Abstract
Methylmalonic aciduria and homocystinuria, cblC type (OMIM 277400), is the most common inborn error of vitamin B12 (cobalamin) metabolism, with about 250 known cases. Affected individuals have developmental, hematological, neurological, metabolic, ophthalmologic and dermatologic clinical findings1. Although considered a disease of infancy or childhood, some individuals develop symptoms in adulthood2. The cblC locus was mapped to chromosome region 1p by linkage analysis3. We refined the chromosomal interval using homozygosity mapping and haplotype analyses and identified the MMACHC gene. In 204 individuals, 42 different mutations were identified, many consistent with a loss of function of the protein product. One mutation, 271dupA, accounted for 40% of all disease alleles. Transduction of wild-type MMACHC into immortalized cblC fibroblast cell lines corrected the cellular phenotype. Molecular modeling predicts that the C-terminal region of the gene product folds similarly to TonB, a bacterial protein involved in energy transduction for cobalamin uptake.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Late-onset cblC deficiency around puberty: a retrospective study of the clinical characteristics, diagnosis, and treatment
Orphanet Journal of Rare Diseases Open Access 02 September 2022
-
Genetic origin of patients having spastic paraplegia with or without other neurologic manifestations
BMC Neurology Open Access 16 May 2022
-
Mutations in Hcfc1 and Ronin result in an inborn error of cobalamin metabolism and ribosomopathy
Nature Communications Open Access 10 January 2022
Access options
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Rent or buy this article
Get just this article for as long as you need it
$39.95
Prices may be subject to local taxes which are calculated during checkout




Accession codes
Accessions
GenBank/EMBL/DDBJ
Protein Data Bank
Change history
30 June 2006
The error has been corrected in the PDF version of this article.
References
Rosenblatt, D. & Fenton, W.A. Inherited disorders of folate and cobalamin transport and metabolism in The Metabolic & Molecular Bases of Inherited Disease Vol. 3, 3897–3933 (McGraw-Hill, New York, 2001).
Rosenblatt, D.S. et al. Clinical heterogeneity and prognosis in combined methylmalonic aciduria and homocystinuria (cblC). J. Inherit. Metab. Dis. 20, 528–538 (1997).
Atkinson, J. Genetic Mapping of Cobalamin C Deficiency: Linkage to Chromosome 1p32–34. Thesis. Univ. of Toronto, (2003).
Homocysteine in Health and Disease (eds. Carmel, R. & Jacobsen, D.W.) (Cambridge Univ. Press, Cambridge, 2001).
Andersson, H.C. & Shapira, E. Biochemical and clinical response to hydroxocobalamin versus cyanocobalamin treatment in patients with methylmalonic acidemia and homocystinuria (cblC). J. Pediatr. 132, 121–124 (1998).
Mellman, I., Willard, H.F., Youngdahl-Turner, P. & Rosenberg, L.E. Cobalamin coenzyme synthesis in normal and mutant fibroblasts: evidence for a processing enzyme activity deficient in cblC cells. J. Biol. Chem. 254, 11847–11853 (1979).
Templeton, A.R. et al. Recombinational and mutational hotspots within the human lipoprotein lipase gene. Am. J. Hum. Genet. 66, 69–83 (2000).
Stephens, M., Smith, N.J. & Donnelly, P. A new statistical method for haplotype reconstruction from population data. Am. J. Hum. Genet. 68, 978–989 (2001).
Stephens, M. & Donnelly, P. A comparison of Bayesian methods for haplotype reconstruction. Am. J. Hum. Genet. 73, 1162–1169 (2003).
Maquat, L.E. Nonsense-mediated mRNA decay: splicing, translation and mRNP dynamics. Nat. Rev. Mol. Cell Biol. 5, 89–99 (2004).
Drennan, C.L., Huang, S., Drummond, J.T., Matthews, R.G. & Ludwig, M.L. How a protein binds B12: a 3.0 A X-ray structure of B12 -binding domains of methionine synthase. Science 266, 1669–1674 (1994).
Chang, C., Mooser, A., Plückthun, A. & Wlodawer, A. Crystal structure of the dimeric C-terminal domain of TonB reveals a novel fold. J. Biol. Chem. 276, 27535–27540 (2001).
Ködding, J. et al. Crystal structure of a 92-residue C-terminal fragment of TonB from Escherichia coli reveals significant conformational changes compared to structures of smaller TonB fragments. J. Biol. Chem. 280, 3022–3028 (2005).
Peacock, R.S., Weljie, A.M., Howard, S.P., Price, F.D. & Vogel, H.J. The solution structure of the C-terminal domain of TonB and interaction studies with TonB box peptides. J. Mol. Biol. 345, 1185–1197 (2005).
Sali, A. & Blundell, T.L. Comparative protein modelling by satisfaction of spatial restraints. J. Mol. Biol. 234, 779–815 (1993).
Laskowski, R.A., MacArthur, M.W. & Thornton, J.M. PROCHECK: a program to check the stereochemical quality of protein structure. J. Appl. Crystallogr. 26, 283–291 (1993).
Kleywegt, G.J. Experimental assessment of differences between related protein crystal structures. Acta Crystallogr. D Biol. Crystallogr. 55, 1878–1884 (1999).
Bell, P.E., Nau, C.D., Brown, J.T., Konisky, J. & Kadner, R.J. Genetic suppression demonstrates interaction of TonB protein with outer membrane transport proteins in Escherichia coli. J. Bacteriol. 172, 3826–3829 (1990).
Cadieux, N. & Kadner, R.J. Site-directed disulfide bonding reveals an interaction site between energy-coupling protein TonB and BtuB, the outer membrane cobalamin transporter. Proc. Natl. Acad. Sci. USA 96, 10673–10678 (1999).
Rosenblatt, D.S., Hosack, A., Matiaszuk, N.V., Cooper, B.A. & Laframboise, R. Defect in vitamin B12 release from lysosomes: newly described inborn error of vitamin B12 metabolism. Science 228, 1319–1321 (1985).
Pezacka, E.H. & Rosenblatt, D.S. Intracellular metabolism of cobalamin. Altered activities of β-axial-ligand transferase and microsomal cob(III)alamin reductase in cblC and cblD fibroblasts in Advances in Thomas Addison's Diseases 315–323 (Journal of Endocrinology, Bristol, UK, 1994).
Brudno, M. et al. LAGAN and Multi-LAGAN: efficient tools for large-scale multiple alignment of genomic DNA. Genome Res. 13, 721–731 (2003).
Watkins, D. Cobalamin metabolism in methionine-dependent human tumour and leukemia cell lines. Clin. Invest. Med. 21, 151–158 (1998).
Watkins, D., Matiaszuk, N. & Rosenblatt, D.S. Complementation studies in the cblA class of inborn error of cobalamin metabolism: evidence for interallelic complementation and for a new complementation class (cblH). J. Med. Genet. 37, 510–513 (2000).
Ewing, B., Hillier, L., Wendl, M.C. & Green, P. Base-calling of automated sequencer traces using Phred I. Accuracy assesment. Genome Res. 8, 175–185 (1998).
Gordon, D., Abajian, C. & Green, P. Consed: A graphical tool for sequence finishing. Genome Res. 8, 195–202 (1998).
Miller, A.D. & Buttimore, C. Redesign of retrovirus packaging cell lines to avoid recombination leading to helper virus production. Mol. Cell. Biol. 6, 2895–2902 (1986).
Yao, J. & Shoubridge, E.A. Expression and functional analysis of SURF1 in Leigh syndrome patients with cytochrome C oxidase deficiency. Hum. Mol. Genet. 8, 2541–2549 (1999).
Horton, P. & Nakai, K. Better prediction of protein cellular localization sites with the k nearest neighbors classifier. Proc. Int. Conf. Intell. Syst. Mol. Biol. 5, 147–152 (1997).
Acknowledgements
We dedicate this work to the memory of J.C. Tirone. We thank the clinicians who provided patient samples and clinical information; N. Matiaszuk and J. Lavallée for complementation analysis; A. Verner and G. Genaud for microsatellite genotyping; N. Roslin for microsatellite analysis; M. Galvez and J. Liu for laboratory work; G. Leveque, T.A. Johns and D. Roquis for technical assistance; S. Froese, L. Worgan, K. Niles and A. Montpetit for discussion and J. Kashul and D. Ellis for editing. This research was supported by grants from the March of Dimes Birth Defects Foundation (6-FY01-11), Canadian Institutes of Health Research (CIHR), the Canada Foundation for Innovation to the Montreal Integrated Genomics Group for Research on Infectious Pathogens, and the Network of Centres of Excellence Program—the Canadian Genetic Diseases Network. D.S.R. is a principal investigator in the CIHR Group in Medical Genetics. This is a publication of the Hess B. and Diane Finestone Laboratory in Memory of Jacob and Jenny Finestone.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Supplementary information
Supplementary Fig. 1
One affected child and one affected fetus were diagnosed with cblC. (PDF 250 kb)
Supplementary Table 1
Markers used for homozygosity mapping and haplotype analyses. (PDF 15 kb)
Supplementary Table 2
Primers used to amplify the MMACHC gene from gDNA and cDNA. (PDF 54 kb)
Rights and permissions
About this article
Cite this article
Lerner-Ellis, J., Tirone, J., Pawelek, P. et al. Identification of the gene responsible for methylmalonic aciduria and homocystinuria, cblC type. Nat Genet 38, 93–100 (2006). https://doi.org/10.1038/ng1683
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ng1683
This article is cited by
-
Genetic origin of patients having spastic paraplegia with or without other neurologic manifestations
BMC Neurology (2022)
-
Late-onset cblC deficiency around puberty: a retrospective study of the clinical characteristics, diagnosis, and treatment
Orphanet Journal of Rare Diseases (2022)
-
Mutations in Hcfc1 and Ronin result in an inborn error of cobalamin metabolism and ribosomopathy
Nature Communications (2022)
-
The roles of homocysteinemia and methylmalonic acidemia in kidney injury in atypical hemolytic uremic syndrome caused by cobalamin C deficiency
Pediatric Nephrology (2022)
-
Subcutaneous vitamin B12 administration using a portable infusion pump in cobalamin-related remethylation disorders: a gentle and easy to use alternative to intramuscular injections
Orphanet Journal of Rare Diseases (2021)