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[Inherited transcobalamin-II-deficiency: clinical, genetic studies and diagnosis using cultured fibroblasts].

A boy born healthy, developed gastrointestinal symptoms (diarrhea, vomiting, ulcerative stomatitis) and megaloblastic anaemia with thrombocytopenia and neutropenia at the age of five weeks. Serum levels of folate and cobalamin were normal, but there was cobalamin-mal absorption. In his serum apo-TC2 was not detectable and immunoreactive total TC2 was very low (10% of normal values). Cultured skin fibroblasts failed to secrete functioning TC2. Pharmacological amounts of parenteral Cyanocobalamin, administered regularly, led to hematological remission and normal development. Interruption of therapy was followed by relapse within a few weeks. A coexisting hypogammaglobulinemia did not respond to cobalamin therapy at the selected dose level. A family investigation of serum TC2 concentrations and the genetic TC2 variants in 7 persons of three generations yielded evidence of autosomal-recessive inheritance of a silent TC2 allele (TC2 QLFL SEA-like). Three persons with heterozygous deficiency were asymptomatic.

Cells, Cultured↗

Macromolecule transfer in the human trophoblast: transcobalamin II-vitamin B12 uptake.

The accumulation of the large and hydrophilic IgG, TC II-B12 and B12 molecules is demonstrated for the first time in a human placental system which has metabolic and physiological functions. A trypsin-sensitive component is present in the human term placental uptake of TC II-B12, for which a placental membrane receptor has been previously identified; this component is absent for the accumulation of free B12, which has no known receptor. Analyses of the cytosol and incubation media indicate degradation, binding and release of TC II-B12 and B12 as TC II-B12, free B12 and TC I-like complexes. It is suggested that the human placental tissue slice be used for studies involving the binding, uptake and processing of macromolecules as exemplified by TC II-B12.

Blood Proteins↗

Persistently elevated serum transcobalamin II in a patient with cerebral malaria and typhus infections.

A 25-year-old man presented with a history of fever, chills and vomiting for three days. The parasite count was 207 ring-forms of P. falciparum per 1000 red cells. He developed hemoglobinuria and excreted hemoglobin in the urine 0.20-0.30 g/dl for 14 days during admission. Many blood transfusions were administered for correcting anemia. Although the malarial parasites disappeared one week after anti-malarial therapy, however, the fever and hemoglobinuria persisted. The Weil-Felix reaction OXK was positive with a titre of 1:40 on admission and increased to 1:160 on the second week. Chloramphenical and prednisolone were given for treatment of typhus fever and all symptoms subsided. Serum TCII levels were found to be increased and persisted high during the hemoglobinuria. The clearance of TCII was lower and increased relatively slowly to the normal level on day 30. On the other hand, TCII excretion in the urine was found to be increased during hemoglobinuria. These findings indicate that the catabolism and clearance of TCII in this patients is impaired with increased TCII excretion in the urine in parallel to the hemoglobinuria. Serum TCII level is, therefore, increased and persistently high in a patient with malaria and typhus fever infections with hemoglobinuria.

Adult↗

Serum transcobalamin II levels in patients with acute and chronic renal failure.

Serum TCII levels were determined in 57 patients with acute and chronic renal failure. They were divided into 3 groups, group I was malarial patients with acute renal failure, group II and III were patients with acute renal failure and chronic renal failure from other underlying causes, respectively. All patients in group I had serum TCII over 2000 pg/ml while these values were within the normal limits in the other 2 groups. These findings indicated that elevated serum TCII occurred only in malarial patients with acute renal failure. The clearance and urinary excretion of TCII in malarial patients were found to be lower and increased to the normal levels after recovery from azotemia, indicating that the failure of excretion of TCII by the kidneys may be responsible for elevated serum TCII levels. The pathophysiological changes in the kidneys in malarial patients may reduce the amount of filtered TCII-B12 through the glomeruli and decrease TCII-B12 uptake by the renal tubules resulting in the decreased TCII degradation by tubular cells. Therefore, the intravascular TCII survival is prolonged with elevated serum TCII levels in these patients.

Acute Kidney Injury↗

[Anemias due to disorder of folate, vitamin B12 and transcobalamin metabolism].

Macrocytic megaloblastic anemia is the most typical but the latest sign of a cobalamin (vitamin B12) and/or folic acid deficiency or of a congenital abnormality of cobalamin and folate metabolism. Macrocytosis in blood and megaloblastosis in bone marrow are the morphological features of a disturbance in cell division related to a defect in DNA biosynthesis. Macrocytosis without anemia, normocytic normochronic anemia with a low reticulocyte cell count or microcytic hypochromic anemia in case of associated iron deficiency do not exclude a vitamin deficiency. Neurological or psychiatric disorders and immune abnormalities have been reported in patients with vitamin B12 or folate deficiencies or in children with congenital abnormalities of these 2 vitamins; such manifestations may even occur without anemia.

Anemia, Megaloblastic↗