School of Public Health, Rensselaer, New York, USA
| | - James L Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Carol Van Ryzin
- Organic Acid Research Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Oleg Shchelochkov
- Organic Acid Research Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Jennifer Sloan
- Organic Acid Research Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Charles P Venditti
- Organic Acid Research Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
| | - Kyriakie Sarafoglou
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - David S Rosenblatt
- Department of Human Genetics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Medical Biochemistry, Department of Specialized Medicine, McGill University Health Centre, Montreal, Quebec, Canada.,Division of Medical Genetics, Department of Specialized Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denise M Kay
- Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Lawrence C Brody
- Genetics and Environment Interaction Section, National Human Genome Research Institute, National Institutes of Health, Maryland, USA
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9
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O'Logbon J, Crook M, Steed D, Harrington DJ, Sobczyńska-Malefora A. Ethnicity influences total serum vitamin B 12 concentration: a study of Black, Asian and White patients in a primary care setting. J Clin Pathol 2021; 75:598-604. [PMID: 33952588 DOI: 10.1136/jclinpath-2021-207519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/21/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
AIMS A growing body of evidence suggests that ethnicity and race influence vitamin B12 metabolism and status yet clinical awareness of this is poor, causing doubts regarding diagnosis and treatment. Moreover, deficiency and insufficiency cut-offs are universally applied for this test in most diagnostic settings. The objective of this study was to assess serum vitamin B12 concentrations in Black, Asian and White primary care patients in London, UK, particularly in patients of Black or Black British ethnic origin and establish if there is a need for specific reference ranges. METHODS Serum B12 results from 49 414 patients were processed between January 2018 and November 2019 using the Architect assay (Abbott Diagnostics) at St. Thomas' Hospital, London, UK. Age, sex and ethnicity data were collected from the laboratory Health Informatics Team. RESULTS Black patients (n=13 806) were found to have significantly higher serum vitamin B12 concentration across all age groups and both sexes, especially Nigerian patients (median B12 505 pmol/L,IQR: 362-727, n=891), compared with Asian and White ethnic groups (p<0.001). Binary logistic regression analysis revealed that the Black or Black British ethnic group had the strongest association with elevated serum B12 (>652 pmol/L) (adjusted OR 3.38, 95% CI 3.17 to 3.61, p<0.0001). CONCLUSIONS It is likely that a combination of genetic and acquired/environmental factors are responsible for the ethnic differences in serum B12. This suggests that there is a need for ethnic-specific reference ranges with indications for the incorporation of age and sex too.
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Affiliation(s)
- Jessica O'Logbon
- GKT School of Medicine, King's College London Faculty of Life Sciences and Medicine, London, UK jessica.o'
| | - Martin Crook
- Clinical Biochemistry and Metabolic Medicine, Guy's, St Thomas' Trust, London, UK.,Clinical Biochemistry and Metabolic Medicine, Lewisham and Greenwich Trust, London, UK.,Hon Professor in Biochemical Medicine, King's College London, London, UK
| | - David Steed
- Viapath Informatics, Viapath, Francis House, St Thomas' Hospital, London, UK
| | - Dominic Jon Harrington
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK
| | - Agata Sobczyńska-Malefora
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK
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10
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Williams JE, McGuire MK, Meehan CL, McGuire MA, Brooker SL, Kamau-Mbuthia EW, Kamundia EW, Mbugua S, Moore SE, Prentice AM, Otoo GE, Rodríguez JM, Pareja RG, Foster JA, Sellen DW, Kita DG, Neibergs HL, Murdoch BM. Key genetic variants associated with variation of milk oligosaccharides from diverse human populations. Genomics 2021; 113:1867-1875. [PMID: 33831438 DOI: 10.1016/j.ygeno.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/20/2021] [Accepted: 04/04/2021] [Indexed: 11/30/2022]
Abstract
Human milk oligosaccharides (HMO), the third most abundant component of human milk, are thought to be important contributors to infant health. Studies have provided evidence that geography, stage of lactation, and Lewis and secretor blood groups are associated with HMO profile. However, little is known about how variation across the genome may influence HMO composition among women in various populations. In this study, we performed genome-wide association analyses of 395 women from 8 countries to identify genetic regions associated with 19 different HMO. Our data support FUT2 as the most significantly associated (P < 4.23-9 to P < 4.5-70) gene with seven HMO and provide evidence of balancing selection for FUT2. Although polymorphisms in FUT3 were also associated with variation in lacto-N-fucopentaose II and difucosyllacto-N-tetrose, we found little evidence of selection on FUT3. To our knowledge, this is the first report of the use of genome-wide association analyses on HMO.
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Affiliation(s)
- Janet E Williams
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID 83844, USA
| | - Michelle K McGuire
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID 83844, USA
| | - Courtney L Meehan
- Department of Anthropology, Washington State University, Pullman, WA 99164, USA
| | - Mark A McGuire
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID 83844, USA
| | - Sarah L Brooker
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID 83844, USA
| | | | | | - Samwel Mbugua
- Department of Human Nutrition, Egerton University, Nakuru, Kenya
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, United Kingdom; MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Andrew M Prentice
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Gloria E Otoo
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Juan M Rodríguez
- Dpto. of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | | | - James A Foster
- Department of Biological Sciences and Institute for Bioinformatics and Evolutionary Studies, University of Idaho, Moscow, ID, USA
| | - Daniel W Sellen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Debela G Kita
- Department of Anthropology, Hawassa University, Hawassa, Ethiopia
| | - Holly L Neibergs
- Department of Animal Sciences, Washington State University, Pullman, WA, USA
| | - Brenda M Murdoch
- Department of Animal, Veterinary, and Food Sciences, University of Idaho, Moscow, ID 83844, USA.
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11
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Mhatre S, Richmond RC, Chatterjee N, Rajaraman P, Wang Z, Zhang H, Badwe R, Goel M, Patkar S, Shrikhande SV, Patil PS, Smith GD, Relton CL, Dikshit RP. The Role of Gallstones in Gallbladder Cancer in India: A Mendelian Randomization Study. Cancer Epidemiol Biomarkers Prev 2021; 30:396-403. [PMID: 33187967 PMCID: PMC7611244 DOI: 10.1158/1055-9965.epi-20-0919] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Past history of gallstones is associated with increased risk of gallbladder cancer in observational studies. We conducted complementary observational and Mendelian randomization (MR) analyses to determine whether history of gallstones is causally related to development of gallbladder cancer in an Indian population. METHODS To investigate associations between history of gallstones and gallbladder cancer, we used questionnaire and imaging data from a gallbladder cancer case-control study conducted at Tata Memorial Hospital, Mumbai, Maharashtra, India (cases = 1,170; controls = 2,525). We then used 26 genetic variants identified in a genome-wide association study of 27,174 gallstone cases and 736,838 controls of European ancestry in an MR approach to assess causality. The association of these genetic variants with both gallstones and gallbladder cancer was examined in the gallbladder cancer case-control study. Various complementary MR approaches were used to evaluate the robustness of our results in the presence of pleiotropy and heterogeneity, and to consider the suitability of the selected SNPs as genetic instruments for gallstones in an Indian population. RESULTS We found a strong observational association between gallstones and gallbladder cancer using self-reported history of gallstones [OR = 4.5; 95% confidence interval (CI) = 3.5-5.8] and with objective measures of gallstone presence using imaging techniques (OR = 2.0; 95% CI = 1.5-2.7). We found consistent causal estimates across all MR techniques, with ORs for gallbladder cancer in the range of 1.3-1.6. CONCLUSIONS Our findings indicate a causal relationship between history of gallstones and increased risk of gallbladder cancer, albeit of a smaller magnitude than those found in observational analysis. IMPACT Our findings emphasize the importance of gallstone treatment for preventing gallbladder cancer in high-risk individuals.
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Affiliation(s)
- Sharayu Mhatre
- Centre for Cancer Epidemiology, Tata Memorial Centre, Kharghar, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rebecca C. Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PR, UK
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
- Department of Biostatistics, Bloomberg School of Public Health, John Hopkins University, Baltimore 21218, MD, USA
- Department of Oncology, School of Medicine, John Hopkins University, Baltimore 21218, MD, USA
| | - Preetha Rajaraman
- Office of Global Affairs, Department of Health and Human Services, Washington, DC, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Departments of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Haoyu Zhang
- School of Materials Science and Engineering, Shenyang University of Technology, Shenyang 110870, China
| | - Rajendra Badwe
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Tata Memorial Centre - Surgical Oncology, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Clinical Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shailesh V. Shrikhande
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Division of Cancer Surgery, GI & HPB Surgical Services, Tata Memorial Hospital, Mumbai, Maharashtra 400012, India
| | - Prachi S. Patil
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Medical Gastroenterology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PR, UK
| | - Caroline L. Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PR, UK
| | - Rajesh P. Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre, Kharghar, Navi Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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12
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Soejima M, Koda Y. High-resolution melting analysis for detection of fusion allele of FUT2. Electrophoresis 2021; 42:315-318. [PMID: 33128385 DOI: 10.1002/elps.202000241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/01/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
The secretor status of ABH antigens, determined by FUT2 polymorphisms, affects susceptibility to various infectious diseases. In addition to many SNPs responsible for the nonsecretor phenotype, five nonfunctional alleles (se) resulting from copy number variations have been reported. One of the five alleles generated by an unequal crossover between FUT2 and a pseudogene (SEC1), is sefus . This allele may be misidentified as a functional allele if only common inactivating SNPs are genotyped because it contains the 3' region of the functional FUT2. Therefore, accurate detection of sefus is desirable. For this purpose, a high-resolution melting (HRM) analysis is developed for detection of sefus in which a 284bp fragment of SEC1 and sefus but not FUT2, are amplified. This HRM analysis detected sefus reliably. Thus, an initial screening or prescreening for sefus using HRM analysis seems to be useful for association studies of FUT2.
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Affiliation(s)
- Mikiko Soejima
- Department of Forensic Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan
| | - Yoshiro Koda
- Department of Forensic Medicine, Kurume University School of Medicine, Kurume, 830-0011, Japan
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13
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Reilly JP, Meyer NJ, Shashaty MG, Anderson BJ, Ittner C, Dunn TG, Lim B, Forker C, Bonk MP, Kotloff E, Feng R, Cantu E, Mangalmurti NS, Calfee CS, Matthay MA, Mikacenic C, Walley KR, Russell J, Christiani DC, Wurfel MM, Lanken PN, Reilly MP, Christie JD. The ABO histo-blood group, endothelial activation, and acute respiratory distress syndrome risk in critical illness. J Clin Invest 2021; 131:139700. [PMID: 32931480 PMCID: PMC7773362 DOI: 10.1172/jci139700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDThe ABO histo-blood group is defined by carbohydrate modifications and is associated with risk for multiple diseases, including acute respiratory distress syndrome (ARDS). We hypothesized that genetically determined blood subtype A1 is associated with increased risk of ARDS and markers of microvascular dysfunction and coagulation.METHODSWe conducted analyses in 3 cohorts of critically ill trauma and sepsis patients (n = 3710) genotyped on genome-wide platforms to determine the association of the A1 blood type genotype with ARDS risk. We subsequently determined whether associations were present in FUT2-defined nonsecretors who lack ABO antigens on epithelium, but not endothelium. In a patient subgroup, we determined the associations of blood type with plasma levels of endothelial glycoproteins and disseminated intravascular coagulation (DIC). Lastly, we tested whether blood type A was associated with less donor lung injury recovery during human ex vivo lung perfusion (EVLP).RESULTSThe A1 genotype was associated with a higher risk of moderate to severe ARDS relative to type O in all 3 populations. In sepsis, this relationship was strongest in nonpulmonary infections. The association persisted in nonsecretors, suggesting a vascular mechanism. The A1 genotype was also associated with higher DIC risk as well as concentrations of thrombomodulin and von Willebrand factor, which in turn were associated with ARDS risk. Blood type A was also associated with less lung injury recovery during EVLP.CONCLUSIONWe identified a replicable association between ABO blood type A1 and risk of ARDS among the critically ill, possibly mediated through microvascular dysfunction and coagulation.FUNDINGNIH HL122075, HL125723, HL137006, HL137915, DK097307, HL115354, HL101779, and the University of Pennsylvania McCabe Fund Fellowship Award.
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Affiliation(s)
- John P. Reilly
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
| | - Nuala J. Meyer
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
| | - Michael G.S. Shashaty
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
- Center for Clinical Epidemiology and Biostatics, and
| | - Brian J. Anderson
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
| | | | - Thomas G. Dunn
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
| | - Brian Lim
- Division of Pulmonary, Allergy, and Critical Care
| | | | | | | | - Rui Feng
- Center for Clinical Epidemiology and Biostatics, and
| | - Edward Cantu
- Center for Translational Lung Biology
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nilam S. Mangalmurti
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
| | - Carolyn S. Calfee
- Department of Medicine and
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Michael A. Matthay
- Department of Medicine and
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Carmen Mikacenic
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Keith R. Walley
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Russell
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David C. Christiani
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Mark M. Wurfel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | | | - Muredach P. Reilly
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason D. Christie
- Division of Pulmonary, Allergy, and Critical Care
- Center for Translational Lung Biology
- Center for Clinical Epidemiology and Biostatics, and
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14
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Abstract
BACKGROUND There is conflicting evidence in the literature on the association between (elevated) serum B12 concentrations and subsequent disease or mortality. We evaluated in the NHANES general population the association of serum B12 concentrations as well as vitamin B12 supplement intake with all-cause, cardiovascular, and cancer-related mortality, while taking into account demographic and lifestyle factors and significant other diseases which are known to be associated with poorer outcome. METHODS The main outcomes of our study were all-cause mortality, cardiovascular mortality, and cancer-related mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index public access files through December 31, 2015. The association of serum B12 concentrations and vitamin B12 supplement intake with mortality was assessed with Cox proportional hazard (PH) models, with adjustment for a number of relevant demographic and lifestyle factors and comorbidity. RESULTS The final study population of 24,262 participants had a mean age of 48 (SD 19) years; 50.1% were males. The median follow-up duration was 109 months (range 1-201 months). On the census day of December 31, 2015, 3023 participants were determined as deceased (12.5%). The fully adjusted Cox PH model indicated that low serum B12 concentrations < 140 pmol/l were associated with a small increase in all-cause (hazard ratio, HR 1.39, 95% CI 1.08-1.78, p = 0.011) and cardiovascular (HR 1.64, 95% CI 1.08-2.47, p = 0.020) mortality. Similarly, high serum B12 concentrations > 700 pmol/l were associated with an increase in cardiovascular mortality only (HR 1.45, 95% CI 1.01-2.06, p = 0.042). Participants with a diagnosis of hypertension, dyslipidemia, CVD, and cancer more frequently used vitamin B12-containing supplements than those without these diagnoses. We could not demonstrate an association between vitamin B12 supplement intake and mortality, when adjusted for comorbidity. CONCLUSIONS In the general population of NHANES, low serum B12 concentrations were associated with a moderate increase in all-cause mortality. There was a small but significant increase in cardiovascular mortality in the groups with low or high serum B12. High intake of vitamin B12 in the form of supplements was not associated with any adverse effect on mortality and therefore can be regarded as safe.
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15
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Wolffenbuttel BH, Wouters HJ, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B 12) Deficiency. Mayo Clin Proc Innov Qual Outcomes 2019; 3:200-214. [PMID: 31193945 PMCID: PMC6543499 DOI: 10.1016/j.mayocpiqo.2019.03.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Although cobalamin (vitamin B12) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B12 deficiency may present with the classic megaloblastic anemia. In clinical practice, many cases of vitamin B12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B12 deficiency in whom the diagnosis was either based on low serum B12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B12 therapy. We discuss the possible clinical signs and symptoms of patients with B12 deficiency and the various pitfalls of diagnosis and treatment.
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Affiliation(s)
- Bruce H.R. Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Correspondence: Address to Bruce H. R. Wolffenbuttel, MD, PhD, Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31 9700 RB Groningen, The Netherlands
| | - Hanneke J.C.M. Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
- Department of Haematology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - M. Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
| | - Melanie M. van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, NL-9700 RB, The Netherlands
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16
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Kozyraki R, Cases O. Cubilin, the Intrinsic Factor-Vitamin B12 Receptor in Development and Disease. Curr Med Chem 2018; 27:3123-3150. [PMID: 30295181 DOI: 10.2174/0929867325666181008143945] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/11/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
Gp280/Intrinsic factor-vitamin B12 receptor/Cubilin (CUBN) is a large endocytic receptor serving multiple functions in vitamin B12 homeostasis, renal reabsorption of protein or toxic substances including albumin, vitamin D-binding protein or cadmium. Cubilin is a peripheral membrane protein consisting of 8 Epidermal Growth Factor (EGF)-like repeats and 27 CUB (defined as Complement C1r/C1s, Uegf, BMP1) domains. This structurally unique protein interacts with at least two molecular partners, Amnionless (AMN) and Lrp2/Megalin. AMN is involved in appropriate plasma membrane transport of Cubilin whereas Lrp2 is essential for efficient internalization of Cubilin and its ligands. Observations gleaned from animal models with Cubn deficiency or human diseases demonstrate the importance of this protein. In this review addressed to basic research and medical scientists, we summarize currently available data on Cubilin and its implication in renal and intestinal biology. We also discuss the role of Cubilin as a modulator of Fgf8 signaling during embryonic development and propose that the Cubilin-Fgf8 interaction may be relevant in human pathology, including in cancer progression, heart or neural tube defects. We finally provide experimental elements suggesting that some aspects of Cubilin physiology might be relevant in drug design.
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Affiliation(s)
- Renata Kozyraki
- INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris-Diderot University, Paris, France
| | - Olivier Cases
- INSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris-Diderot University, Paris, France
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17
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Hu Y, Raffield LM, Polfus LM, Moscati A, Nadkarni G, Preuss MH, Zhong X, Wei Q, Rich SS, Li Y, Wilson JG, Correa A, Loos RJF, Li B, Auer PL, Reiner AP. A common TCN1 loss-of-function variant is associated with lower vitamin B 12 concentration in African Americans. Blood 2018; 131:2859-2863. [PMID: 29764838 PMCID: PMC6014360 DOI: 10.1182/blood-2018-03-841023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yao Hu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Linda M Polfus
- Center for Genetic Epidemiology, Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Arden Moscati
- Charles Bronfman Institute for Personalized Medicine and
| | - Girish Nadkarni
- Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Xue Zhong
- Vanderbilt Genetics Institute, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Qiang Wei
- Vanderbilt Genetics Institute, Nashville, TN
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA
| | - Yun Li
- Department of Genetics
- Department of Biostatistics, and
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Adolfo Correa
- Department of Pediatrics and Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Ruth J F Loos
- Charles Bronfman Institute for Personalized Medicine and
- Genetics of Obesity and Related Metabolic Traits Program and
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bingshan Li
- Vanderbilt Genetics Institute, Nashville, TN
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | - Paul L Auer
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI; and
| | - Alex P Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
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