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Schleicher, E. ; Didangelos, T.* ; Kotzakioulafi, E.* ; Cegan, A.* ; Peter, A. ; Kantartzis, K.

Clinical pathobiochemistry of vitamin B12 deficiency: improving our understanding by exploring novel mechanisms with a focus on diabetic neuropathy.

Nutrients 15:18 (2023)
DOI PMC
Creative Commons Lizenzvertrag
Open Access Gold as soon as Publ. Version/Full Text is submitted to ZB.
Vitamin B12 (B12) is an essential cofactor of two important biochemical pathways, the degradation of methylmalonic acid and the synthesis of methionine from homocysteine. Methionine is an important donor of methyl groups for numerous biochemical reactions, including DNA synthesis and gene regulation. Besides hematological abnormalities (megaloblastic anemia or even pancytopenia), a deficiency in B12 may cause neurological symptoms, including symptoms resembling diabetic neuropathy. Although extensively studied, the underlining molecular mechanism for the development of diabetic peripheral neuropathy (DPN) is still unclear. Most studies have found a contribution of oxidative stress in the development of DPN. Detailed immunohistochemical investigations in sural nerve biopsies obtained from diabetic patients with DPN point to an activation of inflammatory pathways induced via elevated advanced glycation end products (AGE), ultimately resulting in increased oxidative stress. Similar results have been found in patients with B12 deficiency, indicating that the observed neural changes in patients with DPN might be caused by cellular B12 deficiency. Since novel results show that B12 exerts intrinsic antioxidative activity in vitro and in vivo, B12 may act as an intracellular, particularly as an intramitochondrial, antioxidant, independent from its classical, well-known cofactor function. These novel findings may provide a rationale for the use of B12 for the treatment of DPN, even in subclinical early states.
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Publication type Article: Journal article
Document type Review
Corresponding Author
Keywords Vitamin B12 ; Cobalamin ; Diabetes ; Homocysteine ; Laboratory Biomarker ; Methylmalonic Acid ; Oxidative Stress ; Peripheral Neuropathy ; Reactive Oxygen Species ; Redox; Proton-pump Inhibitor; Peripheral Neuropathy; Cobalamin Deficiency; Atrophic Gastritis; Metformin; Methylcobalamin; Pathogenesis; Disorders; Receptor; Supplementation
ISSN (print) / ISBN 2072-6643
e-ISSN 2072-6643
Journal Nutrients
Quellenangaben Volume: 15, Issue: 11, Pages: , Article Number: 18 Supplement: ,
Publisher MDPI
Publishing Place Basel
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research and Metabolic Diseases (IDM)