Evidence map›Paper›PMID 36376887›Full record

Trial reportOrphanet journal of rare diseases2022

Efficacy and pharmacokinetics of betaine in CBS and cblC deficiencies: a cross-over randomized controlled trial.

Apolline Imbard, Artemis Toumazi, Sophie Magréault, Nuria Garcia-Segarra, Dimitri Schlemmer, Florentia Kaguelidou, Isabelle Perronneau, Jérémie Haignere, Hélène Ogier de Baulny, Alice Kuster and 5 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled TrialEquivalence Trial
In one paragraph

Trial report in Orphanet journal of rare diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02404337 (Betaine METABOLISM OF PATIENTS With Homocystinuria), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.9field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02404337 phase2completednot on this map

Betaine METABOLISM OF PATIENTS With Homocystinuria

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2015 to 2018Enrolled12ConditionsHomocystinuriaArmsBetaine
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 7 citations in OpenAlex.

  1. Review
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  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 5 institutions in 2 countries.

Apolline ImbardLaboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Filière G2M, Paris, France. apolline.imbard@aphp.fr.ORCID 0000-0002-0420-8322
Artemis Toumazi *Unité d'Epidémiologie Clinique, Unité de Recherche Clinique, Hôpital Robert Debré, Paris, France.
Sophie Magréault *UF de Pharmacologie | Service de Microbiologie, Hôpital Jean Verdier, Paris, France.
Nuria Garcia-Segarra *Centre de Référence Maladies Héréditaires du Métabolisme, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Dimitri SchlemmerLaboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Florentia KaguelidouInserm CIC-EC 1426, Paris, France.
Isabelle PerronneauLaboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Jérémie HaignereUnité d'Epidémiologie Clinique, Unité de Recherche Clinique, Hôpital Robert Debré, Paris, France.
Hélène Ogier de BaulnyCentre de Référence Maladies Héréditaires du Métabolisme, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Alice KusterCentre de Compétence Maladies Héréditaires du Métabolisme, Centre Hospitalo-Universitaire de Nantes, Filière G2M, Nantes, France.
François FeilletCentre de Référence des Maladies Métaboliques, Inserm U1256 NGERE, Centre Hospitalo-Universitaire Brabois Enfants, Filière G2M, Vandoeuvre-Les-Nancy, France.
Corinne AlbertiUnité d'Epidémiologie Clinique, Unité de Recherche Clinique, Hôpital Robert Debré, Paris, France.
Sophie Guilmin-Crépon *Unité d'Epidémiologie Clinique, Unité de Recherche Clinique, Hôpital Robert Debré, Paris, France.
Jean-François Benoist *Laboratoire de Biochimie-Hormonologie, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Manuel Schiff *Centre de Référence Maladies Héréditaires du Métabolisme, Hôpital Robert Debré, APHP, Filière G2M, Paris, France.
Inserm · FRAssistance Publique – Hôpitaux de Paris · FRHôpital Necker-Enfants Malades · FRHôpital Robert-Debré · FRCentre Hospitalier Universitaire de Nantes · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBetaine is an "alternate" methyl donor for homocysteine remethylation catalyzed by betaine homocysteine methyltransferase (BHMT), an enzyme mainly expressed in the liver and kidney. Betaine has been used for more than 30 years in pyridoxine non-responsive cystathionine beta-synthase (pnrCBS) and cobalamin C (cblC) deficiencies to lower the hyperhomocysteinemia, although little is known about the optimal therapeutic dosage and its pharmacokinetic in these patients.

aimsWe compared 2 betaine doses (100 mg/kg/day vs. 250 mg/kg/day) in children affected by pnrCBS or cblC deficiencies. We also measured the pharmacokinetics parameters after a single dose of betaine (100 or 250 mg/kg) in these patients.

methodsWe conducted a prospective, randomized, crossover clinical trial with blinded evaluation. The primary outcome was the equivalence of total plasma homocysteine (tHcy) concentrations upon one-month oral treatment with betaine at 100 versus 250 mg/kg/day.

resultsEleven patients completed the study (5 pnrCBS and 6 cblC). tHcy concentrations were equivalent after a one-month treatment period for the two betaine dosages. Multivariate analysis showed a significant effect of betaine dose on methionine (Met) (p = 0.01) and S-adenosylmethionine (SAM) concentrations (p = 0.006).

conclusionsOur analysis shows that there is no overt benefit to increasing betaine dosage higher than 100 mg/kg/day to lower tHcy concentrations in pnrCBS and cblC deficiencies. However, increasing betaine up to 250 mg/kg/d could benefit cblC patients through the increase of methionine and SAM concentrations, as low Met and SAM concentrations are involved in the pathophysiology of this disease. In contrast, in pnrCBS deficiency, betaine doses higher than 100 mg/kg/day could be harmful to these patients with pre-existing hypermethioninemia.

trial registrationClinical Trials, NCT02404337. Registered 23 May 2015-prospectively registered, https://clinicaltrials.gov .

Indexed as

HomocystinuriaVitamin B 12 DeficiencyBetaineChildCystathionine beta-SynthaseHomocysteineHumansMethionineProspective StudiesS-AdenosylmethionineBetaineCystathionine beta-SynthaseHomocysteineMethionineS-AdenosylmethionineBetainecblC deficiencyCystathionine-beta-synthase deficiencyHomocysteineHyperhomocysteinemiaMethioninePharmacokineticsS-adenosylmethionine

Identifiers

PMID36376887
PMCPMC9664596
OpenAlexW4308966160

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.