Methionine synthetase deficiency

This is another rare inherited disorder of vitamin B12 metabolism in which both coenzyme forms, adenosylcobalamin and methylcobalamin, are affected. Methylcobalamin is required for the transfer of the methyl group of 5-methyltetrahydrofolate to homocysteine to give methionine. Lack of methylcobalamin results in deficient activity of 2V5-methyltetrahydrofolate-homo-cysteine methyltransferase, resulting in a reduced ability to methylate homocysteine. A failure of methionine synthetase would produce a similar result. 

Vitamin B12 is required by only two enzymes in human metabolism methionine synthetase and L-methylmalonyl-CoA mutase. Methionine synthetase has an absolute requirement for methylcobalamin and catalyzes the conversion of homocysteine to methionine (Fig. 28-5). 5-Methyltetrahydrofolate is converted to tetrahydrofolate (THF) in this reaction. This vitamin B12-catalyzed reaction is the only means by which THF can be regenerated from 5-methyltetrahydrofolate in humans. Therefore, in vitamin B12 deficiency, folic acid can become trapped in the 5-methyltetrahydrofolate form, and THF is then unavailable for conversion to other coenzyme forms required for purine, pyrimidine, and amino acid synthesis (Fig. 28-6). All folate-dependent reactions are impaired in vitamin B12 deficiency, resulting in indistinguishable hematological abnormalities in both folate and vitamin B12 deficiencies. 

The principal substrate for glutamylation is free tetrahydrofolate one-carbon substituted folates are poor substrates. Because the main circulating folate, and the main form that is taken up into tissues, is methyl-tetrahydrofolate, demethylation by the action of methionine synthetase (Section 10.3.3) is essential for effective metabolic trapping of folate. In vitamin B12 deficiency, when methionine synthetase activity is impaired, there wUl be impairment of the retention of folate in tissues. 

Impairment of methionine synthetase activity, for example, in vitamin B12 deficiency or after prolonged exposure to nitrous oxide (Section 10.9.7), will result in the accumulation of methyl-tetrahydrofolate. This can neither be utilized for any other one-carbon transfer reactions nor demethylated to provide free tetrahydrofolate. 

Deficiency of vitamins Bg, B12, or folate are aU associated with elevated plasma homocysteine, with vitamin Bg deficiency as a result of impaired activity of cystathionine synthetase (Section 9.5.5) and folate and vitamin B12 as a result of impaired activity of methionine synthetase (Section 10.3.4). In subjects with apparently adequate intakes of vitamins Bg and B12, supplements of these two vitamins have little or no effect on fasting plasma homocysteine, although additional vitamin Bg reduces the plasma concentration of homocysteine after a test dose of methionine. By contrast, supplements of... 

The cause of megaloblastosis is depressed DNA synthesis, as a result of impaired methylation of dCDP to TDP, catalyzed by thymidylate synthetase, but more or less normal synthesis of RNA. As discussed in Section 10.3.3, thymidylate synthetase uses methylene tetrahydrofolate as the methyl donor it is obvious that folic acid deficiency will result in unpaired thymidylate synthesis. It is less easy to see how vitamin B12 deficiency results in impaired thymidylate synthesis without invoking the methyl folate trap hypothesis (Section 10.3.4.1). The main circulating form of folic acid is methyl-tetrahydrofolate before this can be used for other reactions in tissues, it must be demethylated to yield free folic acid. The only reaction that achieves this is the reaction of methionine synthetase (Section 10.8.1). Thus, vitamin B12 deficiency results in a functional deficiency of folate. 

Demyelination is because of failure of the methylation of arginine of myelin basic protein. The nervous system is especially vulnerable to depletion of S-adenosylmethionine in vitamin B12 deficiency because, unlike other tissues, it contains only methionine synthetase, which is vitamin B12-dependent and not vitamin B12-independent homocysteine methyl transferase that uses betaine as the methyl donor (Section 10.3.4 Weir and Scott, 1995). 

One of the biochemical adverse effects of nitric oxide is inactivation of vitamin B12, with subsequent potentiation of folate deficiency (19). This effect is mediated by irreversible oxidation of the cobalt residue in vitamin B12 to its Co++ and Co forms. This leads to a reduction in methionine synthetase activity, with downstream effects on DNA synthesis. Previous studies have identified five patients with unsuspected vitamin B12 deficiency who developed subacute combined degeneration of the spinal cord following inhalation anesthesia with nitrous oxide... 

Nitrous oxide inactivates the enzyme methionine synthetase, and caution is urged in giving nitrous oxide to patients who may be deficient in vitamin B12. Low serum vitamin B12 concentrations have previously been reported in patients with sickle cell disease, but the reason for this is uncertain. Three cases of peripheral neuropathy have been reported in patients with sickle cell disease who received nitrous oxide (12-14). AU three had a history of frequent painful sickle crises, for which they received nitrous oxide for prolonged periods. Serum vitamin B12 concentrations were slightly reduced in two patients and very low in the third. The patients aU presented with difficulty in walking and paresthesia. Peripheral sensorimotor neuropathy was confirmed by nerve conduction studies. The patients all responded well to vitamin B12 injections and avoiding further exposure to nitrous oxide. Caution is therefore recommended when using nitrous oxide in patients with sickle cell disease or who are suspected of vitamin B12 deficiency. Two cases of polyneuropathy have also been reported after the use of nitrous oxide for 80 minutes and 3 hours in patients who were subsequently found to have pernicious anemia. They both responded well to hydroxocobalamin. 

Answer A. Folic acid can relieve hematologic symptoms in vitamin B12 deficiency because it can serve as a cofactor for methionine synthetase in the conversion of homocysteine to methionine. However, it cannot replace vitamin Bu (cyanocobalamin) in the reaction that converts malonyl-CoA to succinyl-CoA, so folic acid has no impact on the neurologic dysfunction of pernicious anemia. 

The mechanisms responsible for the neurological lesions of vitamin Bjj deficiency are less well understood. Damage to the myelin sheath is the most striking lesion in this neuropathy this observation led to the early suggestion that the deoxyadenosyl B j -dependent methylmalonyl CoA mutase reaction, a step in propionate metabohsm, is related to the abnormality. However, other evidence suggests that the deficiency of methionine synthetase and the block of the conversion of methionine to SAM are more hkely to be responsible. 

The reduction of methylene-tetrahydrofolate to methyl-tetrahydrofolate is irreversible, and the major source of folate for tissues is methyl-tetrahydrofolate. The only metabolic role of methyl-tetrahydrofolate is the methylation of homocysteine to methionine, and this is the only way in which methyl-tetrahydrofolate can be demethylated to yield free folate in tissues. Methionine synthetase thus provides the link between the physiological functions of folate and vitamin Impairment of methionine synthetase activity in vitamin deficiency will result in the accumulation of methyl-tetrahydrofolate, which can neither be utilized for any other one-carbon transfer reactions nor be demethylated to provide free folate. There is therefore functional deficiency of folate, secondary to the deficiency of vitamin B ... 

Methionine synthetase which requires the direct participation of vitamin Bj 2 5 Me THF is reduced in bone marrow cells (Sauer and V/ilmanns, 1977) and peripheral leukocytes from patients with vitamin Bj 2 deficiency. Injection of B 2 t-estored the activity to normal levels (Robertson et al., 1976). The folate dependent conversion of formate to serine is also reduced in lymphocytes from patients with various vitamin B 2 deficiency syndromes (Robertson et al., 1976 Tikerpal and Chanarin, 1978). The activity returned to the normal range following vitamin B 2 therapy while folate therapy was not successful even though a satisfactory hematological response was obtained. 

The metabolism of methionine, shown in Figure 9.5, includes two pyri-doxal phosphate-dependent steps cystathionine synthetase and cystathionase. Cystathionine synthetase is litde affected by vitamin Bg deficiency,... 

Several analytes are known to be indicative of folate metabolism. Plasma total homocysteine increases when there is a deficiency of 5-MTHF, such that the methylation of homocysteine to methionine is compromised. However, though plasma homocysteine is considered to be a sensitive functional indicator, it is not specific because its concentration can be influenced by deficiency of other vitamins (Bg and B12) involved in the metabolism of homocysteine. Similarly the methylation of DNA is dependent upon adequate 5-MTHF. A sensitive new method for the rapid detection of abnormal methylation patterns in global DNA patterns has been reported and may have promise as a functional marker, as may the measurement of the degree of uracil incorporation into DNA, 5,10-metliylene THF being required for die conversion of deoxyuridine monophosphate (dUMP) to dTMP by thymidylate synthetase. ... 

Selenomethionine metabolism to selenide and the incorporation into selenium-specific proteins may occur by two pathways metabolism to methane selenol and selenide or via selenocysteine. Evidence that the incorporation of selenium from selenomethionine into protein is by the transsulfuration pathway (methionine to cysteine) comes from studies of selenomethionine metabolism in lymphoblast cell lines deficient in cystathionine lyase and cystathionine synthetase, enzymes of the transsulfuration pathway (Beilstein and Whanger 1992). Deficiency in these enzymes greatly reduces the incorporation of selenomethionine into glutathione peroxidase. 

The controls of the heme-BCHL biosynthetic chain are summarized in Fig. 10. As discussed above, at least three kinds of control regulate ALA-synthetase activity. One is by heme acting as corepressor in the synthesis of this enzyme (2). Another is by heme acting as inhibitor of the enzyme (3). A third is by activation possibly of a precursor ALA-synthetase, the ratio of activator to inhibitor serving to control the degree of activation (1). Another control is somewhere between coproporphyrinogen and heme as revealed in methionine deficiency (4). In addition there is a control of the enzymes of the Mg branch (5), in contrast to those enzymes from ALA to heme. The enzymes of the Mg... 

The metabolism of methionine, shown in Figure 11.22, includes two pyridoxal phosphate-dependent steps cystathionine synthetase and cystathionase. Cystathionase activity falls markedly in vitamin deficiency, and as a result there is an increase in the urinary excretion of homocysteine and cystathionine, both after a loading dose of methionine and under basal conditions. However, as discussed below, homocysteine metabolism is affected more by folate status than by vitamin status, and, like the tryptophan load test, the methionine load test is probably not reliable as an index of... 

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