ABSTRACT
A 2-year-old girl required medical attention for a sudden onset of repetitive tonic-clonic convulsions after ingesting 20-30 ginkgo seeds. Concentrations of the major forms of circulating vitamin B6, pyridoxal-5'-phosphate (PLP), pyridoxal (PL), and 4-pyridoxic acid, as well as the known ginkgo seed toxin 4'-O-methylpyridoxine (MPN) were measured in the serum and cerebrospinal fluid (CSF). PLP is an active form of vitamin B6 and necessary for γ-aminobutyric acid (GABA) production. High MPN concentrations were observed in both the serum and CSF. As the PLP to PL ratio was markedly decreased in serum and CSF examinations, we suspected the ratio to be important in GABA production. This case report provides novel information on the metabolism of vitamin B6 in humans as a result of ginkgo seed poisoning.
Subject(s)
Foodborne Diseases , Plant Extracts/poisoning , Seeds/poisoning , Child, Preschool , Developmental Disabilities/etiology , Female , Foodborne Diseases/blood , Foodborne Diseases/cerebrospinal fluid , Foodborne Diseases/complications , Foodborne Diseases/etiology , Ginkgo biloba , Glutamic Acid/metabolism , Humans , Pyridoxic Acid/metabolism , Pyridoxine/analogs & derivatives , Pyridoxine/cerebrospinal fluid , Pyridoxine/metabolism , Vitamin B 6 , gamma-Aminobutyric Acid/metabolismABSTRACT
BACKGROUND AND OBJECTIVE: Vitamin B(6) plays a pivotal role in brain development and functioning. Differences in vitamin B(6) homeostasis between preterm and term newborn infants have been reported. The authors sought to investigate whether B(6) vitamers in cerebrospinal fluid (CSF) of preterm and term newborn infants are different. METHODS: B(6) vitamer concentrations were determined in 69 CSF samples of 36 newborn infants (26 born preterm and 10 born term) by ultra performance liquid chromatography-tandem mass spectrometry. CSF samples, taken from a subcutaneous intraventricular reservoir, were bedside frozen and protected from light. RESULTS: Concentrations of pyridoxal (PL), pyridoxal phosphate (PLP), pyridoxic acid (PA), and pyridoxamine (PM) in preterm newborns (postmenstrual age 30-37 weeks) were at least twice as high as in older newborns (postmenstrual age ≥ 42 weeks). Pyridoxine and pyridoxamine phosphate concentrations were below limits of quantification in all newborns. In CSF of 2 very preterm newborns (postmenstrual age <30 weeks), significant amounts of pyridoxine were present besides high concentrations of PL, PA, and PM, whereas PLP concentrations were relatively low. B(6) vitamers in CSF were positively correlated, especially PA, PLP, and PL. CONCLUSIONS: In CSF of newborn infants, PL, PLP, PA, and PM are present, and concentrations are strongly dependent on postmenstrual age. Our results indicate that vitamin B(6) homeostasis in brain differs between preterm and term newborns. These results should be taken into account for diagnosis and treatment of epilepsy and vitamin B(6) deficiency in newborn infants.
Subject(s)
Homeostasis , Infant, Premature/cerebrospinal fluid , Vitamin B 6/cerebrospinal fluid , Biomarkers/cerebrospinal fluid , Chromatography, Liquid , Female , Gestational Age , Humans , Infant, Newborn , Male , Pyridoxal/cerebrospinal fluid , Pyridoxamine/cerebrospinal fluid , Pyridoxine/cerebrospinal fluid , Tandem Mass SpectrometryABSTRACT
Content of pyridoxal in cerebrospinal fluid exceeded its level in blood plasma of healthy children. Transport of pyridoxal through hematoencephalic barrier was decreased in children with acute leukosis, especially, with neuroleukosis, while content of pyridoxal-5-phosphate was similar to normal values. Possible mechanisms are considered which are involved in stabilization of pyroxal-5-phosphate content in cerebrospinal fluid of patients with acute leukosis, when transport of pyridoxal was impaired in central nervous system.
Subject(s)
Brain Neoplasms/cerebrospinal fluid , Leukemia/cerebrospinal fluid , Pyridoxine/cerebrospinal fluid , Acute Disease , Adolescent , Brain Neoplasms/blood , Child , Child, Preschool , Humans , Infant , Leukemia/blood , Pyridoxal Phosphate/blood , Pyridoxal Phosphate/cerebrospinal fluid , Pyridoxine/bloodABSTRACT
Twenty-seven epileptic patients, most from low socioeconomic groups and aged 15-54 years, were studied for effects of prolonged anticonvulsant medication. They had received the usual doses of phenobarbitone and diphenylhydantoin (PHT) regularly for 3-32 years, with control of seizures, and had not taken any B-vitamins in the year before investigation. Besides reduced serum and cerebrospinal fluid (CSF) folate levels, significantly increased levels of total vitamin B6 in CSF and serum and of vitamin B12 in serum were found in patients as compared with normal healthy subjects. The bone marrow was normoblastic, and significant elevation of serum triglycerides and/or cholesterol was observed in patients. The total protein level was only slightly reduced as compared with that of controls, but there was significant increase in beta-lipoprotein fraction on gel electrophoresis. Plasma proteins concerned with vitamins and lipid transport showed no remarkable change, and no abnormal protein was detected. Although there was no clinical hepatic involvement, liver biopsy performed in 9 of 27 patients revealed fine structural changes in hepatocytes suggestive of varying degrees of drug-induced changes. A ramifying network of short, smooth, endoplasmic cisternae with depleted rough endoplasmic reticulum (RER), distended sinusoids with Kupffer cells, dark shrunken hepatocytes with reduced mitochondria, and increased lipofuscin were observed. This suggested an adaptive response of the liver, a reversible change, possibly related to the increased serum lipids in the same patients.