Biotin deficiency

Biotin

Biotin deficiency is a nutritional disorder which can become serious, even fatal, if allowed to progress untreated. It can occur in people of any age, ancestry, or of either sex. Biotin is part of the B vitamin family. Biotin deficiency rarely occurs among healthy people because the daily requirement of biotin is low, many foods provide adequate amounts of it, intestinal bacteria synthesize small amounts of it, and the body effectively scavenges and recycles it in the kidneys during production of urine.

Genetic disorders such as multiple carboxylase deficiency (MCD) (which includes biotinidase deficiency and holocarboxylase synthetase deficiency)[1] can also lead to inborn or late-onset forms of biotin deficiency.[2] In all cases – dietary, genetic, or otherwise – supplementation with biotin is the primary (and usually only)[3] method of treatment.[1][4] The prognosis for congenital MCD is good if biotin supplementation is begun quickly after birth and carried on throughout the patients life.[5]

The average dietary intake of biotin ranges between 35 and 70 micrograms/day in the western population.[2]

## Contents

* 1 Signs and symptoms
* 1.1 Physical
* 1.2 Psychological
* 2 Causes
* 2.1 Potential causes
* 3 Biochemistry
* 4 Diagnosis
* 5 Treatment
* 6 Epidemiology
* 7 See also
* 8 References
* 9 Possible references
* 10 External links

## Signs and symptoms

### Physical

* Rashes including red, patchy ones near openings[6] (e.g. erythematous periorofacial macular rash)[7]
* Hair loss (alopecia)[8]
* Conjunctivitis[8]
* Brittle nails[6]
* Generalized muscular pains (myalgia)[9]
* Paresthesias (pins and needles)[10] and numbness[8] in the extemities

### Psychological

* Hallucinations[6]
* Lethargy[6]
* Mild depression[11]
* Fatigue, drowsiness[12] and somnolence[9]

## Causes

1. Total parenteral nutrition without biotin supplementation: Several cases[13] of biotin deficiency in patients receiving prolonged total parenteral nutrition (TPN) therapy without added biotin have been reported. Therefore, all patients receiving TPN must also receive biotin at the recommended daily dose, especially if TPN therapy is expected to last more than 1 week. All hospital pharmacies currently include biotin in TPN preparations.[2]
2. Protein deficiency (not certain): A shortage of proteins involved in biotin homeostasis can cause biotin deficiency. The main problems involved in biotin homeostasis are HCS, BTD (biotinidase deficiency) and SMVT[14]
3. Anticonvulsant therapy: Prolonged use of certain drugs (especially highly common prescription anti-seizure medications such as phenytoin, primidone, and carbamazepine), may lead to biotin deficiency; however, valproic acid therapy is less likely to cause this condition.[15] Some anticonvulsants (antiepileptic drugs) inhibit biotin transport across the intestinal mucosa. Evidence suggests that these anticonvulsants accelerate biotin catabolism, which means that it's necessary for people to take supplemental biotin, in addition to the usual minimum daily requirements, if they're treated with anticonvulsant medication(s) that have been linked to biotin deficiency.
4. Severe malnourishment[16][2]
5. Prolonged oral antibiotic therapy: Prolonged use of oral antibiotics has been associated with biotin deficiency. Alterations in the intestinal flora caused by the prolonged administration of antibiotics are presumed to be the basis for biotin deficiency.[2][17]
6. Genetic mutation: Mikati et al. (2006) reported a case of partial biotinidase deficiency (plasma biotinidase level of 1.3 nm/min/mL) in a 7-month-old boy. The boy presented with perinatal distress followed by developmental delay, hypotonia, seizures, and infantile spasms without alopecia or dermatitis. The child's neurologic symptoms abated following biotin supplementation and antiepileptic drug therapy. DNA mutational analysis revealed that the child was homozygous for a novel E64K mutation and that his mother and father were heterozygous for the novel E64K mutation.[18]

### Potential causes

1. Smoking: Recent studies[14] suggest that smoking can lead to marginal biotin deficiency because it speeds up biotin catabolism (especially in women).[19]
2. Excessive alcohol consumption[20] (causes a significant reduction in plasma biotin levels)
3. Excessive consumption of antidiuretics or inadequate levels of antidiuretic hormone[21]
4. Intestinal malabsorption caused by short bowel syndrome[22]

## Biochemistry

Biotin is a coenzyme for five carboxylases in the human body (propionyl-CoA carboxylase, methylcrotonyl-CoA carboxylase, pyruvate carboxylase, and 2 forms of acetyl-CoA carboxylase.) Therefore, biotin is essential for amino acid catabolism, gluconeogenesis, and fatty acid metabolism. Biotin is also necessary for gene stability because it is covalently attached to histones. Biotinylated histones play a role in repression of transposable elements and some genes. Normally, the amount of biotin in the body is regulated by dietary intake, biotin transporters (monocarboxylate transporter 1 and sodium-dependent multivitamin transporter), peptidyl hydrolase biotinidase (BTD), and the protein ligase holocarboxylase synthetase. When any of these regulatory factors are inhibited, biotin deficiency could occur.[23]

## Diagnosis

The only reliable method for determining biotin deficiency is the abundance of biotinylated 3-methylcrotonyl-CoA carboxylase and propionyl-CoA carboxylase in lymphocytes. The level of biotin in urine can be used to identify biotin-supplemented individuals, and the level of 3-hydroxyisovaleric acid in urine can (unreliably) detect biotin-deficient patients.[24]

## Treatment

In the United States, biotin supplements are readily available without a prescription[25] in amounts ranging from 300 to 10,000 micrograms.[26] 30 micrograms daily is identified as Adequate Intake for men and women 19 years and older. 35 micrograms daily is required for lactating women.[27]

Most healthy individuals meet these recommended intakes, however many still take up to 500 to 1,000 micrograms of biotin daily.[28]

## Epidemiology

Deficiency is rare[2] in locations where egg-white enriched or ketogenic diets are common.[29] Pregnancy, however, alters biomarkers of biotin[30] and despite a regular biotin intake, approximately half of the pregnant women in the U.S. are marginally biotin deficient.[14]

## See also

* Biotinidase deficiency
* Holocarboxylase synthetase deficiency
* Multiple carboxylase deficiency

## References

1. ↑ 1.0 1.1 Chinese Medical Association, Division of Biochemistry and Metabolism; Chinese Association for Maternal and Child Health, Division of Genetics and Metabolism; Rare Diseases Committee of Beijing Medical Association, Division of Genetics and Metabolism (2022-02-25). "Expert consensus on screening, diagnosis and treatment of multiple carboxylase deficiency". Zhejiang da Xue Xue Bao. Yi Xue Ban = Journal of Zhejiang University. Medical Sciences 51 (1): 129–135. doi:10.3724/zdxbyxb-2022-0164. ISSN 1008-9292. PMID 35576117.
2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Saleem, Fatima; Soos, Michael P. (2023), "Biotin Deficiency", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 31613531, http://www.ncbi.nlm.nih.gov/books/NBK547751/, retrieved 2023-06-19
3. ↑ "Multiple Carboxylase Deficiency". 2023-06-19. https://www.dshs.texas.gov/sites/default/files/newborn/pdf/FactMCD.pdf.
4. ↑ "Biotinidase Deficiency - Symptoms, Causes, Treatment | NORD" (in en-US). https://rarediseases.org/rare-diseases/biotinidase-deficiency/.
5. ↑ Baumgartner, E. R.; Suormala, T. (1997). "Multiple carboxylase deficiency: inherited and acquired disorders of biotin metabolism". International Journal for Vitamin and Nutrition Research 67 (5): 377–384. ISSN 0300-9831. PMID 9350481. https://pubmed.ncbi.nlm.nih.gov/9350481/.
6. ↑ 6.0 6.1 6.2 6.3 "Office of Dietary Supplements - Biotin" (in en). https://ods.od.nih.gov/factsheets/Biotin-HealthProfessional/.
7. ↑ Rajendiran, Ashwin; Sampath, Sowmya (2011-09-30). "Biotinidase deficiency – clinching the diagnosis rapidly can make all the difference!". BMJ Case Reports 2011: bcr0720114494. doi:10.1136/bcr.07.2011.4494. ISSN 1757-790X. PMID 22679321.
8. ↑ 8.0 8.1 8.2 Trüeb, Ralph M (2016). "Serum Biotin Levels in Women Complaining of Hair Loss". International Journal of Trichology 8 (2): 73–77. doi:10.4103/0974-7753.188040. ISSN 0974-7753. PMID 27601860.
9. ↑ 9.0 9.1 LLC, HealthMatters io. "Biotin | Healthmatters.io" (in en). https://healthmatters.io/understand-blood-test-results/biotin.
10. ↑ "Biotin (vitamin B7) for hair growth: Uses, sources, health benefits" (in en). 2017-10-18. https://www.medicalnewstoday.com/articles/287720.
11. ↑ "Biotin" (in en). 2014-04-22. https://lpi.oregonstate.edu/mic/vitamins/biotin.
12. ↑ Abed, Ali-Reza; Abed, Alireza; Banafshe, Hamid Reza; Malekabad, Ebadallah Shiri; Gorgani-firuzjaee, Sattar; Dadashi, Ali-Reza (2021-05-12). "Effect of biotin supplementation on neuropathic pain induced by chronic constriction of the sciatic nerve in the rat". Research in Pharmaceutical Sciences 16 (3): 250–259. doi:10.4103/1735-5362.314823. ISSN 1735-5362. PMID 34221058.
13. ↑ Innis, S. M.; Allardyce, D. B. (February 1983). "Possible biotin deficiency in adults receiving long-term total parenteral nutrition". The American Journal of Clinical Nutrition 37 (2): 185–187. doi:10.1093/ajcn/37.2.185. ISSN 0002-9165. PMID 6401910. https://pubmed.ncbi.nlm.nih.gov/6401910/.
14. ↑ 14.0 14.1 14.2 Zempleni, Janos; Hassan, Yousef I; Wijeratne, Subhashinee SK (2008-11-01). "Biotin and biotinidase deficiency". Expert Review of Endocrinology & Metabolism 3 (6): 715–724. doi:10.1586/17446651.3.6.715. ISSN 1744-6651. PMID 19727438.
15. ↑ Krause et al. 1982, p. 485.
16. ↑ Velázquez, A.; Martín-del-Campo, C.; Báez, A.; Zamudio, S.; Quiterio, M.; Aguilar, J. L.; Pérez-Ortiz, B.; Sánchez-Ardines, M. et al. (March 1989). "Biotin deficiency in protein-energy malnutrition". European Journal of Clinical Nutrition 43 (3): 169–173. ISSN 0954-3007. PMID 2499449. https://pubmed.ncbi.nlm.nih.gov/2499449/.
17. ↑ Hayashi, Atsushi; Mikami, Yohei; Miyamoto, Kentaro; Kamada, Nobuhiko; Sato, Toshiro; Mizuno, Shinta; Naganuma, Makoto; Teratani, Toshiaki et al. (2017-08-15). "Intestinal Dysbiosis and Biotin Deprivation Induce Alopecia through Overgrowth of Lactobacillus murinus in Mice". Cell Reports 20 (7): 1513–1524. doi:10.1016/j.celrep.2017.07.057. ISSN 2211-1247. PMID 28813664.
18. ↑ Mikati, Mohamad A.; Zalloua, Pierre; Karam, Pascale; Habbal, Mohamad-Zuheir; Rahi, Amal C. (November 2006). "Novel mutation causing partial biotinidase deficiency in a Syrian boy with infantile spasms and retardation". Journal of Child Neurology 21 (11): 978–981. doi:10.1177/08830738060210110301. ISSN 0883-0738. PMID 17092467. https://pubmed.ncbi.nlm.nih.gov/17092467/.
19. ↑ Sealey, Wendy M; Teague, April M; Stratton, Shawna L; Mock, Donald M (October 2004). "Smoking accelerates biotin catabolism in women". The American Journal of Clinical Nutrition 80 (4): 932–935. doi:10.1093/ajcn/80.4.932. ISSN 0002-9165. PMID 15447901.
20. ↑ Subramanya, Sandeep B.; Subramanian, Veedamali S.; Kumar, Jeyan S.; Hoiness, Robert; Said, Hamid M. (March 2011). "Inhibition of intestinal biotin absorption by chronic alcohol feeding: cellular and molecular mechanisms". American Journal of Physiology. Gastrointestinal and Liver Physiology 300 (3): G494–G501. doi:10.1152/ajpgi.00465.2010. ISSN 0193-1857. PMID 21148397.
21. ↑ Hoffman, Kristine (January 2015). "When Vitamin And Nutritional Deficiencies Cause Skin And Nail Changes". https://www.hmpgloballearningnetwork.com/site/podiatry/when-vitamin-and-nutritional-deficiencies-cause-skin-and-nail-changes.
22. ↑ Khalidi, N.; Wesley, J. R.; Thoene, J. G.; Whitehouse, W. M.; Baker, W. L. (1984). "Biotin deficiency in a patient with short bowel syndrome during home parenteral nutrition". Journal of Parenteral and Enteral Nutrition 8 (3): 311–314. doi:10.1177/0148607184008003311. ISSN 0148-6071. PMID 6429370. https://pubmed.ncbi.nlm.nih.gov/6429370/.
23. ↑ Said, H (2012). "Biotin: Biochemical, Physiological and Clinical Aspects". Water Soluble Vitamins. Subcellular Biochemistry. 56. pp. 1–19. doi:10.1007/978-94-007-2199-9_1. ISBN 978-94-007-2198-2.
24. ↑ Eng, Wei Kay; Giraud, David; Schlegel, Vicki L.; Wang, Dong; Lee, Bo Hyun; Zempleni, Janos (2013-07-28). "Identification and assessment of markers of biotin status in healthy adults". The British Journal of Nutrition 110 (2): 321–329. doi:10.1017/S0007114512005065. ISSN 0007-1145. PMID 23302490.
25. ↑ "Biotin (Oral Route) Description and Brand Names - Mayo Clinic". https://www.mayoclinic.org/drugs-supplements/biotin-oral-route/description/drg-20062359.
26. ↑ Katzman, Brooke M.; Lueke, Alan J.; Donato, Leslie J.; Jaffe, Allan S.; Baumann, Nikola A. (2018-09-01). "Prevalence of biotin supplement usage in outpatients and plasma biotin concentrations in patients presenting to the emergency department" (in en). Clinical Biochemistry 60: 11–16. doi:10.1016/j.clinbiochem.2018.07.004. ISSN 0009-9120. PMID 30036510. https://www.sciencedirect.com/science/article/pii/S0009912018303151.
27. ↑ Avenue, 677 Huntington; Boston; Ma 02115 (2019-07-24). "Biotin – Vitamin B7" (in en-us). https://www.hsph.harvard.edu/nutritionsource/biotin-vitamin-b7/.
28. ↑ Patel, Deepa P.; Swink, Shane M.; Castelo-Soccio, Leslie (August 2017). "A Review of the Use of Biotin for Hair Loss". Skin Appendage Disorders 3 (3): 166–169. doi:10.1159/000462981. ISSN 2296-9195. PMID 28879195.
29. ↑ Dakshinamurti, Krishnamurti; Dakshinamurti, Shyamala; Czubryt, Michael P. (2019), Preedy, Victor R.; Patel, Vinood B., eds., "Effects of Biotin Deprivation and Biotin Supplementation" (in en), Handbook of Famine, Starvation, and Nutrient Deprivation: From Biology to Policy (Cham: Springer International Publishing): pp. 1613–1633, doi:10.1007/978-3-319-55387-0_73, ISBN 978-3-319-55387-0, https://doi.org/10.1007/978-3-319-55387-0_73, retrieved 2023-06-19
30. ↑ Perry, Cydne A; West, Allyson A; Gayle, Antoinette; Lucas, Lauren K; Yan, Jian; Jiang, Xinyin; Malysheva, Olga; Caudill, Marie A (December 2014). "Pregnancy and Lactation Alter Biomarkers of Biotin Metabolism in Women Consuming a Controlled Diet123". The Journal of Nutrition 144 (12): 1977–1984. doi:10.3945/jn.114.194472. ISSN 0022-3166. PMID 25122647.

## Possible references

* "Biotin responsive limb weakness". Indian Pediatr 44 (3): 228–30. March 2007. PMID 17413203.
* "Asymptomatic adults and older siblings with biotinidase deficiency ascertained by family studies of index cases". J. Inherit. Metab. Dis. 28 (6): 903–12. 2005. doi:10.1007/s10545-005-0161-3. PMID 16435182.
* Boas MA (1927). "The Effect of Desiccation upon the Nutritive Properties of Egg-white". Biochem. J. 21 (3): 712–724.1. doi:10.1042/bj0210712. PMID 16743887.
* "Real time PCR assays to detect common mutations in the biotinidase gene and application of mutational analysis to newborn screening for biotinidase deficiency". Mol. Genet. Metab. 78 (2): 100–7. February 2003. doi:10.1016/S1096-7192(02)00231-7. PMID 12618081.
* "Micronutrient status in patients receiving home parenteral nutrition". Nutrition 13 (11–12): 941–4. 1997. doi:10.1016/S0899-9007(97)00334-1. PMID 9433708.
* "Audiologic findings in children with biotinidase deficiency in Turkey". Int. J. Pediatr. Otorhinolaryngol. 71 (2): 333–9. February 2007. doi:10.1016/j.ijporl.2006.11.001. PMID 17161472.
* "Qualitative colorimetric ultramicroassay for the detection of biotinidase deficiency in newborns". Clin. Chim. Acta 369 (1): 35–9. July 2006. doi:10.1016/j.cca.2006.01.009. PMID 16480705.
* "Epigenetic regulation of chromatin structure and gene function by biotin". J. Nutr. 136 (7): 1763–5. July 2006. doi:10.1093/jn/136.7.1763. PMID 16772434.
* "Intractable diaper dermatitis as an early sign of biotin deficiency". Acta Paediatr. 87 (2): 228–9. February 1998. doi:10.1080/08035259850157732. PMID 9512215.
* "Neonatal screening for biotinidase deficiency in Hungary: clinical, biochemical and molecular studies". J. Inherit. Metab. Dis. 26 (7): 693–8. 2003. doi:10.1023/B:BOLI.0000005622.89660.59. PMID 14707518.
* Mock DM (February 1999). "Biotin status: which are valid indicators and how do we know?". J. Nutr. 129 (2S Suppl): 498S–503S. doi:10.1093/jn/129.2.498S. PMID 10064317.
* Mock DM (December 1991). "Skin manifestations of biotin deficiency". Semin Dermatol 10 (4): 296–302. PMID 1764357.
* "Molecular characterisation and neuropsychological outcome of 21 patients with profound biotinidase deficiency detected by newborn screening and family studies". Eur. J. Pediatr. 162 (Suppl 1): S46–9. December 2003. doi:10.1007/s00431-003-1351-3. PMID 14628140.
* "Newborn screening for biotinidase deficiency in Brazil: biochemical and molecular characterizations". Braz. J. Med. Biol. Res. 37 (3): 295–9. March 2004. doi:10.1590/S0100-879X2004000300001. PMID 15060693.
* "The effect of neonatal jaundice on biotinidase activity". Early Hum. Dev. 72 (1): 15–24. May 2003. doi:10.1016/S0378-3782(02)00097-X. PMID 12706308.
* Thompson, J; Manore M; Sheeshka J (2010). "Nutrients involved in energy metabolism and blood health". Nutrition: A functional Approach. Toronto: Pearson Canada. pp. 353. ISBN 9780321740212.
* Velázquez A (1997). "Biotin deficiency in protein-energy malnutrition: implications for nutritional homeostasis and individuality". Nutrition 13 (11–12): 991–2. doi:10.1016/S0899-9007(97)00345-6. PMID 9433719.
* "Outcome in patients with profound biotinidase deficiency: relevance of newborn screening". Dev Med Child Neurol 46 (7): 481–4. July 2004. doi:10.1111/j.1469-8749.2004.tb00509.x. PMID 15230462.
* Welling DB (August 2007). "Long-term follow-up of hearing loss in biotinidase deficiency". J. Child Neurol. 22 (8): 1055. doi:10.1177/0883073807305789. PMID 17761663.
* "Biotinidase deficiency: clinical and MRI findings consistent with myelopathy". Pediatr. Neurol. 29 (1): 56–8. July 2003. doi:10.1016/S0887-8994(03)00042-0. PMID 13679123.
* Wolf B (2001). "Disorders of biotin metabolism". The metabolic & molecular bases of inherited disease. New York: McGraw-Hill. pp. 3935–62. ISBN 978-0-07-913035-8.

## External links

* GeneReviews/NCBI/NIH/UW entry on Biotinidase deficiency
* OMIM entries on Biotinidasa deficiency

Classification|

* ICD-10: E53.8
* ICD-9-CM: 266.2

|

External resources|

* eMedicine: ped/238

* v
* t
* e

Malnutrition or nutrition disorders (E40–E68, 260–269)

Malnutrition|

| Protein-energy
malnutrition|

* Kwashiorkor
* Marasmus
* Catabolysis

|

Vitamin deficiency|

| B vitamins|

* B1: Beriberi / Wernicke–Korsakoff syndrome (Wernicke's encephalopathy
* Korsakoff's syndrome)
* B2: Riboflavin deficiency
* B3: Pellagra (Niacin deficiency)
* B6: Pyridoxine deficiency
* B7: Biotin deficiency
* B9: Folate deficiency
* B12: Vitamin B12 deficiency

|

Other
vitamins|

* A: Vitamin A deficiency/Bitot's spots
* C: Scurvy
* D: Vitamin D deficiency/Rickets/Osteomalacia

Mineral
deficiency|

* Sodium
* Potassium
* Magnesium
* Calcium
* Iron
* Zinc
* Manganese
* Copper
* Iodine
* Chromium
* Molybdenum
* Selenium (Keshan disease)

Overnutrition|

* Overweight
* Obesity

* Childhood obesity
* Obesity hypoventilation syndrome
* Abdominal obesity

|

Vitamin poisoning|

* Hypervitaminosis A
* Hypervitaminosis D
* Hypervitaminosis E
* Megavitamin-B6 syndrome

Mineral overload|

* see inborn errors of metal metabolism, toxicity

0.00

(0 votes)

Original source: https://en.wikipedia.org/wiki/Biotin deficiency. Read more

|

Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Biotin_deficiency&oldid=870267"
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template