Holotranscobalamin (active Vitamin B12)

Other names: HoloTC, Vitamin B12, active

check icon Optimal Result: 25.1 - 165 pmol/L.

Holotranscobalamin: A Key Biomarker for Vitamin B12 Status

Holotranscobalamin (HoloTC) is the bioactive form of vitamin B12 circulating in the body. It is the only form that can be readily absorbed and utilized by cells, making it an essential marker for determining vitamin B12 levels. Unlike serum B12, which reflects both active and inactive forms, HoloTC offers a more accurate and sensitive measure of B12 status. This makes it a critical tool for detecting early vitamin B12 deficiency, especially when used alongside other markers such as methylmalonic acid (MMA) and homocysteine.

Why Holotranscobalamin is a Superior Marker

While serum B12 levels are often measured to assess B12 status, they may not always give a full picture, as they include both active and inactive forms. HoloTC, on the other hand, represents the fraction of B12 that is biologically active and available to cells. Research shows that HoloTC is a more reliable marker, particularly in detecting early B12 deficiency. It's also considered more sensitive than MMA and homocysteine in certain cases, especially in elderly populations.

When to Test Holotranscobalamin

Low levels of HoloTC are linked to several health concerns, including:

- B12 insufficiency and deficiency

- Peripheral neuropathy

- Macrocytosis (enlarged red blood cells)

- Neural tube defects (in pregnancy)

- White matter brain damage (linked to cognitive decline)

- Vegetarianism (due to lower intake of B12)

In contrast, elevated HoloTC levels could indicate issues such as liver cell leakage or conditions like anorexia nervosa.

Understanding Holotranscobalamin Levels

Standard Range: 25.10 – 165.00 pmol/L

A low HoloTC level may indicate B12 insufficiency or deficiency and can be linked to a range of conditions such as neuropathy, chemotherapy side effects, and gastrectomy. High HoloTC levels, although less common, may suggest liver damage or conditions like anorexia.

Health Implications of Holotranscobalamin Levels

A decrease in HoloTC can signal B12 deficiency long before it shows up in standard serum B12 tests. Research highlights the connection between low HoloTC levels and cognitive decline in older adults. Studies have shown that increasing HoloTC levels can slow cognitive deterioration, while high levels of homocysteine and MMA can accelerate it.

Low HoloTC has also been linked to an increased risk of neural tube defects (NTDs) in pregnancy. Women with lower HoloTC levels during pregnancy are more likely to experience NTDs, highlighting the importance of adequate B12 intake for fetal development.

Holotranscobalamin in Special Populations

- Vegetarians: A study found that vegetarians tend to have lower median HoloTC levels (around 34 pmol/L), as they consume less B12 from food sources.

- Renal Failure: Patients with renal failure may have higher circulating HoloTC levels (around 70 pmol/L) but still be at risk for intracellular B12 deficiencies. This complicates the use of HoloTC as a marker in such individuals.

Holotranscobalamin is a crucial marker in assessing vitamin B12 status, offering a more sensitive measure than traditional serum B12 tests. Monitoring HoloTC alongside other biomarkers like MMA and homocysteine can help identify early B12 deficiency and guide appropriate treatment. For those at risk, such as vegetarians, pregnant women, and individuals with certain medical conditions, regular testing of HoloTC levels can be essential in maintaining overall health and preventing complications.

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