Posted in Flagyl on May 19, 2015

Vitamin B12, vitamin B12 or vitamin B-12, likewise called cobalamin, is a water-soluble vitamin by a key role in the legitimate functioning of the brain and forcible system, and for the formation of passion. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially pathetic DNA synthesis and regulation, but besides fatty acid metabolism and amino pungent metabolism. Neither fungi, plants, nor animals are capable of producing vitamin B12. Only bacteria and archaea desire the enzymes required for its synthesis, although many foods are a life-like source of B12 because of bacterial symbiosis. The vitamin is the largest and ut~ structurally complicated vitamin and can exist produced industrially only through bacterial fermentation-putting together.

Vitamin B12 consists of a class of chemically related compounds (vitamers), totality of which have vitamin activity. It contains the biochemically choice element cobalt sitting in the center of a planar tetra-pyrrole ring called a Corrin ring. Biosynthesis of the basic configuration of the vitamin is accomplished only by bacteria and archaea (which usually yield hydroxocobalamin), but conversion between different forms of the vitamin be possible to be accomplished in the human corpse. A common semi-synthetic form of the vitamin is cyanocobalamin, that does not occur in nature limit is produced from bacterial hydroxocobalamin. Because of its immovability and lower production cost, this shape is then used in many pharmaceuticals and supplements being of the kind which well as a food additive. In the dead ~ it is converted to the human physiological forms methylcobalamin and 5′-deoxyadenosylcobalamin, leaving aft the cyanide ion, albeit in a minimal reduction by evaporation. More recently, hydroxocobalamin, methylcobalamin, and adenosylcobalamin be able to be found in more expensive pharmacological products and fare supplements. Their extra utility is currently debated.

Vitamin B12 was discovered from its affinity to disease pernicious anemia, which is one autoimmune disease in which parietal cells of the swallow responsible for secreting intrinsic factor are destroyed (these cells are also responsible for secreting acid in the swallow). Because intrinsic factor is crucial conducive to the normal absorption of B12, its deficit in pernicious anemia causes a vitamin B12 infirmity. Many other subtler kinds of vitamin B12 shortage and their biochemical effects have as been elucidated.

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The names vitamin B12, vitamin B12, or vitamin B-12, and the alternative name cobalamin, generally refer to the whole of forms of the vitamin. Some of medicine practitioners have suggested that its use be split into two categories.

In a liberal sense, B12 refers to a group of cobalt-containing vitamer compounds known similar to cobalamins: these include cyanocobalamin (an artifact formed from using activated carbon, which always contains trace cyanide, to purge hydroxycobalamin), hydroxocobalamin (another medicinal form, produced ~ the agency of bacteria), and finally, the two naturally occurring cofactor forms of B12 in the human body: 5′-deoxyadenosylcobalamin (adenosylcobalamin–AdoB12), the cofactor of Methylmalonyl Coenzyme A mutase (MUT), and methylcobalamin (MeB12), the cofactor of enzyme Methionine synthase, which is responsible for conversion of homocysteine to methionine and of 5-methyltetrahydrofolate to tetrahydrofolate.

The bourn B12 may be properly used to make ~ence to cyanocobalamin, the principal B12 con~ation used for foods and in nutritional supplements. This generally creates no problem, except perhaps in infrequent cases of eye nerve damage, where the body is only marginally skilful to use this form due to vainglorious cyanide levels in the blood suitable to cigarette smoking; it thus requires intermission of smoking or B12 given in one more form, for the optic symptoms to mollify. However, tobacco amblyopia is a thin condition, and it is yet unclear whether it represents a peculiar B12 scantiness that is resistant to treatment with cyanocobalamin.

Finally, so-called pseudovitamin-B12 refers to B12-like analogues that are biologically torpid in humans and yet found to have existence present alongside B12 in humans, numerous food sources (including animals), and perhaps supplements and fortified foods. In greatest in number cyanobacteria, including Spirulina, and some algae, of the like kind as dried Asakusa-nori (Porphyra tenera), pseudovitamin-B12 is set up to predominate.

Medical uses

Vitamin B12 is used to behave to vitamin B12 deficiency, cyanide poisoning, and patrimonial deficiency of transcobalamin II. It is given being of the cl~s who part of the Schilling test during detecting pernicious anemia.

For cyanide poisoning, a spacious amount of hydroxocobalamin may be given intravenously and at intervals in combination with sodium thiosulfate. The mechanism of action is straightforward: the hydroxycobalamin hydroxide ligand is displaced ~ the agency of the toxic cyanide ion, and the resulting harmless B12 complex is excreted in animal-water. In the United States, the Food and Drug Administration approved (in 2006) the application of hydroxocobalamin for acute treatment of cyanide poisoning.

High vitamin B12 flat in elderly individuals may protect for brain atrophy or shrinkage associated by Alzheimer’s disease and impaired cognitive office.

High-dose administration of Vitamin B12 has been additionally validated to incense the activity of the body’s TH1 suppressor T-Cells, what one. then down-regulates the over-lengthening of the allergen antibody IgE in allergic individuals.

Recommended intake

The dietary respect intake for an adult ranges from 2 to 3 µg through day (US), and 1.5 µg per day (UK). But according to a new study, the DRI should be 4 to 7 µg per day. The Center for Food Safety and Applied Nutrition recommends 6 µg by day, based on a caloric intake of 2,000 calories, as antidote to adults and children four or again years of age.

Vitamin B12 is believed to be safe when used orally in amounts that finish not exceed the recommended dietary commission (RDA). There have been studies that showed in ~ degree adverse consequences of doses above the RDA. The RDA as antidote to vitamin B12 in pregnant women is 2.6 µg by means of day and 2.8 µg during lactation periods. There is insufficient trusty information available about the safety of consuming greater amounts of vitamin B12 during pregnancy.

The Institute of Medicine states that for 10 to 30% of older clan may be unable to absorb naturally occurring vitamin B12 in foods, it is fit for those 51 years old and older to waste B12-fortified foods or B12 supplements to come together the recommended intake.

Controversial sources in algae

The UK Vegan Society, the Vegetarian Resource Group, and the Physicians Committee in favor of Responsible Medicine, among others, recommend that vegans each consistently eat B12-fortified foods or take a daily or weekly B12 supplement to get the recommended intake.

It is of great weight for vegans, whose food provides scarcely any sources of B12, and anyone other wishing to obtain B12 from diet sources other than animals, to squander foods that contain little or nay pseudovitamin-B12 and are high in biologically industrious B12. However, there have been in ~ degree significant human trials of sufficient glutinous substance to demonstrate enzymatic activity of B12 from nonbacterial sources, similar as Chlorella and edible sea algae (seaweeds, similar as lavers), although chemically some of these sources be delivered of been reported to contain B12 that seems chemically like to active vitamin. However, among these sources, single fresh sea algae such as Susabi-nori (Porphyra yezoensis) acquire been reported to demonstrate vitamin B12 mode of exercise in B12 deficient rats. This has over and above to be demonstrated for Chlorella, and nay study in rats of any algal B12 rise has yet to be confirmed through a second independent study. The possibility of algae-derived active forms of B12 soon remains an active topic of exploration, with no results that have yet reached consensus in the nutritional common.


Vitamin B12 deficiency can potentially incentive severe and irreversible damage, especially to the brain and strong system. At levels only slightly diminish than normal, a range of symptoms like as fatigue, depression, and poor remembrance may be experienced.

Vitamin B12 failure can also cause symptoms of frenzy and psychosis. Vitamin B12 deficiency is ~ numerous commonly caused by low intakes, only can also result from mal-absorption, certain intestinal disorders, low presence of obligatory proteins, and using of certain medications. Vitamin B12 is exquisite from plant sources, so vegetarians bequeath be the vulnerable populations most agreeable to suffer from vitamin B12 dearth. Infants are at a higher danger of vitamin B12 deficiency if they were born to vegetarian mothers. The somewhat advanced in life who have diets with limited fare or animal products are vulnerable populations in the same manner with well. Vitamin B12 deficiency can visible itself as anemia and in some cases cause permanent neurological damage. Recent studies showed vitiation is associated with vitamin B12 insufficiency; sufficient vitamin B12 level was independently associated by a decreased risk of depression and more fit cognitive performance adjusted for confounders. Vitamin B12 is a co-substrate of various cell reactions involved in methylation combination of nucleic acid and neurotransmitters. Synthesis of the trimonoamine neurotransmitters have power to enhance the effects of a traditional antidepressant. The intracellular concentrations of vitamin B12 be able to be inferred through the total plasma collection upon a single point of homocysteine, which can be converted to methionine from one side an enzymatic reaction that uses 5-methyletetrahydrofolate similar to the methyl donor group. Consequently, the plasma collection upon a single point of homocysteine falls as the intracellular condensation of vitamin B12 rises. The assiduous metabolite of vitamin B12 is required beneficial to the methylation of homocysteine in the fruit of methionine, which is involved in a run over of biochemical processes including the monoamine neurotransmitters. Thus, a dearth in vitamin B12 may impact the prolongation and function of those neurotransmitters.

Imerslund-Gräsbeck syndrome is a scarce disease where there is selective malabsorption of cobalamine with proteinuria caused due to defect in ileal receptor.

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Ultimately, animals be obliged to obtain vitamin B12 directly or indirectly from bacteria, and these bacteria may reside in a section of the gut that is distal to the part where B12 is absorbed. Thus, herbivorous animals must either obtain B12 from bacteria in their rumens or (granting that fermenting plant material in the hindgut) by reingestion of cecotrope feces.

Vitamin B12 is base in most animal derived foods, including seek by artifice and shellfish, meat (especially liver), poultry, eggs, milk, and milk products. However, the covering capacity of egg yolks and stimulate whites is markedly diminished after race treatment. An NIH Fact Sheet arena a variety of animal food sources of B12.

Besides undeniable fermented foods, there are currently alone a few non-animal food sources of biologically in action B12 suggested, and none of these desire been subjected to human trials.

A Japanese fermented monstrous tea known as Batabata-cha has been raise to contain biologically active B12. Unlike kombucha, that is made by fermenting already prepared tea, Batabata-cha is fermented while hushed in the tea leaf state.

Chlorella, a renewed-water single cell green algae, has been suggested during the time that a vitamin B12 source but not proven by any live animal assay. Algae are design to acquire B12 through a symbiotic connection with heterotrophic bacteria, in which the bacteria minister B12 in exchange for fixed carbon. Spirulina and dried Asakusa-nori (Porphyra tenera) be the subject of been found to contain mostly pseudovitamin-B12 (regard Terminology) instead of biologically active B12. While Asakusa-nori (Porphyra tenera) contains mostly pseudovitamin-B12 in the dry commonwealth, it has been reported to restrain mostly biologically active B12 in the new state, but even its fresh quality vitamin activity has not been verified by animal enzyme assay.

One group of researchers has reported that the purple laver seaweed known at the same time that Susabi-nori (Pyropia yezoensis). in its fresh parade contains B12 activity in the rat standard, which implies that source would be active in humans. These results hold not been confirmed.

A single commensal bacteria not heedless in the gut of many mammals has demonstrated ~y ability to perform all steps that cannot be spared to synthesize B12 from common metabolically serviceable products.

Foods fortified with B12 are in addition sources of the vitamin, although they cannot exist regarded as true food sources of B12 seeing that the vitamin is added in addition form, from commercial bacterial production sources, like as cyanocobalamin. Examples of B12-fortified foods include fortified breakfast cereals, fortified soy products, fortified efficacy bars, and fortified nutritional yeast. The UK Vegan Society, the Vegetarian Resource Group, and the Physicians Committee ~ the sake of Responsible Medicine, among others, recommend that each vegan who is not consuming B12 foods stiffen with supplements. Not all of these may hold labeled amounts of vitamin activity. Supplemental B12 added to beverages in united study was found to degrade to have capacity for varying levels of pseudovitamin-B12. One relation has found B12 analogues present in varying amounts in more multivitamins.

Unconventional natural sources of B12 also exist, but their utility as fare sources of B12 are doubtful. For exemplification, plants pulled from the ground and not washed may include remnants of B12 from the bacteria donative in the surrounding soil. B12 is moreover found in lakes if the wet has not been sanitized. Certain insects in the same state as termites contain B12 produced through their gut bacteria, in a scheme analogous to ruminant animals. The human of the intestines tract itself may contain B12-producing bacteria in the inconsiderable intestine, but it is unclear whether adequate amounts of the vitamin could have ~ing produced to meet nutritional needs.


Vitamin B12 is by stipulation as a supplement in many processed foods, and is in addition available in vitamin pill form, including multi-vitamins. Vitamin B12 be possible to be supplemented in healthy subjects also by liquid, transdermal patch, nasal branch, or injection and is available sincerely or in combination with other supplements. It is a for the use of all ingredient in energy drinks and activity shots, usually at many times the minimum recommended daily allowance of B12. Vitamin B12 supplements are forcible for preventing deficiencies, especially in vegetarians, and are many times marketed as weight loss supplements. However, ~t any scientific studies have shown that B12 is effectual for weight loss.

Cyanocobalamin is converted to its lively forms, first hydroxocobalamin and then methylcobalamin and adenosylcobalamin in the liver.

The sublingual route, in which B12 is presumably or supposedly taken in else directly under the tongue, has not proven to be necessary or helpful, even though a figure of lozenges, pills, and even a sugar-plum designed for sublingual absorption, are centre of life marketed. A 2003 study found ~t one significant difference in absorption for serum levels from verbal vs. sublingual delivery of 0.5 mg of cobalamin. Sublingual methods of replacement are effective only because of the typically complete doses (0.5 mg), which are swallowed, not for of placement of the tablet. As remarkable below, such very high doses of parole B12 may be effective as treatments, so much as if gastro-intestinal tract absorption is impaired ~ the agency of gastric atrophy (pernicious anemia).

Injection and patches are at times used if digestive absorption is impaired, if it were not that there is evidence that this give chase to of action may not be requirement with modern high potency oral supplements (so as 0.5 to 1 mg or greater quantity). Even pernicious anemia can be treated entirely by the oral route. These supplements push forward such large doses of the vitamin that 1% to 5% of pre-eminent oral doses of free crystalline B12 is absorbed longitudinally the entire intestine by passive circulation.

However, if the patient has instinctive errors in the methyltransfer pathway (cobalamin C disease, combined methylmalonic aciduria and homocystinuria), method of treating with intravenous, intramuscular hydroxocobalamin or transdermal B12 is needed.

Non-cyano forms in the same proportion that supplements

Recently sublingual methylcobalamin has suit available in 5 mg tablets. The metabolic fate and biological distribution of methylcobalamin are expected to be similar to that of other sources of vitamin B12 in the diet. No cyanide is released through methylcobalamin, although the amount of cyanide (2% of the importance, or 20 micrograms cyanide in a 1 mg cyanocobalamin tab) is far less than ingested in many normal foods. Although the safety of cyanocobalamin has all a~ been proven, the safety of the other types is furthermore well established.

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Adverse effects

Hematologic:Peripheral vascular thrombosis has been reported. Treatment of vitamin B12 scarcity can unmask polycythemia vera, which is characterized ~ dint of. an increase in blood volume and the calculate of red blood cells. The amendment of megaloblastic anemia with vitamin B12 have power to result in fatal hypokalemia and gout in susceptible individuals, and it be able to obscure folate deficiency in megaloblastic anemia.

Leber’s complaint: Vitamin B12 in the form of cyanocobalamin is contraindicated in in good time Leber’s disease, which is ancestral optic nerve atrophy. Cyanocobalamin can trial severe and swift optic atrophy, excepting other forms of vitamin B12 are profitable. However, the sources of this specification are not clear, while an opposite view concludes: “The clinical picture of eye neuropathy associated with vitamin B12 deficiency shows similarity to that of Leber’s disease optic neuropathy. Both involve the brace fibers of the papillomacular bundle. The not away case reports suggest that optic neuropathy in patients carrying a elementary LHON mtDNA mutation may be precipitated ~ the agency of vitamin B12 deficiency. Therefore, known carriers should take care to require an adequate dietary intake of vitamin B12 and malabsorption syndromes like those occurring in familial malign anaemia or after gastric surgery should have existence excluded.”


Vitamin B12 supplements in hypothesis should be avoided in people perceptive or allergic to cobalamin, cobalt, or a single one other product ingredients. However, direct allergy to a vitamin or nutrient is extremely uncommon, and if reported, other causes should exist sought.


Alcohol (ethanol): Excessive spirits of wine intake lasting longer than two weeks have power to decrease vitamin B12 absorption from the gastrointestinal disquisition.

Aminosalicylic acid (para-aminosalicylic acid, PAS, Paser): Aminosalicylic sharp can reduce oral vitamin B12 absorbing., possibly by as much as 55%, being of the cl~s who part of a general malabsorption syndrome. Megaloblastic changes, and accidental cases of symptomatic anemia have occurred, usually succeeding doses of 8 to 12 g/light of ~ for several months. Vitamin B12 levels should subsist monitored in people taking aminosalicylic pricking for more than one month.

Antibiotics: An increased bacterial incubus can bind significant amounts of vitamin B12 in the narrow pass, preventing its absorption. In people by bacterial overgrowth of the small bowel, antibiotics of that kind as metronidazole (Flagyl) can actually improve vitamin B12 station. The effects of most antibiotics forward gastrointestinal bacteria are unlikely to be the subject of clinically significant effects on vitamin B12 levels.

Hormonal contraception: The premises regarding the effects of oral contraceptives without ceasing vitamin B12 serum levels are conflicting. Some studies hold found reduced serum levels in verbal contraceptive users, but others have form in a mould no effect despite use of spoken contraceptives for up to 6 months. When spoken contraceptive use is stopped, normalization of vitamin B12 levels usually occurs. Lower vitamin B12 serum levels seen through oral contraceptives probably are not clinically eminently expressive.

Chloramphenicol (Chloromycetin): Limited case reports prompt that chloramphenicol can delay or hinder from proceeding the reticulocyte response to supplemental vitamin B12 in more patients. Blood counts should be monitored closely admitting that this combination cannot be avoided.

Cobalt irradiation: Cobalt irradiation of the petty bowel can decrease gastrointestinal (GI) absorbing. of vitamin B12.

Colchicine: Colchicine in doses of 1.9 to 3.9 mg/generation can disrupt normal intestinal mucosal function, leading to malabsorption of several nutrients, including vitamin B12. Lower doses act not seem to have a momentous effect on vitamin B12 absorption after 3 years of colchicine therapy. The import of this interaction is unclear. Vitamin B12 levels should be monitored in people taking large doses of colchicine ~ the sake of prolonged periods.

Colestipol (Colestid), cholestyramine (Questran): These resins used concerning sequestering bile acids to decrease cholesterol, be able to decrease gastrointestinal (GI) absorption of vitamin B12. It is unlikely this interaction will deplete body stores of vitamin B12 unless there are other factors contributing to foible. In a group of children treated with cholestyramine for up to 2.5 years, in that place was not any change in serum vitamin B12 levels. Routine supplements are not unavoidable.

H2-receptor antagonists: include cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). Reduced secretion of of the stomach acid and pepsin produced by H2 blockers have power to reduce absorption of protein-bound (dietary) vitamin B12, limit not of supplemental vitamin B12. Gastric stinging is needed to release vitamin B12 from protein concerning absorption. Clinically significant vitamin B12 insufficiency and megaloblastic anemia are unlikely, if not H2 blocker therapy is prolonged (2 years or besides), or the person’s diet is unprolific. It is also more likely on the supposition that the person is rendered achlorhydric(with complete absence of gastric acid secretion), which occurs more frequently with proton interrogate inhibitors than H2 blockers. Vitamin B12 levels should subsist monitored in people taking high doses of H2 blockers on account of prolonged periods.

Metformin (Glucophage): Metformin may weaken serum folic acid and vitamin B12 levels. Long-word use of metformin substantially increases the dare to undertake of B12 deficiency and (in those patients who get deficient) hyperhomocysteinemia, which is “an independent risk factor for cardiovascular disease, especially among individuals with type 2 diabetes.” There are too rare reports of megaloblastic anemia in the vulgar who have taken metformin for five years or additional. Reduced serum levels of vitamin B12 occur in up to 30% of folks taking metformin chronically. However, clinically expressive deficiency is not likely to be ~ed if dietary intake of vitamin B12 is sufficient. Deficiency can be corrected with vitamin B12 supplements on the same level if metformin is continued. The metformin-induced malabsorption of vitamin B12 is reversible ~ means of oral calcium supplementation. The general clinical moment of metformin upon B12 levels is like yet unknown.

Neomycin: Absorption of vitamin B12 be able to be reduced by neomycin, but prolonged use of large doses is needed to set on pernicious anemia. Supplements are not usually needed through normal doses.

Nicotine: Nicotine can decrease serum vitamin B12 levels. The poverty for vitamin B12 supplementation in smokers has not been adequately well-considered.

Nitrous oxide: Nitrous oxide inactivates the cobalamin con~ation of vitamin B12 by oxidation. Symptoms of vitamin B12 shortage, including sensory neuropathy, myelopathy, and encephalopathy, be possible to occur within days or weeks of exposing. to nitrous oxide anesthesia in people with subclinical vitamin B12 deficiency. Symptoms are treated by high doses of vitamin B12, further recovery can be slow and uncompleted. People with normal vitamin B12 levels acquire sufficient vitamin B12 stores to cause to be the effects of nitrous oxide immaterial, unless exposure is repeated and prolonged (in the same state as recreational use). Vitamin B12 levels should exist checked in people with risk factors because of vitamin B12 deficiency prior to using nitrous oxide anesthesia. Chronic nitrous oxide B12 poisoning (usually from conversion to an act of nitrous oxide as a recreational deaden with narcotics), however, may result in B12 functional weak side even with normal measured blood levels of B12.

Phenytoin (Dilantin), phenobarbital, primidone (Mysoline): These anticonvulsants be obliged been associated with reduced vitamin B12 absorption, and reduced serum and cerebrospinal fluidlevels in more patients. This may contribute to the megaloblastic anemia, in the first place caused by folate deficiency, associated by these drugs. It is also suggested that reduced vitamin B12 levels may give to the neuropsychiatric side effects of these drugs. Patients should have existence encouraged to maintain adequate dietary vitamin B12 intake. Folate and vitamin B12 rank should be checked if symptoms of anemia advance in successive.

Proton pump inhibitors (PPIs): The PPIs hold omeprazole (Prilosec, Losec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix, Pantoloc), and esomeprazole (Nexium). The reduced secretion of gastric acid and pepsin produced by PPIs be possible to reduce absorption of protein-bound (dietary) vitamin B12, on the contrary not supplemental vitamin B12. Gastric pricking is needed to release vitamin B12 from protein against absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are in addition likely to produce achlorhydria (complete musing of gastric acid secretion). However, clinically expressive vitamin B12 deficiency is unlikely, unless PPI therapy is prolonged (2 years or greater degree of) or dietary vitamin intake is poor. Vitamin B12 levels should be monitored in rabble taking high doses of PPIs toward prolonged periods.

Zidovudine (AZT, Combivir, Retrovir): Reduced serum vitamin B12 levels may occur when zidovudine therapy is started. This adds to other factors that effect low vitamin B12 levels in populace with HIV, and might contribute to the hematological toxicity associated through zidovudine. However, the data suggest vitamin B12 supplements are not ready to help for people taking zidovudine.

Folic pungent: Folic acid, particularly in large doses, be able to mask vitamin B12 deficiency by completely correcting hematological abnormalities. In vitamin B12 deficiency, folic acid can produce complete decision of the characteristic megaloblastic anemia, though allowing potentially irreversible neurological damage (from continued supineness of methylmalonyl mutase) to progress. Thus, vitamin B12 condition should be determined before folic pricking is given as monotherapy.

Potassium: Potassium supplements can reduce absorption of vitamin B12 in more people. This effect has been reported by potassium chloride and, to a less extent, with potassium citrate. Potassium force contribute to vitamin B12 deficiency in more people with other risk factors, further routine supplements are not necessary.

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B12 is the ~ly chemically complex of all the vitamins. The pile of B12 is based on a corrin keep sounding, which is similar to the porphyrin resonance found in heme, chlorophyll, and cytochrome. The central metal ion is cobalt. Four of the six coordination sites are with the understanding by the corrin ring, and a fifth by a dimethylbenzimidazole group. The sixth coordination site, the center of reactivity, is variable, being a cyano group (-CN), a hydroxyl collection (-OH), a methyl group (-CH3) or a 5′-deoxyadenosyl assemblage (here the C5′ atom of the deoxyribose forms the covalent attraction with Co), respectively, to yield the four B12 forms mentioned on the earth. Historically, the covalent C-Co ~age is one of first examples of carbon-metal bonds to subsist discovered in biology. The hydrogenases and, ~ means of necessity, enzymes associated with cobalt utilization, comprise metal-carbon bonds.

Vitamin B12 is a generic descriptor praise referring to a collection of cobalt and corrin ring molecules which are defined by their individual vitamin function in the body. All of the substrate cobalt-corrin molecules from what one. B12 is made, must be synthesized ~ means of bacteria. However, after this synthesis is thorough, except in rare cases, the human visible form has the ability to convert some form of B12 to an unremitting form, by means of enzymatically removing indubitable prosthetic chemical groups from the cobalt atom, and replacing them with others.

The four forms (vitamers) of B12 are wholly deeply red colored crystals and shed ~ solutions, due to the color of the cobalt-corrin composed of several elements.

Cyanocobalamin is one such form, i.e. “vitamer”, of B12 on this account that it can be metabolized in the visible form to an active co-enzyme cast. However, the cyanocobalamin form of B12 does not occur in disposition normally, but is a byproduct of the circumstance that other forms of B12 are avid binders of cyanide (-CN) which they pilfer up in the process of activated carbon purification of the vitamin after it is made ~ dint of. bacteria in the commercial process. Since the cyanocobalamin configuration of B12 is easy to crystallize and is not perceptive to air-oxidation, it is typically used viewed like a form of B12 for feed additives and in many common multivitamins. Pure cyanocobalamin possesses the ~est part pink color associated with most octahedral cobalt(II) complexes and the crystals are well formed and easily grown up to millimeter sizing.

Hydroxocobalamin is another form of B12 commonly encountered in pharmacology, bound which is not normally present in the human visible form. Hydroxocobalamin is sometimes denoted B12a. This con~ation of B12 is the form produced ~ dint of. bacteria, and is what is converted to cyanocobalmin in the trading charcoal filtration step of production. Hydroxocobalamin has one avid affinity for cyanide ion and has been used since an antidote to cyanide poisoning. It is supplied typically in irrigate solution for injection. Hydroxocobalamin is conception to be converted to the prompt enzymic forms of B12 more easily than cyanocobalamin, and seeing that it is little more expensive than cyanocobalamin, and has longer reserve times in the body, has been used as far as concerns vitamin replacement in situations where added reinsurance of activity is desired. Intramuscular the cabinet of hydroxocobalamin is also the preferred handling for pediatric patients with intrinsic cobalamin metabolic diseases, as being vitamin B12 deficient patients with tobacco amblyopia (what one. is thought to perhaps have a composing of cyanide poisoning from cyanide in cigarette fumigate); and for treatment of patients through pernicious anemia who have optic neuropathy.

Adenosylcobalamin (adoB12) and methylcobalamin (MeB12) are the brace enzymatically active cofactor forms of B12 that naturally occur in the corpse. Most of the body’s reserves are stored taken in the character of adoB12 in the liver. These are converted to the other methylcobalamin fashion as needed.

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Synthesis and industrial lengthening

Neither plants nor animals are independently efficient of constructing vitamin B12. Only bacteria and archaea be in possession of the enzymes required for its biosynthesis. The amount synthesis of B12 was reported ~ the agency of Robert Burns Woodward and Albert Eschenmoser in 1972, and literary works one of the classic feats of instrumental synthesis. Species from the following genera are known to synthesize B12: Acetobacterium, Aerobacter, Agrobacterium, Alcaligenes, Azotobacter, Bacillus, Clostridium, Corynebacterium, Flavobacterium, Lactobacillus, Micromonospora, Mycobacterium, Nocardia, Propionibacterium, Protaminobacter, Proteus, Pseudomonas, Rhizobium, Salmonella, Serratia, Streptomyces, Streptococcus and Xanthomonas.

Industrial production of B12 is through fermentation of selected microorganisms. Streptomyces griseus, a bacterium once thought to be a yeast, was the trading source of vitamin B12 for many years. The species Pseudomonas denitrificans and Propionibacterium freudenreichii subsp. shermanii are greater amount of commonly used today. These are repeatedly grown under special conditions to increase yield, and at least one firm, Rhône-Poulenc of France, which has merged into Sanofi-Aventis, used genetically engineered versions of any or both of these species. Since a tell of species of Propionibacterium produce none exotoxins or endotoxins and are without particularizing regarded as safe (have been granted GRAS station) by the Food and Drug Administration of the United States, they are presently the FDA-preferred bacterial fermentation organisms during the term of vitamin B12 production.

The total nature production of vitamin B12, by four companies (the French Sanofi-Aventis and three Chinese companies) is before-mentioned to have been 35 tonnes in 2008.

See cyanocobalamin during the term of discussion of the chemical preparation of reduced-cobalt vitamin analogs and arrangement of physiological forms of the vitamin like as adenosylcobalamin and methylcobalamin.

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Mechanism of rencontre

Coenzyme B12’s reactive C-Co captivity participates in three main types of enzyme-catalyzed reactions.




In humans, sum of ~ units major coenzyme B12-dependent enzyme families corresponding to the first two reaction types, are known. These are typified ~ means of the following two enzymes:

MUT is an isomerase which uses the AdoB12 fashion and reaction type 1 to catalyze a carbon outline rearrangement (the X group is -COSCoA). MUT’s reciprocal action converts MMl-CoA to Su-CoA, each important step in the extraction of energy from proteins and fats (despite more see MUT’s reaction machinery). This functionality is lost in vitamin B12 scantiness, and can be measured clinically for example an increased methylmalonic acid (MMA) even. Unfortunately, an elevated MMA, though easily affected to B12 deficiency, is probably overly sensitive, and not all who have it actually have B12 deficiency. For example, MMA is elevated in 90-98% of patients through B12 deficiency; however 20-25% of patients c~ing the age of 70 have elevated levels of MMA, to this time 25-33% of them do not get B12 deficiency. For this reason, valuation of MMA levels is not routinely recommended in the somewhat old. There is no “gold standard” exhibition for B12 deficiency because as a B12 failure occurs, serum values may be maintained though tissue B12 stores become depleted. Therefore, serum B12 values in a high place the cut-off point of frailty do not necessarily indicate adequate B12 condition The MUT function is necessary notwithstanding proper myelin synthesis (see mechanism in the regions of the dead) and is not affected by folate supplementation.

MTR, in like manner known as methionine synthase, is a methyltransferase enzyme, what one. uses the MeB12 and reaction sign 2 to transfer a methyl arrange from 5-methyltetrahydrofolate to homocysteine, in consequence of that generating tetrahydrofolate (THF) and methionine (in opposition to more see MTR’s reaction mechanical construction). This functionality is lost in vitamin B12 dearth, resulting in an increased homocysteine plain and the trapping of folate to the degree that 5-methyl-tetrahydrofolate, from which THF (the diligently employed form of folate) cannot be recovered. THF plays one important role in DNA synthesis such reduced availability of THF results in ineffective production of cells with rapid turnover, in exact red blood cells, and also intestinal wall cells which are responsible since absorption. THF may be regenerated by way of MTR or may be obtained from renewed folate in the diet. Thus whole of the DNA synthetic effects of B12 deficit, including the megaloblastic anemia of deadly anemia, resolve if sufficient dietary folate is not away. Thus the best-known “function” of B12 (that that is involved with DNA synthesis, enclosed space-division, and anemia) is actually a facultative business which is mediated by B12-maintenance of an active form of folate that is needed for efficient DNA prolongation. Other cobalamin-requiring methyltransferase enzymes are furthermore known in bacteria, such as Me-H4-MPT, coenzyme M methyl transferase.

Enzyme derivative

If folate is present in aggregate, then of the two absolutely vitamin B12-pendent enzyme-family reactions in humans, the MUT-kindred reactions show the most direct and characteristic minor effects, focusing on the nervous order (see below). This is because the MTR (methyltransferase-printing character) reactions are involved in regenerating folate, and so are less evident when folate is in richness supply.

Since the late 1990s, folic pricking has begun to be added to fortify flour in many countries, so folate failing is now more rare. At the sort time, since DNA synthetic-sensitive tests toward anemia and erythrocyte size are routinely vouchsafed in even simple medical test clinics (with equal rea~n that these folate-mediated biochemical personal estate are more often directly detected), the MTR-hanging effects of B12 deficiency are decorous apparent not as anemia due to DNA-synthetic problems (while they were classically), but now principally as a simple and less visible elevation of homocysteine in the hotspur and urine (homocysteinuria). This condition may effect in long term damage to arteries and in clotting (shock and heart attack), but this tenor is difficult to separate from other indifferent processes associated with atherosclerosis and aging.

The specific myelin damage resulting from B12 error, even in the presence of equal folate and methionine, is more specifically and clearly a vitamin error problem. It has been connected to B12 principally directly by reactions related to MUT, what one. is absolutely required to convert methylmalonyl coenzyme A into succinyl coenzyme A. Failure of this side with reaction to occur results in elevated levels of MMA, a myelin destabilizer. Excessive MMA direct prevent normal fatty acid synthesis, or it decree be incorporated into fatty acid itself for better reason than normal malonic acid. If this strange fatty acid subsequently is incorporated into myelin, the resulting myelin have a mind be too fragile, and demyelination wish occur. Although the precise mechanism(s) are not known through certainty, the result is subacute combined degeneration of central nervy system and spinal cord. Whatever the action, it is known that B12 foible causes neuropathies, even if folic stinging is present in good supply, and accordingly anemia is not present.

Vitamin B12-contingent MTR reactions may also have neurological goods, through an indirect mechanism. Adequate methionine (what one., like folate, must otherwise be obtained in the diet, whether it is not regenerated from homocysteine ~ dint of. a B12 dependent reaction) is needed to be productive of S-adenosyl-methionine (SAMe), which is in become necessary for methylation of myelin case phospholipids. Although production of SAMe is not B12 contingent, help in recycling for provision of one adequate substrate for it (the diffusible amino acid methionine) is assisted ~ dint of. B12. In addition, SAMe is involved in the manufacture of certain neurotransmitters, catecholamines and in brain metabolism. These neurotransmitters are serious for maintaining mood, possibly explaining wherefore depression is associated with B12 fault. Methylation of the myelin sheath phospholipids may too depend on adequate folate, which in ~ round is dependent on MTR recycling, except ingested in relatively high amounts.

Lipotropic Injections

Absorption and division

Methyl-B12 is absorbed by every intestinal mechanism using intrinsic factor and ~ dint of. a diffusion process in which near 1% of the oral dose is absorbed. The human science of the functions of animals and vegetables of vitamin B12 is complex, and in return is prone to mishaps leading to vitamin B12 deficit. Protein-bound vitamin B12 must have ~ing released from the proteins by the representation of digestive proteases in both the taste and small intestine. Gastric acid releases the vitamin from food particles; therefore antacid and acid-blocking medications (especially proton-pump inhibitors) may inhibit absorption of B12. In addition some elderly people produce less desire acid as they age thereby increasing their likeliness of B12 deficiencies.

B12 taken in a moderate-solubility, non-chewable supplement pill form may bypass the spokesman and stomach and not mix with gastric acids, but these are not that must be for the absorption of free B12 not limit to protein.

R-proteins (such in the same proportion that haptocorrins and cobalaphilin) are B12 fillet proteins that are produced in the salivary glands. They be obliged to wait until B12 has been freed from proteins in subsistence by pepsin in the stomach. B12 in consequence binds to the R-Proteins to keep aloof from degradation of it in the acidic environment of the abide.

This pattern of secretion of a astringent protein secreted in a previous digestive step is repeated formerly more before absorption. The next cover protein is intrinsic factor (IF), a protein synthesized through gastric parietal cells that is secreted in replication to histamine, gastrin and pentagastrin, of the same kind with well as the presence of nourishment. In the duodenum, proteases digest R-proteins and receipt in full B12, which then binds to IF, to configuration a complex (IF/B12). B12 fustiness be attached to IF for it to be absorbed, as receptors on the enterocytes in the limiting ileum of the small bowel only recognize the B12-IF complex; in etc., intrinsic factor protects the vitamin from catabolism by intestinal bacteria.

Absorption of food vitamin B12 so requires an intact and functioning taste, exocrine pancreas, intrinsic factor, and puny bowel. Problems with any one of these organs makes a vitamin B12 scarcity possible. Individuals who lack intrinsic go-between have a decreased ability to appropriate B12. In pernicious anemia, there is a be wanting of IF due to autoimmune atrophic gastritis, in that antibodies form against parietal cells. Antibodies may alternately mould against and bind to IF, inhibiting it from carrying off its B12 protective function. Due to the entanglement of B12 absorption, geriatric patients, divers of whom are hypoacidic due to reduced parietal organic unit function, have an increased risk of B12 scarcity. This results in 80-100% excreted matter of oral doses in the feces against 30-60% excretion in feces being of the kind which seen in individuals with adequate IF.

Once the IF/B12 composite is recognized by specialized ileal receptors, it is transported into the portal circulation. The vitamin is then transferred to transcobalamin II (TC-II/B12), which serves as the plasma transporter. Hereditary defects in produce of the transcobalamins and their receptors may make functional deficiencies in B12 and childish megaloblastic anemia, and abnormal B12 akin biochemistry, even in some cases by normal blood B12 levels. For the vitamin to perform duty inside cells, the TC-II/B12 compages must bind to a cell receptor, and have ~ing endocytosed. The transcobalamin-II is degraded not more than a lysosome, and free B12 is for good released into the cytoplasm, where it may subsist transformed into the proper coenzyme, ~ dint of. certain cellular enzymes (see above).

It’s grave to note that investigations into the of the intestines absorption of B12 point out that the upper limit per single dose, under normal provisions, is about 1.5 µg: “Studies in vertical persons indicated that about 1.5 µg is assimilated at the time a single dose varying from 5 to 50 µg is administered by mouth. In a similar study Swendseid et al. detailed that the average maximum absorption was 1.6 µg […]”

The gross amount amount of vitamin B12 stored in material substance is about 2-5 mg in adults. Around 50% of this is stored in the liver. Approximately 0.1% of this is imperceptible per day by secretions into the paunch, as not all these secretions are reabsorbed. Bile is the requisite form of B12 excretion; however, principally of the B12 secreted in the venom. is recycled via enterohepatic circulation. Excess B12 out of the grasp of the blood’s binding capacity is typically excreted in animal-water. Owing to the extremely efficient enterohepatic number of copies disposed of of B12, the liver can supply several years’ worth of vitamin B12; in return, nutritional deficiency of this vitamin is inimitable. How fast B12 levels change depends without interrupti~ the balance between how much B12 is obtained from the diet, by what mode much is secreted and how a great deal of is absorbed. B12 deficiency may arise in a year admitting that initial stores are low and genetic factors unfavourable, or may not turn up for decades. In infants, B12 imperfection can appear much more quickly.


B12 weak side is the cause of pernicious anemia, some anemic disease that was usually baleful and had unknown etiology when it was primary described in medicine. The cure, and B12, were discovered ~ dint of. accident. George Whipple had been doing experiments in what one. he induced anemia in dogs ~ dint of. bleeding them, and then fed them changeable foods to observe which diets allowed them fastest retrieval from the anemia produced. In the series of measures, he discovered that ingesting large amounts of liver seemed to greatest number rapidly cure the anemia of feelings loss. Thus, he hypothesized that liver ingestion power treat pernicious anemia. He tried this and reported more signs of success in 1920.

After a succession of careful clinical studies, George Richards Minot and William Murphy suit out to partly isolate the pith in liver which cured anemia in dogs, and ground that it was iron. They also found that an entirely different liver vital part cured pernicious anemia in humans, that had ~t any effect on dogs under the conditions used. The specific factor treatment in favor of pernicious anemia, found in liver fluid, had been found by this exact overlapping. Minot and Murphy reported these experiments in 1926. This was the rudimentary real progress with this disease. Despite this finding out, for several years patients were till now required to eat large amounts of green liver or to drink considerable amounts of liver juice.

In 1928, the chemist Edwin Cohn prepared a liver quote that was 50 to 100 spells more potent than the natural liver products. The cite was the first workable treatment because of the disease. For their initial toil in pointing the way to a working treatment, Whipple, Minot, and Murphy shared the 1934 Nobel Prize in Physiology or Medicine.

These events in pivot eventually led to discovery of the soluble vitamin, called vitamin B12, from bacterial broths. In 1947, under which circumstances working for the Poultry Science Department at the University of Maryland, Mary Shaw Shorb (in a collaborative shoot forward with Folkers and Merck) was supposing with a $400 grant to be ~ed the so-called “LLD assay” in spite of B12. LLD stood for Lactobacilis lactis Dorner, a filter of bacterium which required “LLD middleman” for growth, which was eventually identified in the manner that B12. Shorb and colleagues used the LLD test to rapidly extract the anti-evil-hearted anemia factor from liver extracts, and undefiled B12 was isolated in this resolved mode of action by 1948, with the contributions of chemists Shorb, Karl A. Folkers of the United States and Alexander R. Todd of Great Britain. For this ascertainment, in 1949 Mary Shorb and Karl Folkers accepted the Mead Johnson Award from the American Society of Nutritional Sciences.

The chemical configuration of the molecule was determined ~ means of Dorothy Crowfoot Hodgkin and her team in 1956, based in c~tinuance crystallographic data. Eventually, methods of producing the vitamin in great quantities from bacteria cultures were developed in the 1950s, and these led to the present form of treatment for the disorder.

See also


Cyanocobalamin includes controversy of chemistry of preparation of reduced-cobalt B12 analogs




External links

Vitamin B12 Fact Sheet from the U.S. National Institutes of Health

Jane Higdon, “Vitamin B12”, Micronutrient Information Center, Linus Pauling Institute, Oregon State University

Vitamin B12 infirmity article in American Family Physician daily register

Vitamin B12 and Folate at Lab Tests Online

Cyanocobalamin at the US National Library of Medicine Medical Subject Headings (MeSH)

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The drug is usually utilised anesthetic and it inhibits equally b12 conditioned enzymes.