Journal of Inherited Metabolic Disease

, Volume 33, Supplement 3, pp 435–442 | Cite as

Clinical, biochemical, and molecular analysis of combined methylmalonic acidemia and hyperhomocysteinemia (cblC type) in China

  • Fei Wang
  • Lianshu Han
  • Yanling Yang
  • Xuefan Gu
  • Jun Ye
  • Wenjuan Qiu
  • Huiwen Zhang
  • Yafen Zhang
  • XiaoLan Gao
  • Yu Wang
Research Report


The most common inborn error of cobalamin (cbl) metabolism in China is the cblC type characterized by combined methylmalonic acidemia and hyperhomocysteinemia. The clinical presentation is relatively nonspecific, such as feeding difficulty, recurrent vomiting, hypotonia, lethargy, seizures, progressive developmental delay, and mental retardation, together with anemia and metabolic acidosis. More specific biochemical findings include high levels of propionylcarnitine (C3), free carnitine (C3/C0), and acetylcarnitine (C3/C2) measured by tandem mass spectrometry (MS/MS), elevation of methylmalonic acid (MMA) measured by gas chromatography–mass spectrometry (GC-MS), and increased total homocysteine with normal or decreased methionine. We report on 50 Chinese patients with combined methylmalonic acidemia and hyperhomocysteinemia. Forty-six belonged to the cblC complementation group. Mutation analysis of the MMACHC gene was performed to characterize the mutational spectrum of cblC deficiency, and 17 different mutations were found. Most were clustered in exons 3 and 4, accounting for 91.3% of all mutant alleles. Two mutations were novel, namely, c.315 C>G (p.Y105X) and c.470 G>C(p.W157S). In terms of genotype–phenotype correlation, the c.609 G>A mutation was associated with early-onset disease when homozygous. Unlike previous reports from other populations, c.609 G>A (p.W203X) was the most frequent cblC mutation detected in our study of Chinese patients, affecting 51 of 92 MMACHC alleles (55.4%). The high prevalence of this nonsense mutation could have potential therapeutic significance for Chinese cblC patients. Besides traditional approaches consisting of hydroxocobalamin injections, carnitine, betaine, and protein restriction, novel drugs that target premature termination codons may have a role in the future.





cobalamin C




free carnitine






gas chromatography–mass spectrometry




margaric acid


methylmalonic acid


tandem mass spectrometry


polymerase chain reaction


DL-tropic acid


vitamin B12 cyanocobalamin


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Copyright information

© SSIEM and Springer 2010

Authors and Affiliations

  • Fei Wang
    • 1
  • Lianshu Han
    • 1
  • Yanling Yang
    • 2
  • Xuefan Gu
    • 1
  • Jun Ye
    • 1
  • Wenjuan Qiu
    • 1
  • Huiwen Zhang
    • 1
  • Yafen Zhang
    • 1
  • XiaoLan Gao
    • 1
  • Yu Wang
    • 1
  1. 1.Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric ResearchXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
  2. 2.Department of PediatricThe first Hospital, Beijing UniversityBeijingChina

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