Cystathioninuria from Pyridoxine Deficiency Complicating Treatment of Hypercalcaemia in a Cretin
Arch Dis Child: first published as 10.1136/adc.41.217.273 on 1 June 1966. Downloaded from Arch. Dis. Childh., 1966, 41, 273. Cystathioninuria from Pyridoxine Deficiency Complicating Treatment of Hypercalcaemia in a Cretin PAUL FOURMAN, JEAN W. SUMMERSCALES, and D. M. MORGAN From the Departments of Chemical Pathology and Paediatrics, Leeds General Infirmary Rats with vitamin B6 deficiency excrete cysta- deficiency may continue to make cystathionine but thionine in the urine (Hope, 1957). Cystathionine they fail to split it. is an amino acid in the pathway of synthesis of Pyridoxal phosphate is a co-enzyme for many cysteine from methionine (Fig. 1). A methyl group other enzymes that are important in metabolism is removed from methionine to produce homocyst- (Holtz and Palm, 1964), including certain trans- eine, which condenses with serine to yield cysta- aminases and decarboxylases. Several of the thionine. This condensation is catalysed by a enzymes concerned in tryptophan metabolism transulphurase enzyme requiring pyridoxal phos- require pyridoxal phosphate. The net effect of phate as a co-enzyme. Finally, cystathionine splits vitamin B6 deficiency on tryptophan metabolism is to yield cysteine and homoserine. This reaction is usually to increase the excretion of xanthurenic acid, catalysed by cystathionase and also requires particularly after the addition ofa dose of tryptophan pyridoxal phosphate (White, Handler, and Smith, to the diet, but the precise reason for the increased 1964). Pyridoxal and its phosphate are forms of xanthurenic acid excretion is not clear (Greenberg, vitamin B6, the others being pyridoxamine and its Bohr, McGrath, and Rinehart, 1949; Holtz and copyright. phosphate, and pyridoxine.
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