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Vitamins and Their Deficiency Symptoms: From Metabolic Role to Clinical Sign

1The General Logic: Why One Missing Vitamin Produces a Specific Set of Symptoms2Energy Metabolism Vitamins: Thiamine, Riboflavin, Niacin, Pantothenate, and Biotin3One-Carbon Metabolism and Blood: Folate and Cobalamin4Collagen, Antioxidant, and Redox Vitamins: Vitamin C and Vitamin E5Fat-Soluble Vitamins: A, D, and K6Reasoning from Mechanism to Symptom: An Integrated Framework
One-Carbon Metabolism and Blood: Folate and Cobalamin

Two Coenzymes That Move Single Carbons

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Folate and cobalamin are not energy vitamins. They carry single carbon units. Folate becomes tetrahydrofolate, which donates a methyl group to convert dUMP into dTMP, the thymine building block of DNA. Cobalamin has two coenzyme forms. Methylcobalamin takes methyl from 5-methyl-THF and gives it to homocysteine to make methionine. Adenosylcobalamin helps convert methylmalonyl-CoA to succinyl-CoA. Notice the asymmetry: folate has one main job here, cobalamin has two, and that difference will explain why cobalamin deficiency damages nerves while folate deficiency does not.
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Folate and cobalamin do not transfer electrons or acyl groups; they transfer one-carbon units. Folate enters the cell and is reduced to tetrahydrofolate (THF), the active coenzyme. THF accepts a single carbon at different oxidation states and carries it between reactions. The most important of these for this chapter is the conversion of deoxyuridylate (dUMP) to thymidylate (dTMP), catalyzed by thymidylate synthase. THF donates the methyl group, and in doing so is oxidized to dihydrofolate (DHF); dihydrofolate reductase (DHFR) regenerates THF so the cycle can continue. Without THF, dTMP cannot be made, and dTMP is the only de novo route to the thymine base of DNA.

Cobalamin works differently. It is a cobalt-containing ring, and it serves as a coenzyme in only two reactions in humans. As methylcobalamin, it accepts a methyl group from 5-methyl-THF and hands it to homocysteine, forming methionine; this is the methionine synthase reaction. As adenosylcobalamin, it assists methylmalonyl-CoA mutase, which converts methylmalonyl-CoA to succinyl-CoA. The two cobalamin coenzymes are chemically distinct and serve unrelated pathways, which is why cobalamin deficiency has two consequences while folate deficiency has one.

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