ABSTRACT
In cross-sectional studies, low levels of folate and B12 have been shown to be associated with cognitive decline and dementia Evidence for the putative role of folate, vitamin B12 in neurocognitive and other neurological functions comes from reported cases of severe vitamin deficiencies, particularly pernicious anemia, and homozygous defects in genes that encode for enzymes of one-carbon metabolism. The neurological alterations seen in these cases allow for a biological role of vitamins in neurophysiology. Results are quite controversial and there is an open debate in literature, considering that the potential and differential role of folate and B12 vitamin in memory acquisition and cognitive development is not completely understood or accepted. What is not clear is the fact that vitamin B12 and folate deficiency deteriorate a pre-existing not overt pathological situation or can be dangerous even in normal subjects. Even more intriguing is the interaction between B12 and folate, and their role in developing hyperhomocysteinemia. The approach to the rehabilitation of the deficiency with adequate vitamin supplementation is very confusing. Some authors suggest it, even in chronic situations, others deny any possible role. Starting from these quite confusing perspectives, the aim of this review is to report and categorize the data obtained from the literature. Despite the plausible biochemical mechanism, further studies, based on clinical, neuropsychological, laboratory and (lastly) pathological features will be necessary to better understand this fascinating biochemical riddle.
Subject(s)
Cognition/physiology , Cognition Disorders/drug therapy , Dementia/drug therapy , Folic Acid/physiology , Folic Acid Deficiency/psychology , Homocysteine/physiology , Humans , Methylmalonic Acid/metabolism , Vitamin B 12/physiology , Vitamin B 12 Deficiency/psychologyABSTRACT
Background: Propionic aciduria (PA) and Methymalonic aciduria (MMA) result from an inherited abnormality of the enzymes propionyl CoA carboxylase and methylmalonyl CoA mutase respectively. This produces marked increases in the amino acids methionine, threonine, valine and isoleucine (MTVI). Their clinical presentation can be neonatal or late onset forms. Aim: To report 23 children with organic acidurias. Material and methods: Twenty three cases of organic acidurias diagnosed since 1980 (17 PA and 6 MMA) and followed at the Institute of Nutrition and Food Technology, are reported. Results: The average age of diagnosis was 3.9 days for the neonatal form and 8.3 months for the late onset form. The most frequent symptoms were hypotonia, lethargy and vomiting. Neonatal PA had mean ammonemias of 1089ñ678.3 µg/dl. The figure for MMA was 933ñ801.9 µg/dl. Seven children were dialyzed and 30 percent died. 16 children are followed and 81.2 percent have normal weight for age. Seven children required gastrostomy because of anorexia and failure to thrive. The nutritional treatment is based on natural and artificial proteins without MTVI, with periodical controls, amino acid and ammonia quantification. Some patients were submitted to enzyme assays and molecular studies. Conclusions: An early diagnosis and a very strict follow up allows a normal development of children with organic aciduras. There is a relationship between prognosis and the presentation form, the nutritional status and the emergency treatment during acute episodes. The importance of the enzymatic and molecular studies is emphasized because they facilitate treatment, accurate diagnosis and allow an adequate genetic counseling
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Methylmalonic Acid/urine , Propionates/urine , Amino Acid Metabolism, Inborn Errors/diagnosis , Nutritional Status , Methylmalonyl-CoA Mutase , Methylmalonic Acid/metabolism , Propionates/metabolism , Amino Acids/administration & dosage , Amino Acid Metabolism, Inborn Errors/diet therapy , Amino Acid Metabolism, Inborn Errors/drug therapy , Energy IntakeABSTRACT
Methylmalonate (MMA) levels (2.0-2.5 mM) comparable to those of human methylmalonic acidemia were achieved in blood of young rats from the 5th to the 25th day of life by of life by injecting the drug subcutaneously twice a day with an interval of 8h. MMA doses ranged from 0.76 to 1.69 *mol/g body weight as a function of animal age. MMA-treated rats had normal body and brain weights. Behavioral studies using aversive and nonaversive tasks were performaed at 60 days of life. Motor activity was similar in MMA-treated and saline-treated controls. No differences in performance between these groups were identified in the shuttle-avoidance responses and in the inhibitory avoidance tasks. However, MMA-injected rats escaped footshock faster than the controls (1.22 ñ 0.11 vs 1.76 ñ 0.14 (mean ñ SEM) for 24 rats in each group (P<0.01)) suggesting that they may be hyperreactive to this stimulus. In the open field, a nonaversive behavior task, MMA-injected rats, in contrast to control rats, presented no habituation. Our results suggest that MMA by itself may impair central nervous system function, causing minor disabilities which result in specific learning deficiencies