Methylmalonic Aciduria and Methylmalonic Acidemia

As discussed in Section 10.8.2, moderate vitamin B12 deficiency results in increased accumulation of methylmalonyl CoA, and methylmalonic aciduria and methylmalonic acidemia. This can be exploited as both a means of detecting subclinical deficiency and monitoring vitamin B12 status in patients with pernicious anemia who have been treated with parenteral vitamin. As they become depleted, the excretion of methylmalonic acid, especially after a loading dose of valine, will provide a sensitive index of depletion of vitamin B12 reserves.

Methylmalonyl CoA mutase is especially sensitive to vitamin B12 depletion, so methylmalonic aciduria is the most sensitive index of vitamin B12 status. Folate deficiency does not cause methylmalonic aciduria. However, up to 25% of patients with confirmed pernicious anemia excrete normal amounts of methylmalonic acid, even after a loading dose of valine (Chanarin et al., 1973).

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