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B12 METABOLISM IN HUMANS By NICOLE AURORA LEAL A ...

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23<br />

The cblB complementation group is characterized by a deficiency in the conversion<br />

of cobalamin to AdoCbl. Cell extracts derived from patients with cblB disorder were<br />

unable to synthesize AdoCbl even when provided with a reducing system, labeled<br />

HOCbl, and ATP (Fenton and Rosenberg 1981). Patients with this disorder are defective<br />

in ATP:cob(I)alamin ATR activity. At the start of this study, the gene encoding the cblB<br />

defect was unknown and the protein had not been isolated.<br />

The clinical presentation of cblA, cblB, and cblH disorders are very similar and<br />

include methylmalonic aciduria, lethargy, failure to thrive, vomiting, dehydration,<br />

respiratory distress, and anemia (Fenton and Rosenberg 2000). These disorders have<br />

been treated by a diet restricted in amino acid precursors of methylmalonate and<br />

cobalamin supplementation (Kapadia 1995).<br />

Homocystinuria without Methylmalonic Aciduria<br />

Inborn errors of cellular cobalamin metabolism resulting in homocystinuria without<br />

methylmalonic aciduria are defined by cblE and cblG complementation groups. There<br />

has been only one patient in the cblE group that had combined homocystinuria and mild<br />

methylmalonic aciduria (Wilson et al. 1999). Cultured fibroblasts from these patients<br />

show a deficiency in CH3Cbl synthesis and decreased methionine synthase activity<br />

(Watkins and Rosenblatt 1989). Complementation analysis has shown that cblE and<br />

cblG defects occur at distinct chromosomal locations (Watkins and Rosenblatt 1988).<br />

Fibroblasts from patients with cblE and cblG disorders showed normal incorporation of<br />

labeled propionate into macromolecules; however, the incorporation of labeled CH3THF<br />

was reduced when compared to controls suggesting an abnormality in the methionine<br />

synthase pathway (Watkins and Rosenblatt 1989). To date there are 12 patients

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