Vitamin B<sub>12</sub>Deficiency and Depression in the Elderly

Hanna, S. George; Lachover, Leonard; Rajarethinam, Rajaprabhakaran

doi:10.4088/pcc.08l00707

Cited by 32 publications

(30 citation statements)

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“…23 This supplementation is why we could not correlate our gene expression data with systemic levels of B12 to confirm a potential deficiency in its postoperative absorption. However, given that B12 levels were maintained at normal values 34 3 months after RYGB, changes in GI gene expression of B12 pathway-encoding genes did not seem to be influenced by altered levels of the vitamin.…”

Section: Discussionmentioning

confidence: 92%

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Sala

Belarmino

Torrinhas

et al. 2017

Clinical and Translational Gastroenterology

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Objectives:Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency.Methods:During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9±6.2 years; body mass index, 46.5±5.3 kg/m2) with adult-onset type 2 diabetes (fasting plasma glucose ≥126 mg/dl; hemoglobin A1c≥6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT–qPCR).Results:Gene expression levels with significant changes (P≤0.05) included: transcobalamin I (TCN1) in remnant (−1.914-fold) and excluded (−1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (−0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT–qPCR confirmed (P≤0.05) observed changes for TCN1 in the remnant gastric region (−0.132-fold) and CUBN in jejunum (+2.833-fold).Conclusions:RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.

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Section: Discussionmentioning

confidence: 92%

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Sala

Belarmino

Torrinhas

et al. 2017

Clinical and Translational Gastroenterology

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“…Há na literatura relato de casos que apontam para a propriedade da vitamina B12 de reverter quadros depressivos com ou sem sintomas psicóticos 3 . No presente relato, o quadro depressivo, até então refratário ao tratamento com antidepressivos, respondeu ao uso parenteral de vitamina B12.…”

Section: Discussionunclassified

“…A remissão dos sintomas ocorreu três semanas após o início da reposição de vitamina B12. Com efeito, os sintomas psiquiátricos associados à deficiência de vitamina B12 tendem a regredir após a administração terapêutica da vitamina em um período de uma a quatro semanas 3,4 . A vitamina B12 é disponibilizada em alimentos, sendo sua absorção no íleo dependente da presença de fator intrínseco liberado pelas células parietais do estômago.…”

Section: Discussionunclassified

“…Nos casos em que os valores de vitamina B12 se encontram próximos dos limites inferiores dos valores de referência, a dosagem de ácido metilmalônico e de homocisteína deve ser realizada, pois a elevação deles poderia indicar deficiência funcional de vitamina B12 5 . Causas conhecidas de deficiência de vitamina B12 incluem: dieta deficiente na vitamina; má absorção por uso prolongado de inibidores da bomba de prótons ou de antagonistas histaminérgicos; ausência ou redução no fator intrínseco, como na anemia perniciosa e pós-gastrectomia, enterite ileal, doença de Crohn, ressecção ileal; deficiência de transcobalamina II (transportador responsável por via alternativa de absorção da vitamina) lismo, cirurgia bariátrica e em pacientes com transtornos depressivos ou psicóticos refratários ao tratamento psicofarmacológico 3 . Além disso, a Academia Americana de Neurologia recomenda formalmente que pacientes com quadros demenciais sejam testados rotineiramente com dosagem sé-rica de vitamina B12 7 .…”

Section: Discussionunclassified

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Deficiência de vitamina B12 e transtorno depressivo refratário

Fábregas¹,

Vitorino²,

Teixeira³

2011

J. bras. psiquiatr.

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rESUMoA vitamina B12, ou cianocobalamina, desempenha importantes funções metabólicas e neurotróficas. Sua deficiência está associada a distúrbios hematológicos, neurológicos e psiquiátricos. É relatado o caso de uma paciente com depressão refratária ao tratamento com antidepressivos que melhorou somente após a detecção e o tratamento da deficiência de vitamina B12. Esse relato ilustra a importância de o psiquiatra considerar causas secundárias de depressão em casos refratários. . É interessante notar que, segundo alguns trabalhos, níveis mais elevados de vitamina B12 estiveram associados a melhores resultados em pacientes com depressão maior tratados com antidepressivos 2 . Neste relato, descreveu-se o caso de uma paciente com transtorno depressivo refratário ao tratamento psicofarmacológico tradicional, que evoluiu com remissão dos sintomas depressivos logo após a correção de deficiência de vitamina B12. rElato DE CaSoTrata-se de paciente de 42 anos, do sexo feminino, solteira, sem filhos, católica, com primeiro grau completo, desempregada há cerca de seis meses, período em que interrompeu o trabalho que desempenhava como auxiliar de serviços gerais a fim de cuidar do pai que estava doente. A paciente solicitou ao seu clínico-geral um encaminhamento para acompanhamento psiquiátrico, pois persistia com sintomas depressivos a despeito do uso de amitriptilina na dose de 50 mg/dia,

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“…Since majority of individuals suffering from MBA stay asymptomatic for many years and exhibit characteristic features such as pale skin color (Pallor), shortness and difficulty of breathing, light-headedness and fatigue only at later stages, early diagnosis is difficult [1]. Furthermore, individuals with MBA exhibit tingling and numbness of hands and feet in the initial stages, but once advanced, exhibit symptoms such as loss of memory and vision [4,5]. This loss of memory is due to increase in the homocysteine (HCys) levels in serum [6].…”

Section: Introductionmentioning

confidence: 99%

Comparative Assessment of Vitamin-B12, Folic Acid and Homocysteine Levels in Relation to p53 Expression in Megaloblastic Anemia

2016

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BackgroundMegaloblastic anemia (MBA), also known as macrocytic anemia, is a type of anemia characterized by decreased number of RBCs as well as the presence of unusually large, abnormal and poorly developed erythrocytes (megaloblasts), which fail to enter blood circulation due to their larger size. Lack of vitamin-B12 (VB12) and / or folate (Vitamin-B9, VB9) with elevated homocysteine is the key factor responsible for megaloblastic anemia. Prior studies have demonstrated the induction of apoptosis in these abnormal under-developed erythrocytes. However, it is not clear whether this apoptosis induction is due to elevated p53 level or due to any other mechanism. Furthermore, it is also not fully known whether decreased vitamin-B12 and / or folate are responsible for apoptosis induction mediated by p53 in pre-erythroblasts.MethodsLevels of serum VB9, VB12 and homocysteine in 50 patients suffering from MBA were compared with 50 non-megaloblastic anemia control subjects, who were referred by the clinicians for bone marrow examination for medical conditions other than MBA. Next, we have measured the p53 expression in the paraffin embedded blocks prepared from bone marrow biopsy, using immunohistochemistry, and the expression levels correlated with VB9 and VB12 levels.ResultsOut of 50 MBA patients 40 (80%) and 44 (88%) subjects had very low VB12 and VB9 levels respectively. In contrast, only 2 (4%) and 12 (24%) non-megaloblastic anemia controls, out of 50 subjects, had low VB12 and VB9 respectively. Correlating with low vitamin B9 and B12, the homocysteine levels were high in 80% cases. But, only 20% non-megaloblastic controls exhibited high homocysteine in plasma. Immunohistochemical analysis for p53 expression showed a significantly high level of expression in MBA cases and no—or very low—expression in control subjects. Our correlation studies comparing the VB12 and VB9 levels with p53 expression concludes unusually high p53 levels in patients suffering from VB12 and VB9 deficiency induced MBA compared to control subjects not suffering from MBA.ConclusionTumor protein p53 is the key protein expressed heavily in the bone marrow biopsies of patients suffering from VB12 and VB9 deficiency induced MBA but not in control subjects. Hence, p53 expression could be used as a surrogate marker for confirming the VB9 and VB12 induced MBA.

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Vitamin B₁₂Deficiency and Depression in the Elderly

Cited by 32 publications

References 9 publications

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Deficiência de vitamina B12 e transtorno depressivo refratário

Comparative Assessment of Vitamin-B12, Folic Acid and Homocysteine Levels in Relation to p53 Expression in Megaloblastic Anemia

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Vitamin B12Deficiency and Depression in the Elderly

Cited by 32 publications

References 9 publications

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Deficiência de vitamina B12 e transtorno depressivo refratário

Comparative Assessment of Vitamin-B12, Folic Acid and Homocysteine Levels in Relation to p53 Expression in Megaloblastic Anemia

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Vitamin B₁₂Deficiency and Depression in the Elderly