The role of neurotropic B vitamins in clinical practice
https://doi.org/10.21518/ms2023-403
Abstract
B-group vitamins are a collection of 8 water-soluble vitamins. They are cofactors for many enzymes, as well as axonal transport, synthesis of neurotransmitters and other metabolic processes. Their function can be divided into catabolic metabolism, leading to energy production, and anabolic metabolism. Some B vitamins are considered neurotrophic and play a particularly important role in both the central and peripheral nervous systems. Neurotropic B-group vitamins (B1 – thiamine, B6 – pyridoxine and B12 – cyanocobalamin) play the role of modulators for the treatment of inflammation and pain, they are essential for the proper functioning of the nervous system. B vitamin deficiencies have been considered as etiological factors in the development of various neurological disorders and a broad spectrum of pathological states. The work examines in detail vitamins B1, B6 and B12 and their effect on the course of neuropathies, movement disorders, nociceptive and neuropathic pain. The issues of the synergistic action of these vitamins are highlighted. Evidence of neurotropic B vitamin treatment effectiveness of neuropathy symptoms in different groups of patients is presented. The possibility to use vitamin B1 and B6 complex in clinical practice under the condition of individual intolerance of vitamin B12 is discussed. Information about Cytipigam® compositum as a drug containing B1 and B6 is provided. A clinical case report on the effective use of this drug in clinical practice is described.
About the Author
N. V. PizovaRussian Federation
Nataliia V. Pizova - Dr. Sci. (Med.), Professor of the Department of Nervous Diseases with Medical Genetics and Neurosurgery, Yaroslavl State Medical University.
5, Revolutsionnaya St., Yaroslavl, 150000
References
1. Bender DA. B vitamins in the nervous system. Neurochem Int. 1984;6(3):297–321. https://doi.org/10.1016/0197-0186(84)90072-x.
2. Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy – A Review. Nutrients. 2016;8(2):68. https://doi.org/10.3390/nu8020068.
3. Zempleni J, Suttie JW, Gregory JF III, Stover PJ (eds.). Handbook of Vitamins. 5th ed. Boca Raton: CRC Press; 2013. 605 p. https://doi.org/10.1201/b15413.
4. Calderón-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020;26(1):5–13. https://doi.org/10.1111/cns.13207.
5. Albert MJ, Mathan VI, Baker SJ. Vitamin B12 synthesis by human small intestinal bacteria. Nature. 1980;283(5749):781–782. https://doi.org/10.1038/283781a0.
6. Shideler CE. Vitamin B6: an overview. Am J Med Technol. 1983;49(1):17–22. Available at: https://pubmed.ncbi.nlm.nih.gov/6342384/.
7. Geller M, Oliveira L, Nigri R, Mezitis S, Ribeiro MG, da Fonseca A et al. B Vitamins for neuropathy and neuropathic pain. Vitam Miner. 2017;6(2):161. https://doi.org/10.4172/2376-1318.1000161.
8. Wang ZB, Gan Q, Rupert RL, Zeng YM, Song XJ. Thiamine, pyridoxine, cyanocobalamin and their combination inhibit thermal, but not mechanical hyperalgesia in rats with primary sensory neuron injury. Pain. 2005;114(1-2):266–277. https://doi.org/10.1016/j.pain.2004.12.027.
9. Bonke D, Nickel B. Improvement of fine motoric movement control by elevated dosages of vitamin B1, B6, and B12 in target shooting. Int J Vitam Nutr Res Suppl. 1989;30:198–204. Available at: https://pubmed.ncbi.nlm.nih.gov/2507698/.
10. Leuschner J. Antinociceptive properties of thiamine, pyridoxine and cyanoco-balamin following repeated oral administration to mice. Arzneimittelforschung. 1992;42(2):114–115. Available at: https://pubmed.ncbi.nlm.nih.gov/1610417/.
11. Hakim M, Kurniani N, Pinzon RT, Tugasworo D. Management of peripheral neuropathy symptoms with a fixed dose combination of high‐dose vitamin B1, B6 and B12: a 12‐week prospective non‐interventional study in Indonesia. Asian J Med Sci. 2018;9(1):32–40. https://doi.org/10.3126/ajms.v9i1.18510.
12. Baltrusch S. The Role of Neurotropic B Vitamins in Nerve Regeneration. Biomed Res Int. 2021:9968228. https://doi.org/10.1155/2021/9968228.
13. Reyes-García G, Medina-Santillán R, Terán-Rosales F, Castillo-Henkel C, Rodríguez-Silverio J, Torres-López J et al. Analgesic effect of B vitamins in formalin-induced inflammatory pain. Proc West Pharmacol Soc. 2001;44:139–140. Available at: https://pubmed.ncbi.nlm.nih.gov/11793961/.
14. Isenberg-Grzeda E, Kutner HE, Nicolson SE. Wernicke-Korsakoff-syndrome: under-recognized and under-treated. Psychosomatics. 2012;53(6):507–516. https://doi.org/10.1016/j.psym.2012.04.008.
15. Singleton CK, Martin PR. Molecular mechanisms of thiamine utilization. Curr Mol Med. 2001;1(2):197–207. https://doi.org/10.2174/1566524013363870.
16. Sriram K, Manzanares W, Joseph K. Thiamine in nutrition therapy. Nutr Clin Pract. 2012;27(1):41–50. https://doi.org/10.1177/0884533611426149.
17. Beltramo E, Berrone E, Tarallo S, Porta M. Effects of thiamine and benfotiamine on intracellular glucose metabolism and relevance in the prevention of diabetic complications. Acta Diabetol. 2008;45(3):131–141. https://doi.org/10.1007/s00592-008-0042-y.
18. Martin PR, Singleton CK, Hiller-Sturmhöfel S. The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health. 2003;27(2):134–142. Available at: https://pubmed.ncbi.nlm.nih.gov/15303623/.
19. Osiezagha K, Ali S, Freeman C, Barker NC, Jabeen S, Maitra S et al. Thiamine deficiency and delirium. Innov Clin Neurosci. 2013;10(4):26–32. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659035/.
20. Attaluri P, Castillo A, Edriss H, Nugent K. Thiamine Deficiency: An Important Consideration in Critically Ill Patients. Am J Med Sci. 2018;356(4):382–390. https://doi.org/10.1016/j.amjms.2018.06.015.
21. Bâ A. Metabolic and structural role of thiamine in nervous tissues. Cell Mol Neurobiol. 2008;28(7):923–931. https://doi.org/10.1007/s10571-008-9297-7.
22. Page GL, Laight D, Cummings MH. Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease. Int J Clin Pract. 2011;65(6):684–690. https://doi.org/10.1111/j.1742-1241.2011.02680.x.
23. Bourassa MW, Bergeron G, Brown KH. A fresh look at thiamine deficiency-new analyses by the global thiamine alliance. Ann N Y Acad Sci. 2021;1498(1):5–8. https://doi.org/10.1111/nyas.14594.
24. Smith HA. Forgotten Disease: Illnesses Transformed in Chinese Medicine. Stanford: Stanford University Press; 2017. 245 p. Available at: https://zlibrary.to/dl/forgotten-disease-illnesses-transformed-in-chinese-medicine-pdf.
25. Smith TJ, Johnson CR, Koshy R, Hess SY, Qureshi UA, Mynak ML et al. Thiamine deficiency disorders: a clinical perspective. Ann N Y Acad Sci. 2021;1498(1):9–28. https://doi.org/10.1111/nyas.14536.
26. Parra M, Stahl S, Hellmann H. Vitamin B6 and Its Role in Cell Metabolism and Physiology. Cells. 2018;7(7):84. https://doi.org/10.3390/cells7070084.
27. Bernstein AL. Vitamin B6 in clinical neurology. Ann N Y Acad Sci. 1990;585(1):250–260. https://doi.org/10.1111/j.1749-6632.1990.tb28058.x.
28. Spinneker A, Sola R, Lemmen V, Castillo MJ, Pietrzik K, González-Gross M. Vitamin B6 status, deficiency and its consequences – an overview. Nutr Hosp. 2007;22(1):7–24. Available at: https://pubmed.ncbi.nlm.nih.gov/17260529/.
29. Wendołowicz A, Stefańska E, Ostrowska L. Influence of selected dietary components on the functioning of the human nervous system. Rocz Panstw Zakl Hig. 2018;69(1):15–21. Available at: https://pubmed.ncbi.nlm.nih.gov/29517182/.
30. Talebi M, Andalib S, Bakhti S, Ayromlou H, Aghili A, Talebi A. Effect of vitamin b6 on clinical symptoms and electrodiagnostic results of patients with carpal tunnel syndrome. Adv Pharm Bull. 2013;3(2):283–288. https://doi.org/10.5681/apb.2013.046.
31. Herrmann W, Obeid R. Causes and early diagnosis of vitamin B12 deficiency. Dtsch Arztebl Int. 2008;105(40):680–685. https://doi.org/10.3238/arztebl.2008.0680.
32. Kumar N. Neurologic aspects of cobalamin (B12) deficiency. Handb Clin Neurol. 2014;120:915–926. https://doi.org/10.1016/B978-0-7020-4087-0.00060-7.
33. Adamo AM. Nutritional factors and aging in demyelinating diseases. Genes Nutr. 2014;9(1):360. https://doi.org/10.1007/s12263-013-0360-8.
34. Briani C, Dalla Torre C, Citton V, Manara R, Pompanin S, Binotto G, Adami F. Cobalamin deficiency: clinical picture and radiological findings. Nutrients. 2013;5(11):4521–4539. https://doi.org/10.3390/nu5114521.
35. Morozova TE, Durnetsova OS. B-group vitamins in clinical practice. Meditsinskiy Sovet. 2014;(18):72–77. (In Russ.) Available at: https://elibrary.ru/thqnjz.
36. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149–160. https://doi.org/10.1056/NEJMcp1113996.
37. Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171(3):251–259. https://doi.org/10.1503/cmaj.1031155.
38. Andrès E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J et al. B12 deficiency: a look beyond pernicious anemia. J Fam Pract. 2007;56(7):537–542. Available at: https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/5607JFP_Article1.pdf.
39. Andrès E, Vogel T, Federici L, Zimmer J, Ciobanu E, Kaltenbach G. Cobalamin deficiency in elderly patients: a personal view. Curr Gerontol Geriatr Res. 2008:848267. https://doi.org/10.1155/2008/848267.
40. Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008;112(6):2214–2221. https://doi.org/10.1182/blood-2008-03-040253.
41. Nedeljkovic P, Zmijanjac D, Draskovic‐Pavlovic B, Vasiljevska M. Vitamin B complex treatment improves motor nerve regeneration and recovery of muscle function in a rodent model of peripheral nerve injury. Arch Biol Sci. 2017;69(2):361–368. https://doi.org/10.2298/ABS160320114N.
42. Rizvi A, Ahmad A, Rizvi Z. Efficacy of combination of vitamin B1, B6 and B12 in management of diabetic peripheral neuropathy. Pak J Med Sci. 2013;(7):801–804. Available at: https://pjmhsonline.com/2013/july_sep/pdf/801%20%20%20Efficacy%20of%20Combination%20of%20Vitamin%20B1,%20B6%20and%20B12%20in%20Management%20of%20Diabetic%20Peripheral%20Neuropathy.pdf.
43. Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Res. 2016;5:738. https://doi.org/10.12688/f1000research.7898.1.
44. Mellion M, Gilchrist JM, de la Monte S. Alcohol-related peripheral neuropathy: nutritional, toxic, or both? Muscle Nerve. 2011;43(3):309–316. https://doi.org/10.1002/mus.21946.
45. Miranda-Massari JR, Gonzalez MJ, Jimenez FJ, Allende-Vigo MZ, Duconge J. Metabolic correction in the management of diabetic peripheral neuropathy: improving clinical results beyond symptom control. Curr Clin Pharmacol. 2011;6(4):260–273. https://doi.org/10.2174/157488411798375967.
46. Starobova H, Vetter I. Pathophysiology of Chemotherapy-Induced Peripheral Neuropathy. Front Mol Neurosci. 2017;10:174. https://doi.org/10.3389/fnmol.2017.00174.
47. Paez-Hurtado AM, Calderon-Ospina CA, Nava-Mesa MO. Mechanisms of action of vitamin B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) in pain: a narrative review. Nutr Neurosci. 2023;26(3):235–253. https://doi.org/10.1080/1028415X.2022.2034242.
48. Head KA. Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006;11(4):294–329. Available at: https://pubmed.ncbi.nlm.nih.gov/17176168/.
49. Veraldi S, Benardon S, Diani M, Barbareschi M. Acneiform eruptions caused by vitamin B12: a report of five cases and review of the literature. J Cosmet Dermatol. 2018;17(1):112–115. https://doi.org/10.1111/jocd.12360.
50. Bahbouhi I, Aboudourib M, Hocar O, Amal S. Vitamin B12 induced acneiform eruption. Heliyon. 2023;9(5):e16120. https://doi.org/10.1016/j.heliyon.2023.e16120.
51. Balta I, Ozuguz P. Vitamin B12-induced acneiform eruption. Cutan Ocul Toxicol. 2014;33(2):94–95. https://doi.org/10.3109/15569527.2013.808657.
52. Elmas ÖF, Metin MS, Özyurt K, Atasoy M. Vitamin B12: An underestimated cause of acneiform drug eruption. Dermatol Ther. 2020;33(4):e13531. https://doi.org/10.1111/dth.13531.
Review
For citations:
Pizova NV. The role of neurotropic B vitamins in clinical practice. Meditsinskiy sovet = Medical Council. 2023;(21):116-121. (In Russ.) https://doi.org/10.21518/ms2023-403