nih-gov/www.ncbi.nlm.nih.gov/omim/236270

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<title>
Entry
- #236270 - HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA, cblE TYPE; HMAE
- OMIM
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<span class="h4">#236270</span>
<br />
<strong>Table of Contents</strong>
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<a href="#title"><strong>Title</strong></a>
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<a href="#phenotypeMap"><strong>Phenotype-Gene Relationships</strong></a>
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<li role="presentation">
<a href="/clinicalSynopsis/236270"><strong>Clinical Synopsis</strong></a>
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<a href="/phenotypicSeries/PS236270"> <strong>Phenotypic Series</strong> </a>
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<a href="#text"><strong>Text</strong></a>
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<a href="#description">Description</a>
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<li role="presentation" style="margin-left: 1em">
<a href="#clinicalFeatures">Clinical Features</a>
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<li role="presentation" style="margin-left: 1em">
<a href="#inheritance">Inheritance</a>
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<li role="presentation" style="margin-left: 1em">
<a href="#molecularGenetics">Molecular Genetics</a>
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<li role="presentation">
<a href="#references"><strong>References</strong></a>
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<a href="#contributors"><strong>Contributors</strong></a>
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<a href="#creationDate"><strong>Creation Date</strong></a>
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<div><a href="https://clinicaltrials.gov/search?cond=HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA, cblE TYPE" class="mim-tip-hint" title="A registry of federally and privately supported clinical trials conducted in the United States and around the world." target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'Clinical Trials', 'domain': 'clinicaltrials.gov'})">Clinical Trials</a></div>
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<div style="margin-left: 0.5em;"><a href="https://www.orpha.net/consor/cgi-bin/ClinicalLabs_Search_Simple.php?lng=EN&LnkId=2063&Typ=Pat" title="Methylcobalamin deficiency type cblE" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'EuroGentest', 'domain': 'orpha.net'})">Methylcobalamin deficiency…&nbsp;</a></div><div style="margin-left: 0.5em;"><a href="https://www.orpha.net/consor/cgi-bin/ClinicalLabs_Search_Simple.php?lng=EN&LnkId=3369&Typ=Pat" title="Homocystinuria without methylmalonic aciduria" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'EuroGentest', 'domain': 'orpha.net'})">Homocystinuria without met…&nbsp;</a></div>
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<div style="margin-left: 0.5em;"><a href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=2169" title="Methylcobalamin deficiency type cblE" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'OrphaNet', 'domain': 'orpha.net'})">Methylcobalamin deficiency…</a></div><div style="margin-left: 0.5em;"><a href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=622" title="Homocystinuria without methylmalonic aciduria" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'OrphaNet', 'domain': 'orpha.net'})">Homocystinuria without met…</a></div>
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<a href="#mimAnimalModelsLinksFold" id="mimAnimalModelsLinksToggle" class="collapsed mimSingletonTriangleToggle" role="button" data-toggle="collapse" data-parent="#mimExternalLinksAccordion">
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<div id="mimAnimalModelsLinksToggleTriangle" class="small mimSingletonTriangle" style="color: #337CB5; display: table-cell;">&#9658;</div>
&nbsp;
<div style="display: table-cell;">Animal Models</div>
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<div class="panel-body small mim-panel-body">
<div><a href="https://www.alliancegenome.org/disease/DOID:0112255" class="mim-tip-hint" title="Search Across Species; explore model organism and human comparative genomics." target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'Alliance Genome', 'domain': 'alliancegenome.org'})">Alliance Genome</a></div>
<div><a href="http://www.informatics.jax.org/disease/236270" class="mim-tip-hint" title="Phenotypes, alleles, and disease models from Mouse Genome Informatics." target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'MGI Mouse Phenotype', 'domain': 'informatics.jax.org'})">MGI Mouse Phenotype</a></div>
<div><a href="https://wormbase.org/resources/disease/DOID:0112255" class="mim-tip-hint" title="Database of the biology and genome of Caenorhabditis elegans and related nematodes." target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'Wormbase Disease Ontology', 'domain': 'wormbase.org'})">Wormbase Disease Ontology</a></div>
</div>
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<span>
<span class="mim-tip-bottom" qtip_title="<strong>Looking for this gene or this phenotype in other resources?</strong>" qtip_text="Select a related resource from the dropdown menu and click for a targeted link to information directly relevant.">
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<div class="col-lg-8 col-lg-pull-2 col-md-8 col-md-pull-2 col-sm-8 col-sm-pull-2 col-xs-12">
<div>
<a id="title" class="mim-anchor"></a>
<div>
<a id="number" class="mim-anchor"></a>
<div class="text-right">
<a href="#" class="mim-tip-icd" qtip_title="<strong>ICD+</strong>" qtip_text="
<strong>SNOMEDCT:</strong> 1296847007<br />
<strong>ORPHA:</strong> 2169, 622<br />
<strong>DO:</strong> 0112255<br />
">ICD+</a>
</div>
<div>
<span class="h3">
<span class="mim-font mim-tip-hint" title="Phenotype description, molecular basis known">
<span class="text-danger"><strong>#</strong></span>
236270
</span>
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<div>
<a id="preferredTitle" class="mim-anchor"></a>
<h3>
<span class="mim-font">
HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA, cblE TYPE; HMAE
</span>
</h3>
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<br />
</div>
<div>
<a id="alternativeTitles" class="mim-anchor"></a>
<div>
<p>
<span class="mim-font">
<em>Alternative titles; symbols</em>
</span>
</p>
</div>
<div>
<h4>
<span class="mim-font">
HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA DUE TO DEFECT IN COBALAMIN METABOLISM, cblE COMPLEMENTATION TYPE<br />
VITAMIN B12-RESPONSIVE HOMOCYSTINURIA, cblE TYPE<br />
METHYLCOBALAMIN DEFICIENCY, cblE TYPE
</span>
</h4>
</div>
</div>
<div>
<br />
</div>
</div>
<div>
<a id="phenotypeMap" class="mim-anchor"></a>
<h4>
<span class="mim-font">
<strong>Phenotype-Gene Relationships</strong>
</span>
</h4>
<div>
<table class="table table-bordered table-condensed table-hover small mim-table-padding">
<thead>
<tr class="active">
<th>
Location
</th>
<th>
Phenotype
</th>
<th>
Phenotype <br /> MIM number
</th>
<th>
Inheritance
</th>
<th>
Phenotype <br /> mapping key
</th>
<th>
Gene/Locus
</th>
<th>
Gene/Locus <br /> MIM number
</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<span class="mim-font">
<a href="/geneMap/5/43?start=-3&limit=10&highlight=43">
5p15.31
</a>
</span>
</td>
<td>
<span class="mim-font">
Homocystinuria-megaloblastic anemia, cbl E type
</span>
</td>
<td>
<span class="mim-font">
<a href="/entry/236270"> 236270 </a>
</span>
</td>
<td>
<span class="mim-font">
<abbr class="mim-tip-hint" title="Autosomal recessive">AR</abbr>
</span>
</td>
<td>
<span class="mim-font">
<abbr class="mim-tip-hint" title="3 - The molecular basis of the disorder is known"> 3 </abbr>
</span>
</td>
<td>
<span class="mim-font">
MTRR
</span>
</td>
<td>
<span class="mim-font">
<a href="/entry/602568"> 602568 </a>
</span>
</td>
</tr>
</tbody>
</table>
</div>
</div>
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<a href="/clinicalSynopsis/236270" class="btn btn-warning" role="button"> Clinical Synopsis </a>
<button type="button" id="mimPhenotypicSeriesToggle" class="btn btn-warning dropdown-toggle mimSingletonFoldToggle" data-toggle="collapse" href="#mimClinicalSynopsisFold" onclick="ga('send', 'event', 'Unfurl', 'ClinicalSynopsis', 'omim.org')">
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<a href="/phenotypicSeries/PS236270" class="btn btn-info" role="button"> Phenotypic Series </a>
<button type="button" id="mimPhenotypicSeriesToggle" class="btn btn-info dropdown-toggle mimSingletonFoldToggle" data-toggle="collapse" href="#mimPhenotypicSeriesFold" onclick="ga('send', 'event', 'Unfurl', 'PhenotypicSeries', 'omim.org')">
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<div class="btn-group">
<button type="button" class="btn btn-success dropdown-toggle" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
PheneGene Graphics <span class="caret"></span>
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<ul class="dropdown-menu" style="width: 17em;">
<li><a href="/graph/linear/236270" target="_blank" onclick="gtag('event', 'mim_graph', {'destination': 'Linear'})"> Linear </a></li>
<li><a href="/graph/radial/236270" target="_blank" onclick="gtag('event', 'mim_graph', {'destination': 'Radial'})"> Radial </a></li>
</ul>
</div>
<span class="glyphicon glyphicon-question-sign mim-tip-hint" title="OMIM PheneGene graphics depict relationships between phenotypes, groups of related phenotypes (Phenotypic Series), and genes.<br /><a href='/static/omim/pdf/OMIM_Graphics.pdf' target='_blank'>A quick reference overview and guide (PDF)</a>"></span>
<div>
<p />
</div>
<div id="mimClinicalSynopsisFold" class="well well-sm collapse mimSingletonToggleFold">
<div class="small" style="margin: 5px">
<div>
<div>
<span class="h5 mim-font">
<strong> INHERITANCE </strong>
</span>
</div>
<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Autosomal recessive <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/258211005" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">258211005</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0441748&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0441748</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000007" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000007</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000007" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000007</a>]</span><br />
</span>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> GROWTH </strong>
</span>
</div>
<div style="margin-left: 2em;">
<div>
<div>
<span class="h5 mim-font">
<em> Other </em>
</span>
</div>
<div style="margin-left: 2em;">
<span class="mim-font">
- Failure to thrive <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/432788009" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">432788009</a>, <a href="https://purl.bioontology.org/ontology/SNOMEDCT/54840006" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">54840006</a>]</span> <span class="mim-feature-ids hidden">[ICD9CM: <a href="https://purl.bioontology.org/ontology/ICD9CM/783.41" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD9CM\', \'domain\': \'bioontology.org\'})">783.41</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0015544&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0015544</a>, <a href="https://bioportal.bioontology.org/search?q=C2315100&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C2315100</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001508" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001508</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001508" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001508</a>]</span><br />
</span>
</div>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> HEAD & NECK </strong>
</span>
</div>
<div style="margin-left: 2em;">
<div>
<div>
<span class="h5 mim-font">
<em> Eyes </em>
</span>
</div>
<div style="margin-left: 2em;">
<span class="mim-font">
- Nystagmus (in some patients) <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/563001" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">563001</a>]</span> <span class="mim-feature-ids hidden">[ICD10CM: <a href="https://purl.bioontology.org/ontology/ICD10CM/H55.0" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">H55.0</a>, <a href="https://purl.bioontology.org/ontology/ICD10CM/H55.00" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">H55.00</a>]</span> <span class="mim-feature-ids hidden">[ICD9CM: <a href="https://purl.bioontology.org/ontology/ICD9CM/379.50" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD9CM\', \'domain\': \'bioontology.org\'})">379.50</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0028738&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0028738</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000639" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000639</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000639" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000639</a>]</span><br /> -
Blindness (in some patients) <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0456909&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0456909</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000618" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000618</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000618" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000618</a>]</span><br />
</span>
</div>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> MUSCLE, SOFT TISSUES </strong>
</span>
</div>
<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Hypotonia <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/398151007" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">398151007</a>, <a href="https://purl.bioontology.org/ontology/SNOMEDCT/398152000" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">398152000</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0026827&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0026827</a>, <a href="https://bioportal.bioontology.org/search?q=C1858120&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1858120</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001290" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001290</a>, <a href="https://hpo.jax.org/app/browse/term/HP:0001252" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001252</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001252" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001252</a>]</span><br />
</span>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> NEUROLOGIC </strong>
</span>
</div>
<div style="margin-left: 2em;">
<div>
<div>
<span class="h5 mim-font">
<em> Central Nervous System </em>
</span>
</div>
<div style="margin-left: 2em;">
<span class="mim-font">
- Delayed psychomotor development <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/224958001" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">224958001</a>]</span> <span class="mim-feature-ids hidden">[ICD10CM: <a href="https://purl.bioontology.org/ontology/ICD10CM/F88" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">F88</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0557874&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0557874</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001263" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001263</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001263" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001263</a>]</span><br /> -
Hypotonia <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/398151007" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">398151007</a>, <a href="https://purl.bioontology.org/ontology/SNOMEDCT/398152000" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">398152000</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0026827&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0026827</a>, <a href="https://bioportal.bioontology.org/search?q=C1858120&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1858120</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001290" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001290</a>, <a href="https://hpo.jax.org/app/browse/term/HP:0001252" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001252</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001252" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001252</a>]</span><br /> -
Abnormal gait <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/22325002" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">22325002</a>]</span> <span class="mim-feature-ids hidden">[ICD9CM: <a href="https://purl.bioontology.org/ontology/ICD9CM/781.2" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD9CM\', \'domain\': \'bioontology.org\'})">781.2</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0575081&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0575081</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001288" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001288</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001288" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001288</a>]</span><br /> -
Seizures <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/91175000" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">91175000</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0036572&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0036572</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001250" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001250</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001250" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001250</a>]</span><br /> -
Cerebral atrophy <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/278849000" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">278849000</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0235946&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0235946</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002059" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002059</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002059" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002059</a>]</span><br />
</span>
</div>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> HEMATOLOGY </strong>
</span>
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- Megaloblastic anemia <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/53165003" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">53165003</a>]</span> <span class="mim-feature-ids hidden">[ICD10CM: <a href="https://purl.bioontology.org/ontology/ICD10CM/D53.1" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">D53.1</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0002888&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0002888</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001889" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001889</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0001889" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0001889</a>]</span><br />
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<strong> LABORATORY ABNORMALITIES </strong>
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- Homocystinuria <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/11282001" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">11282001</a>]</span> <span class="mim-feature-ids hidden">[ICD10CM: <a href="https://purl.bioontology.org/ontology/ICD10CM/E72.11" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">E72.11</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0019880&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0019880</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002156" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002156</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002156" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002156</a>]</span><br /> -
Hyperhomocystinemia <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C3806347&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C3806347</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002160" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002160</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0002160" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0002160</a>]</span><br /> -
Hypomethioninemia <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1848555&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1848555</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003658" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003658</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003658" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003658</a>]</span><br />
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<strong> MISCELLANEOUS </strong>
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- Onset in infancy <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1848924&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1848924</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003593" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003593</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003593" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003593</a>]</span><br /> -
Symptoms are responsive to cobalamin treatment<br />
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<strong> MOLECULAR BASIS </strong>
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- Caused by mutation in the methionine synthase reductase gene (MTRR, <a href="/entry/602568#0001">602568.0001</a>)<br />
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<h5>
Homocystinuria-megaloblastic anemia
- <a href="/phenotypicSeries/PS236270">PS236270</a>
- 3 Entries
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<strong>Location</strong>
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<strong>Phenotype</strong>
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<strong>Inheritance</strong>
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<strong>Phenotype<br />mapping key</strong>
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<strong>Phenotype<br />MIM number</strong>
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<strong>Gene/Locus</strong>
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<strong>Gene/Locus<br />MIM number</strong>
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<span class="mim-font">
<a href="/geneMap/1/1829?start=-3&limit=10&highlight=1829"> 1q43 </a>
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<a href="/entry/250940"> Homocystinuria-megaloblastic anemia, cblG complementation type </a>
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<abbr class="mim-tip-hint" title="Autosomal recessive">AR</abbr>
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<abbr class="mim-tip-hint" title="3 - The molecular basis of the disorder is known"> 3 </abbr>
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<a href="/entry/250940"> 250940 </a>
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<a href="/entry/156570"> MTR </a>
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<span class="mim-font">
<a href="/entry/156570"> 156570 </a>
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<span class="mim-font">
<a href="/geneMap/2/683?start=-3&limit=10&highlight=683"> 2q23.2 </a>
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<span class="mim-font">
<a href="/entry/620952"> Homocystinuria-megaloblastic anemia, cblD type </a>
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<abbr class="mim-tip-hint" title="Autosomal recessive">AR</abbr>
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<abbr class="mim-tip-hint" title="3 - The molecular basis of the disorder is known"> 3 </abbr>
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<a href="/entry/620952"> 620952 </a>
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<a href="/entry/611935"> MMADHC </a>
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<span class="mim-font">
<a href="/entry/611935"> 611935 </a>
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<a href="/geneMap/5/43?start=-3&limit=10&highlight=43"> 5p15.31 </a>
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<span class="mim-font">
<a href="/entry/236270"> Homocystinuria-megaloblastic anemia, cbl E type </a>
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<span class="mim-font">
<abbr class="mim-tip-hint" title="Autosomal recessive">AR</abbr>
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<span class="mim-font">
<abbr class="mim-tip-hint" title="3 - The molecular basis of the disorder is known"> 3 </abbr>
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<a href="/entry/236270"> 236270 </a>
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<span class="mim-font">
<a href="/entry/602568"> MTRR </a>
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<span class="mim-font">
<a href="/entry/602568"> 602568 </a>
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<p>A number sign (#) is used with this entry because homocystinuria-megaloblastic anemia cblE type (HMAE) is caused by homozygous or compound heterozygous mutation in the gene encoding methionine synthase reductase (MTRR; <a href="/entry/602568">602568</a>) on chromosome 5p15.</p>
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<strong>Description</strong>
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<p>Homocystinuria and megaloblastic anemia is an autosomal recessive inborn error of metabolism resulting from defects in the cobalamin (vitamin B12)-dependent pathway that converts homocysteine to methionine, which is catalyzed by methionine synthase (MTR; <a href="/entry/156570">156570</a>). Clinical features are somewhat variable, but include delayed psychomotor development, hypotonia, megaloblastic anemia, homocystinuria, and hypomethioninemia, all of which respond to cobalamin supplementation. Methylmalonic aciduria is not present. Two complementation groups have been described based on fibroblast studies: CblE and CblG (<a href="/entry/250940">250940</a>) (<a href="#7" class="mim-tip-reference" title="Watkins, D., Rosenblatt, D. S. &lt;strong&gt;Genetic heterogeneity among patients with methylcobalamin deficiency.&lt;/strong&gt; J. Clin. Invest. 81: 1690-1694, 1988.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/3384945/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;3384945&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1172/JCI113507&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="3384945">Watkins and Rosenblatt, 1988</a>). Cells from patients with CblE fail to incorporate methyltetrahydrofolate into methionine in whole cells, but cell extracts show normal methionine synthase activity in the presence of a reducing agent. Cells from patients with CblG have defects in the methionine synthase enzyme under both conditions (summary by <a href="#2" class="mim-tip-reference" title="Leclerc, D., Campeau, E., Goyette, P., Adjalla, C. E., Christensen, B., Ross, M., Eydoux, P., Rosenblatt, D. S., Rozen, R., Gravel, R. A. &lt;strong&gt;Human methionine synthase: cDNA cloning and identification of mutations in patients of the cblG complementation group of folate/cobalamin disorders.&lt;/strong&gt; Hum. Molec. Genet. 5: 1867-1874, 1996.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/8968737/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;8968737&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1093/hmg/5.12.1867&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="8968737">Leclerc et al., 1996</a>). <a href="https://pubmed.ncbi.nlm.nih.gov/?term=8968737+3384945" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p>CblG is caused by mutation in the MTR gene.</p>
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<strong>Clinical Features</strong>
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<p><a href="#6" class="mim-tip-reference" title="Schuh, S., Rosenblatt, D. S., Cooper, B. A., Schroeder, M.-L., Bishop, A. J., Seargeant, L. E., Haworth, J. C. &lt;strong&gt;Homocystinuria and megaloblastic anemia responsive to vitamin B-12 therapy.&lt;/strong&gt; New Eng. J. Med. 310: 686-690, 1984.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/6700644/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;6700644&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1056/NEJM198403153101104&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="6700644">Schuh et al. (1984)</a> described a 'new,' presumably inborn, error of metabolism due to a defect in cobalamin metabolism. The infant boy, born of unrelated parents, presented with megaloblastic anemia and homocystinuria but without methylmalonic aciduria and showed severe developmental delay. The authors presented evidence to suggest an impairment in the formation or accumulation of methylcobalamin but not of adenosylcobalamin. Treatment with hydroxocobalamin, but not with cyanocobalamin and folic acid, resulted in rapid clinical and biochemical improvement. Cultured fibroblasts showed an absolute growth requirement for methionine and other features indicating an intracellular defect of methionine synthesis. <a href="#4" class="mim-tip-reference" title="Rosenblatt, D. S., Cooper, B. A., Pottier, A., Lue-Shing, H., Matiaszuk, N., Grauer, K. &lt;strong&gt;Altered vitamin B12 metabolism in fibroblasts from a patient with megaloblastic anemia and homocystinuria due to a new defect in methionine biosynthesis.&lt;/strong&gt; J. Clin. Invest. 74: 2149-2156, 1984.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/6511919/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;6511919&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1172/JCI111641&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="6511919">Rosenblatt et al. (1984)</a> performed studies on fibroblasts from the patient reported by <a href="#6" class="mim-tip-reference" title="Schuh, S., Rosenblatt, D. S., Cooper, B. A., Schroeder, M.-L., Bishop, A. J., Seargeant, L. E., Haworth, J. C. &lt;strong&gt;Homocystinuria and megaloblastic anemia responsive to vitamin B-12 therapy.&lt;/strong&gt; New Eng. J. Med. 310: 686-690, 1984.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/6700644/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;6700644&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1056/NEJM198403153101104&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="6700644">Schuh et al. (1984)</a>. Labeled cobalamin was bound in appropriate amounts to the 2 vitamin B12-dependent enzymes, methionine synthase and methylmalonyl-CoA mutase, but intracellular methylcobalamin levels were decreased compared to controls. Although methionine synthase activity was normal in cell extracts under normal conditions, activity was decreased under suboptimal reducing conditions and intact cells were unable to synthesize adequate methionine for growth. <a href="#4" class="mim-tip-reference" title="Rosenblatt, D. S., Cooper, B. A., Pottier, A., Lue-Shing, H., Matiaszuk, N., Grauer, K. &lt;strong&gt;Altered vitamin B12 metabolism in fibroblasts from a patient with megaloblastic anemia and homocystinuria due to a new defect in methionine biosynthesis.&lt;/strong&gt; J. Clin. Invest. 74: 2149-2156, 1984.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/6511919/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;6511919&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1172/JCI111641&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="6511919">Rosenblatt et al. (1984)</a> suggested that the defect was in a reducing system normally responsible for maintaining enzyme-bound cobalamin in a state necessary for proper function of methionine synthase. <a href="#5" class="mim-tip-reference" title="Rosenblatt, D. S., Cooper, B. A., Schmutz, S. M., Zaleski, W. A., Casey, R. E. &lt;strong&gt;Prenatal vitamin B-12 therapy of a fetus with methylcobalamin deficiency (cobalamin E disease).&lt;/strong&gt; Lancet 325: 1127-1129, 1985. Note: Originally Volume I.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/2860337/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;2860337&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/s0140-6736(85)92433-x&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="2860337">Rosenblatt et al. (1985)</a> described a second affected son in this family and found that the parents had a partial defect in the incorporation of (14C)methyltetrahydrofolate into methionine by their fibroblasts. The second affected sib, who was identified prenatally and treated with hydroxocobalamin (OH-B12), showed normal growth and development at age 6 months. <a href="https://pubmed.ncbi.nlm.nih.gov/?term=6700644+6511919+2860337" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#1" class="mim-tip-reference" title="Fowler, B., Schutgens, R. B. H., Rosenblatt, D. S., Smit, G. P. A., Lindemans, J. &lt;strong&gt;Folate-responsive homocystinuria and megaloblastic anaemia in a female patient with functional methionine synthase deficiency (cbl E disease).&lt;/strong&gt; J. Inherit. Metab. Dis. 20: 731-741, 1997.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/9427140/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;9427140&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1023/a:1005372730310&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="9427140">Fowler et al. (1997)</a> stated that 5 males with the cblE defect had been reported and 2 females were known anecdotally. They reported the first detailed study of a female patient with cblE disease. The patient had folate-responsive homocystinuria and megaloblastic anemia. Clinical progress over 17 years was recorded. Before treatment, major findings were microcephaly, psychomotor retardation, episodic lowered consciousness, megaloblastic anemia, increased plasma free homocystine, low plasma methionine, and increased excretion of formiminoglutamate. On high-dose folic acid, biochemical abnormalities such as formiminoglutamate excretion and homocystinuria nearly normalized, but clinical and hematologic abnormalities remained. On replacement of folate with methylcobalamin, alertness, motor function, speech, and electroencephalogram improved, and although biochemical features were similar, the mean corpuscular volume increased. The best control was observed on a combination of folate and methylcobalamin. She remained severely mentally retarded at age 17 years. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9427140" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#8" class="mim-tip-reference" title="Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V. &lt;strong&gt;cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.&lt;/strong&gt; Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/15714522/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;15714522&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/humu.20131&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="15714522">Zavadakova et al. (2005)</a> reported 9 European patients with cblE type homocystinuria. They presented between 2 weeks and 3 years of age (median age, 4 weeks) with anemia, which was macrocytic in only 3 patients, and with neurologic involvement in all but 2 patients. Bone marrow examination performed in 7 patients showed megaloblastic changes in all but 1. All patients exhibited moderate to severe hyperhomocysteinemia, while clearly reduced methionine was observed only in 4 cases. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=15714522" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
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<a id="inheritance" class="mim-anchor"></a>
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<strong>Inheritance</strong>
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<span class="mim-text-font">
<p>The mode of inheritance of HMAE is autosomal recessive (<a href="#8" class="mim-tip-reference" title="Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V. &lt;strong&gt;cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.&lt;/strong&gt; Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/15714522/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;15714522&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/humu.20131&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="15714522">Zavadakova et al., 2005</a>). <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=15714522" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
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<div>
<a id="molecularGenetics" class="mim-anchor"></a>
<h4 href="#mimMolecularGeneticsFold" id="mimMolecularGeneticsToggle" class="mimTriangleToggle" style="cursor: pointer;" data-toggle="collapse">
<span id="mimMolecularGeneticsToggleTriangle" class="small mimTextToggleTriangle">&#9660;</span>
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<strong>Molecular Genetics</strong>
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<p>In 2 sibs with homocystinuria-megaloblastic anemia due to defects in cobalamin metabolism, cblE type, originally reported by <a href="#6" class="mim-tip-reference" title="Schuh, S., Rosenblatt, D. S., Cooper, B. A., Schroeder, M.-L., Bishop, A. J., Seargeant, L. E., Haworth, J. C. &lt;strong&gt;Homocystinuria and megaloblastic anemia responsive to vitamin B-12 therapy.&lt;/strong&gt; New Eng. J. Med. 310: 686-690, 1984.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/6700644/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;6700644&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1056/NEJM198403153101104&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="6700644">Schuh et al. (1984)</a> and <a href="#5" class="mim-tip-reference" title="Rosenblatt, D. S., Cooper, B. A., Schmutz, S. M., Zaleski, W. A., Casey, R. E. &lt;strong&gt;Prenatal vitamin B-12 therapy of a fetus with methylcobalamin deficiency (cobalamin E disease).&lt;/strong&gt; Lancet 325: 1127-1129, 1985. Note: Originally Volume I.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/2860337/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;2860337&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/s0140-6736(85)92433-x&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="2860337">Rosenblatt et al. (1985)</a>, <a href="#3" class="mim-tip-reference" title="Leclerc, D., Wilson, A., Dumas, R., Gafuik, C., Song, D., Watkins, D., Heng, H. H. Q., Rommens, J. M., Scherer, S. W., Rosenblatt, D. S., Gravel, R. A. &lt;strong&gt;Cloning and mapping of a cDNA for methionine synthase reductase, a flavoprotein defective in patients with homocystinuria.&lt;/strong&gt; Proc. Nat. Acad. Sci. 95: 3059-3064, 1998.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/9501215/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;9501215&lt;/a&gt;, &lt;a href=&quot;https://www.ncbi.nlm.nih.gov/pmc/?term=9501215[PMID]&amp;report=imagesdocsum&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed Image&#x27;, &#x27;domain&#x27;: &#x27;ncbi.nlm.nih.gov&#x27;})&quot;&gt;images&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1073/pnas.95.6.3059&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="9501215">Leclerc et al. (1998)</a> identified a heterozygous truncating mutation in the MTRR gene (<a href="/entry/602568#0001">602568.0001</a>). A second mutation was not found. Another unrelated patient carried a different truncation mutation (<a href="/entry/602568#0002">602568.0002</a>); a second mutation was not found. <a href="https://pubmed.ncbi.nlm.nih.gov/?term=6700644+2860337+9501215" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#9" class="mim-tip-reference" title="Zavadakova, P., Fowler, B., Zeman, J., Suormala, T., Pristoupilova, K., Kozich, V. &lt;strong&gt;CblE type of homocystinuria due to methionine synthase reductase deficiency: clinical and molecular studies and prenatal diagnosis in 2 families.&lt;/strong&gt; J. Inherit. Metab. Dis. 25: 461-476, 2002. Note: Erratum: J. Inherit. Metab. Dis. 26: 95 only, 2003.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/12555939/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;12555939&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1023/a:1021299117308&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="12555939">Zavadakova et al. (2002)</a> reported 2 additional patients with cblE type homocystinuria, 1 of whom was compound heterozygous for 2 novel mutations (<a href="/entry/602568#0004">602568.0004</a> and <a href="/entry/602568#0005">602568.0005</a>) and the other homozygous for a 140-bp insertion (<a href="/entry/602568#0006">602568.0006</a>) in the MTRR gene. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12555939" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p>In 9 European patients with cblE type homocystinuria, <a href="#8" class="mim-tip-reference" title="Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V. &lt;strong&gt;cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.&lt;/strong&gt; Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/15714522/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;15714522&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/humu.20131&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="15714522">Zavadakova et al. (2005)</a> identified pathogenic biallelic mutations in the MTRR gene (see, e.g., <a href="/entry/602568#0007">602568.0007</a>). Transfection of fibroblasts of cblE patients with a wildtype MTRR minigene expression construct resulted in a significant increase of approximately 4-fold in methionine synthesis, indicating correction of the enzyme defect. <a href="#8" class="mim-tip-reference" title="Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V. &lt;strong&gt;cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.&lt;/strong&gt; Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/15714522/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;15714522&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/humu.20131&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="15714522">Zavadakova et al. (2005)</a> found no obvious genotype-phenotype correlation except for a link between a milder predominantly hematologic presentation and homozygosity for the S454L mutation (<a href="/entry/602568#0007">602568.0007</a>). <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=15714522" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
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<div>
<a id="references"class="mim-anchor"></a>
<h4 href="#mimReferencesFold" id="mimReferencesToggle" class="mimTriangleToggle" style="cursor: pointer;" data-toggle="collapse">
<span class="mim-font">
<span id="mimReferencesToggleTriangle" class="small mimTextToggleTriangle">&#9660;</span>
<strong>REFERENCES</strong>
</span>
</h4>
<div>
<p />
</div>
<div id="mimReferencesFold" class="collapse in mimTextToggleFold">
<ol>
<li>
<a id="1" class="mim-anchor"></a>
<a id="Fowler1997" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Fowler, B., Schutgens, R. B. H., Rosenblatt, D. S., Smit, G. P. A., Lindemans, J.
<strong>Folate-responsive homocystinuria and megaloblastic anaemia in a female patient with functional methionine synthase deficiency (cbl E disease).</strong>
J. Inherit. Metab. Dis. 20: 731-741, 1997.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/9427140/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">9427140</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9427140" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1023/a:1005372730310" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="2" class="mim-anchor"></a>
<a id="Leclerc1996" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Leclerc, D., Campeau, E., Goyette, P., Adjalla, C. E., Christensen, B., Ross, M., Eydoux, P., Rosenblatt, D. S., Rozen, R., Gravel, R. A.
<strong>Human methionine synthase: cDNA cloning and identification of mutations in patients of the cblG complementation group of folate/cobalamin disorders.</strong>
Hum. Molec. Genet. 5: 1867-1874, 1996.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/8968737/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">8968737</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=8968737" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1093/hmg/5.12.1867" target="_blank">Full Text</a>]
</p>
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</li>
<li>
<a id="3" class="mim-anchor"></a>
<a id="Leclerc1998" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Leclerc, D., Wilson, A., Dumas, R., Gafuik, C., Song, D., Watkins, D., Heng, H. H. Q., Rommens, J. M., Scherer, S. W., Rosenblatt, D. S., Gravel, R. A.
<strong>Cloning and mapping of a cDNA for methionine synthase reductase, a flavoprotein defective in patients with homocystinuria.</strong>
Proc. Nat. Acad. Sci. 95: 3059-3064, 1998.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/9501215/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">9501215</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/?term=9501215[PMID]&report=imagesdocsum" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Image', 'domain': 'ncbi.nlm.nih.gov'})">images</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9501215" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1073/pnas.95.6.3059" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="4" class="mim-anchor"></a>
<a id="Rosenblatt1984" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Rosenblatt, D. S., Cooper, B. A., Pottier, A., Lue-Shing, H., Matiaszuk, N., Grauer, K.
<strong>Altered vitamin B12 metabolism in fibroblasts from a patient with megaloblastic anemia and homocystinuria due to a new defect in methionine biosynthesis.</strong>
J. Clin. Invest. 74: 2149-2156, 1984.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/6511919/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">6511919</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=6511919" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1172/JCI111641" target="_blank">Full Text</a>]
</p>
</div>
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<li>
<a id="5" class="mim-anchor"></a>
<a id="Rosenblatt1985" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Rosenblatt, D. S., Cooper, B. A., Schmutz, S. M., Zaleski, W. A., Casey, R. E.
<strong>Prenatal vitamin B-12 therapy of a fetus with methylcobalamin deficiency (cobalamin E disease).</strong>
Lancet 325: 1127-1129, 1985. Note: Originally Volume I.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/2860337/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">2860337</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=2860337" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1016/s0140-6736(85)92433-x" target="_blank">Full Text</a>]
</p>
</div>
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<li>
<a id="6" class="mim-anchor"></a>
<a id="Schuh1984" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Schuh, S., Rosenblatt, D. S., Cooper, B. A., Schroeder, M.-L., Bishop, A. J., Seargeant, L. E., Haworth, J. C.
<strong>Homocystinuria and megaloblastic anemia responsive to vitamin B-12 therapy.</strong>
New Eng. J. Med. 310: 686-690, 1984.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/6700644/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">6700644</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=6700644" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1056/NEJM198403153101104" target="_blank">Full Text</a>]
</p>
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<a id="7" class="mim-anchor"></a>
<a id="Watkins1988" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Watkins, D., Rosenblatt, D. S.
<strong>Genetic heterogeneity among patients with methylcobalamin deficiency.</strong>
J. Clin. Invest. 81: 1690-1694, 1988.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/3384945/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">3384945</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=3384945" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1172/JCI113507" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="8" class="mim-anchor"></a>
<a id="Zavadakova2005" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V.
<strong>cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.</strong>
Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/15714522/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">15714522</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=15714522" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1002/humu.20131" target="_blank">Full Text</a>]
</p>
</div>
</li>
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<a id="9" class="mim-anchor"></a>
<a id="Zavadakova2002" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Zavadakova, P., Fowler, B., Zeman, J., Suormala, T., Pristoupilova, K., Kozich, V.
<strong>CblE type of homocystinuria due to methionine synthase reductase deficiency: clinical and molecular studies and prenatal diagnosis in 2 families.</strong>
J. Inherit. Metab. Dis. 25: 461-476, 2002. Note: Erratum: J. Inherit. Metab. Dis. 26: 95 only, 2003.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/12555939/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">12555939</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12555939" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1023/a:1021299117308" target="_blank">Full Text</a>]
</p>
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Cassandra L. Kniffin - reorganized : 07/12/2013
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Victor A. McKusick - updated : 1/6/2006<br>Victor A. McKusick - updated : 4/5/2005<br>Ada Hamosh - updated : 9/18/2003<br>Victor A. McKusick - updated : 4/29/1998<br>Victor A. McKusick - updated : 2/19/1998
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Victor A. McKusick : 6/3/1986
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carol : 09/26/2024
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carol : 09/25/2024<br>carol : 05/08/2017<br>carol : 07/12/2013<br>ckniffin : 7/11/2013<br>wwang : 1/17/2006<br>terry : 1/6/2006<br>terry : 4/20/2005<br>wwang : 4/14/2005<br>wwang : 4/5/2005<br>alopez : 9/18/2003<br>mgross : 1/14/2003<br>carol : 4/29/1998<br>terry : 4/8/1998<br>mark : 2/25/1998<br>terry : 2/19/1998<br>joanna : 7/7/1997<br>terry : 5/2/1994<br>warfield : 4/15/1994<br>carol : 2/23/1994<br>mimadm : 2/19/1994<br>supermim : 3/16/1992<br>carol : 3/3/1992
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<h3>
<span class="mim-font">
<strong>#</strong> 236270
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<span class="mim-font">
HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA, cblE TYPE; HMAE
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<em>Alternative titles; symbols</em>
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HOMOCYSTINURIA-MEGALOBLASTIC ANEMIA DUE TO DEFECT IN COBALAMIN METABOLISM, cblE COMPLEMENTATION TYPE<br />
VITAMIN B12-RESPONSIVE HOMOCYSTINURIA, cblE TYPE<br />
METHYLCOBALAMIN DEFICIENCY, cblE TYPE
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<strong>SNOMEDCT:</strong> 1296847007; &nbsp;
<strong>ORPHA:</strong> 2169, 622; &nbsp;
<strong>DO:</strong> 0112255; &nbsp;
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<strong>Phenotype-Gene Relationships</strong>
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Location
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Phenotype
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Phenotype <br /> MIM number
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Inheritance
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Phenotype <br /> mapping key
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Gene/Locus
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Gene/Locus <br /> MIM number
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<span class="mim-font">
5p15.31
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Homocystinuria-megaloblastic anemia, cbl E type
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236270
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Autosomal recessive
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3
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MTRR
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602568
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<strong>TEXT</strong>
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<p>A number sign (#) is used with this entry because homocystinuria-megaloblastic anemia cblE type (HMAE) is caused by homozygous or compound heterozygous mutation in the gene encoding methionine synthase reductase (MTRR; 602568) on chromosome 5p15.</p>
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<strong>Description</strong>
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<p>Homocystinuria and megaloblastic anemia is an autosomal recessive inborn error of metabolism resulting from defects in the cobalamin (vitamin B12)-dependent pathway that converts homocysteine to methionine, which is catalyzed by methionine synthase (MTR; 156570). Clinical features are somewhat variable, but include delayed psychomotor development, hypotonia, megaloblastic anemia, homocystinuria, and hypomethioninemia, all of which respond to cobalamin supplementation. Methylmalonic aciduria is not present. Two complementation groups have been described based on fibroblast studies: CblE and CblG (250940) (Watkins and Rosenblatt, 1988). Cells from patients with CblE fail to incorporate methyltetrahydrofolate into methionine in whole cells, but cell extracts show normal methionine synthase activity in the presence of a reducing agent. Cells from patients with CblG have defects in the methionine synthase enzyme under both conditions (summary by Leclerc et al., 1996). </p><p>CblG is caused by mutation in the MTR gene.</p>
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<strong>Clinical Features</strong>
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<p>Schuh et al. (1984) described a 'new,' presumably inborn, error of metabolism due to a defect in cobalamin metabolism. The infant boy, born of unrelated parents, presented with megaloblastic anemia and homocystinuria but without methylmalonic aciduria and showed severe developmental delay. The authors presented evidence to suggest an impairment in the formation or accumulation of methylcobalamin but not of adenosylcobalamin. Treatment with hydroxocobalamin, but not with cyanocobalamin and folic acid, resulted in rapid clinical and biochemical improvement. Cultured fibroblasts showed an absolute growth requirement for methionine and other features indicating an intracellular defect of methionine synthesis. Rosenblatt et al. (1984) performed studies on fibroblasts from the patient reported by Schuh et al. (1984). Labeled cobalamin was bound in appropriate amounts to the 2 vitamin B12-dependent enzymes, methionine synthase and methylmalonyl-CoA mutase, but intracellular methylcobalamin levels were decreased compared to controls. Although methionine synthase activity was normal in cell extracts under normal conditions, activity was decreased under suboptimal reducing conditions and intact cells were unable to synthesize adequate methionine for growth. Rosenblatt et al. (1984) suggested that the defect was in a reducing system normally responsible for maintaining enzyme-bound cobalamin in a state necessary for proper function of methionine synthase. Rosenblatt et al. (1985) described a second affected son in this family and found that the parents had a partial defect in the incorporation of (14C)methyltetrahydrofolate into methionine by their fibroblasts. The second affected sib, who was identified prenatally and treated with hydroxocobalamin (OH-B12), showed normal growth and development at age 6 months. </p><p>Fowler et al. (1997) stated that 5 males with the cblE defect had been reported and 2 females were known anecdotally. They reported the first detailed study of a female patient with cblE disease. The patient had folate-responsive homocystinuria and megaloblastic anemia. Clinical progress over 17 years was recorded. Before treatment, major findings were microcephaly, psychomotor retardation, episodic lowered consciousness, megaloblastic anemia, increased plasma free homocystine, low plasma methionine, and increased excretion of formiminoglutamate. On high-dose folic acid, biochemical abnormalities such as formiminoglutamate excretion and homocystinuria nearly normalized, but clinical and hematologic abnormalities remained. On replacement of folate with methylcobalamin, alertness, motor function, speech, and electroencephalogram improved, and although biochemical features were similar, the mean corpuscular volume increased. The best control was observed on a combination of folate and methylcobalamin. She remained severely mentally retarded at age 17 years. </p><p>Zavadakova et al. (2005) reported 9 European patients with cblE type homocystinuria. They presented between 2 weeks and 3 years of age (median age, 4 weeks) with anemia, which was macrocytic in only 3 patients, and with neurologic involvement in all but 2 patients. Bone marrow examination performed in 7 patients showed megaloblastic changes in all but 1. All patients exhibited moderate to severe hyperhomocysteinemia, while clearly reduced methionine was observed only in 4 cases. </p>
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<strong>Inheritance</strong>
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<p>The mode of inheritance of HMAE is autosomal recessive (Zavadakova et al., 2005). </p>
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<span class="mim-font">
<strong>Molecular Genetics</strong>
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<p>In 2 sibs with homocystinuria-megaloblastic anemia due to defects in cobalamin metabolism, cblE type, originally reported by Schuh et al. (1984) and Rosenblatt et al. (1985), Leclerc et al. (1998) identified a heterozygous truncating mutation in the MTRR gene (602568.0001). A second mutation was not found. Another unrelated patient carried a different truncation mutation (602568.0002); a second mutation was not found. </p><p>Zavadakova et al. (2002) reported 2 additional patients with cblE type homocystinuria, 1 of whom was compound heterozygous for 2 novel mutations (602568.0004 and 602568.0005) and the other homozygous for a 140-bp insertion (602568.0006) in the MTRR gene. </p><p>In 9 European patients with cblE type homocystinuria, Zavadakova et al. (2005) identified pathogenic biallelic mutations in the MTRR gene (see, e.g., 602568.0007). Transfection of fibroblasts of cblE patients with a wildtype MTRR minigene expression construct resulted in a significant increase of approximately 4-fold in methionine synthesis, indicating correction of the enzyme defect. Zavadakova et al. (2005) found no obvious genotype-phenotype correlation except for a link between a milder predominantly hematologic presentation and homozygosity for the S454L mutation (602568.0007). </p>
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<strong>REFERENCES</strong>
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<li>
<p class="mim-text-font">
Fowler, B., Schutgens, R. B. H., Rosenblatt, D. S., Smit, G. P. A., Lindemans, J.
<strong>Folate-responsive homocystinuria and megaloblastic anaemia in a female patient with functional methionine synthase deficiency (cbl E disease).</strong>
J. Inherit. Metab. Dis. 20: 731-741, 1997.
[PubMed: 9427140]
[Full Text: https://doi.org/10.1023/a:1005372730310]
</p>
</li>
<li>
<p class="mim-text-font">
Leclerc, D., Campeau, E., Goyette, P., Adjalla, C. E., Christensen, B., Ross, M., Eydoux, P., Rosenblatt, D. S., Rozen, R., Gravel, R. A.
<strong>Human methionine synthase: cDNA cloning and identification of mutations in patients of the cblG complementation group of folate/cobalamin disorders.</strong>
Hum. Molec. Genet. 5: 1867-1874, 1996.
[PubMed: 8968737]
[Full Text: https://doi.org/10.1093/hmg/5.12.1867]
</p>
</li>
<li>
<p class="mim-text-font">
Leclerc, D., Wilson, A., Dumas, R., Gafuik, C., Song, D., Watkins, D., Heng, H. H. Q., Rommens, J. M., Scherer, S. W., Rosenblatt, D. S., Gravel, R. A.
<strong>Cloning and mapping of a cDNA for methionine synthase reductase, a flavoprotein defective in patients with homocystinuria.</strong>
Proc. Nat. Acad. Sci. 95: 3059-3064, 1998.
[PubMed: 9501215]
[Full Text: https://doi.org/10.1073/pnas.95.6.3059]
</p>
</li>
<li>
<p class="mim-text-font">
Rosenblatt, D. S., Cooper, B. A., Pottier, A., Lue-Shing, H., Matiaszuk, N., Grauer, K.
<strong>Altered vitamin B12 metabolism in fibroblasts from a patient with megaloblastic anemia and homocystinuria due to a new defect in methionine biosynthesis.</strong>
J. Clin. Invest. 74: 2149-2156, 1984.
[PubMed: 6511919]
[Full Text: https://doi.org/10.1172/JCI111641]
</p>
</li>
<li>
<p class="mim-text-font">
Rosenblatt, D. S., Cooper, B. A., Schmutz, S. M., Zaleski, W. A., Casey, R. E.
<strong>Prenatal vitamin B-12 therapy of a fetus with methylcobalamin deficiency (cobalamin E disease).</strong>
Lancet 325: 1127-1129, 1985. Note: Originally Volume I.
[PubMed: 2860337]
[Full Text: https://doi.org/10.1016/s0140-6736(85)92433-x]
</p>
</li>
<li>
<p class="mim-text-font">
Schuh, S., Rosenblatt, D. S., Cooper, B. A., Schroeder, M.-L., Bishop, A. J., Seargeant, L. E., Haworth, J. C.
<strong>Homocystinuria and megaloblastic anemia responsive to vitamin B-12 therapy.</strong>
New Eng. J. Med. 310: 686-690, 1984.
[PubMed: 6700644]
[Full Text: https://doi.org/10.1056/NEJM198403153101104]
</p>
</li>
<li>
<p class="mim-text-font">
Watkins, D., Rosenblatt, D. S.
<strong>Genetic heterogeneity among patients with methylcobalamin deficiency.</strong>
J. Clin. Invest. 81: 1690-1694, 1988.
[PubMed: 3384945]
[Full Text: https://doi.org/10.1172/JCI113507]
</p>
</li>
<li>
<p class="mim-text-font">
Zavadakova, P., Fowler, B., Suormala, T., Novotna, Z., Mueller, P., Hennermann, J. B., Zeman, J., Vilaseca, M. A., Vilarinho, L., Gutsche, S., Wilichowski, E., Horneff, G., Kozich, V.
<strong>cblE type of homocystinuria due to methionine synthase reductase deficiency: functional correction by minigene expression.</strong>
Hum. Mutat. 25: 239-247, 2005. Note: Erratum: Hum. Mutat. 26: 590 only, 2005.
[PubMed: 15714522]
[Full Text: https://doi.org/10.1002/humu.20131]
</p>
</li>
<li>
<p class="mim-text-font">
Zavadakova, P., Fowler, B., Zeman, J., Suormala, T., Pristoupilova, K., Kozich, V.
<strong>CblE type of homocystinuria due to methionine synthase reductase deficiency: clinical and molecular studies and prenatal diagnosis in 2 families.</strong>
J. Inherit. Metab. Dis. 25: 461-476, 2002. Note: Erratum: J. Inherit. Metab. Dis. 26: 95 only, 2003.
[PubMed: 12555939]
[Full Text: https://doi.org/10.1023/a:1021299117308]
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Contributors:
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<span class="mim-text-font">
Cassandra L. Kniffin - reorganized : 07/12/2013<br>Victor A. McKusick - updated : 1/6/2006<br>Victor A. McKusick - updated : 4/5/2005<br>Ada Hamosh - updated : 9/18/2003<br>Victor A. McKusick - updated : 4/29/1998<br>Victor A. McKusick - updated : 2/19/1998
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Creation Date:
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<span class="mim-text-font">
Victor A. McKusick : 6/3/1986
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