New PDF release: Advances in Human Genetics 6

By Leon E. Rosenberg (auth.), Harry Harris, Kurt Hirschhorn (eds.)

ISBN-10: 1461582644

ISBN-13: 9781461582649

ISBN-10: 1461582660

ISBN-13: 9781461582663

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The following recent evidence has tended to weaken this argument: serum concentration of 25-hydroxycholecalciferol in patients with FHR is normal 50 ; serum parathyroid hormone concentrations have been variable reported as normal, reduced, and modestly elevated6 ,82,122; and treatment with physiological doses of 1, 25-dihydroxycholecalciferol produces unimpressive results. 14 The 38 Leon E. Rosenberg alternate view proposes a primary membrane transport defect for inorganic phosphate in the proximal renal tubule and intestine which results secondarily in calcium malabsorption and renal phosphate diabetesY' 145 Despite this lack of consensus concerning etiology, there is widespread agreement that the bone disease in FHR can be treated effectively with huge doses of vitamin D (more than 1000 times the physiological requirement), large amounts of inorganic phosphate by mouth, or a combination thereof.

70 The diagnosis of pyridoxine deficiency rests on the demonstration of reduced cellular or extracellular concentrations of the vitamin, its active coenzyme, or its catabolite. It is possible to measure serum and tissue concentrations of pyridoxine and PLP by microbiological or chemical means, and quantitation of urinary 4-pyridoxic acid also provides a useful measure of tissue stores. 137 Alternatively, indirect means have been used to estimate the adequacy of tissue pyridoxine content. Assay of PLP-requiring enzymes in serum or tissue has been proposed as a measure of deficiency, but the usefulness of this approach has been compromised by variability either in the affinity of specific apoenzymes for PLP or in the rate of turnover of particular apoprotein species.

Although the molecular basis of none of these mutations is known, it is clear that patients with each of them require far more than physiological amounts of B12 if they are to synthesize sufficient quantities of B12 coenzymes for normal growth or, in some cases, for prolonged viability. Folic Acid Clinicians have often considered cobalamin and folic acid in tandem because megaloblastic anemia is the hallmark of deficiency of both vitamins. These two vitamins have other prominent similarities pertinent to this discussion: both have complex systems of intestinal absorption and coenzyme synthesis and both demonstrate a panorama of vitamin-responsive mutations in these transport and synthetic processes.

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Advances in Human Genetics 6 by Leon E. Rosenberg (auth.), Harry Harris, Kurt Hirschhorn (eds.)

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