Vitamin B6 (Pyridoxine)

The interaction of vitamin B6 pyridoxine with cadmium acetate in ethanolic solution has been studied. The new compound Cd(PN-H)(OOCCH3) (PN-H = pyridoxinato anion) was isolated and its structure studied in the solid state by IR and 13C and 113Cd CP/MAS NMR spectroscopies. The effect of pyridoxine on survival rate among male Sprague rats injected intraperitoneally with 5 mg CdCl2.H2O/kg was also investigated. Vitamin treatment seems to increase (Protocol C) or does not affect the cadmium lethality. Although the analysis of the metal burden in some organs seems to suggest a light increase of the cadmium level in the liver, this change has no significance at a statistical level.

INTRODUCTION: Involuntary, localised leg cramps are common and typically affect the calf muscles at night. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for idiopathic leg cramps? What are the effects of treatments for leg cramps in pregnancy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 16 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics; anti-epileptic drugs; calcium salts; diltiazem; magnesium salts; multivitamin and mineral supplements; quinine; sodium chloride; stretching exercises; verapamil; vitamin B6 (pyridoxine); and vitamin E.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: To assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002). SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the trial quality and extracted the data independently. MAIN RESULTS: Twenty-eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33). AUTHORS' CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

INTRODUCTION: Evidence for the efficacy of treatments for autism has improved in recent years. In this systematic review the evidence for both drug and non-drug treatments is appraised and clinical guidance is provided for their use. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of early intensive multidisciplinary intervention programmes in children with autism? What are the effects of dietary interventions in children with autism? What are the effects of drug treatments in children with autism? What are the effects of non-drug treatments in children with autism? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: applied behavioural analysis; auditory integration training; Autism Preschool Programme; casein-free diet; chelation; Child's Talk programme; cognitive behavioural therapy; digestive enzymes; EarlyBird programme; facilitated communication; Floortime therapy; gluten-free diet; immunoglobulins; melatonin; memantine; methylphenidate; More Than Words programme; music therapy; olanzapine; omega-3 fish oil; picture exchange communication system; Portage scheme; probiotics; relationship development interventions; risperidone; secretin; selective serotonin reuptake inhibitors (SSRIs); sensory integration training; social stories; social skills training; Son-Rise programme; TEACCH; vitamin A; vitamin B6 (pyridoxine) plus magnesium; and vitamin C.

BACKGROUND: Micronutrient status can affect cognitive function at all ages. Vitamin deficiencies could influence memory function and might contribute to age-associated cognitive impairment and dementia. Vitamin B6, comprising three chemically distinct compounds pyridoxal, pyridoxamine, and pyridoxine, is involved in the regulation of mental function and mood. Vitamin B6 is also an essential homocysteine re-methylation cofactor, and deficiency is associated with increase in blood homocysteine levels. Homocysteine is a risk factor for cerebrovascular disease and may also have directly toxic effects on neurons of the central nervous system. Neuropsychiatric disorders including seizures, migraine, chronic pain and depression have been linked to vitamin B6 deficiency. Epidemiological studies indicate that poor vitamin B6 status is common among older people. Hyperhomocysteinaemia has been suggested as a cause or mechanism in the development Alzheimer's disease and other forms of dementia. Supplementation with B vitamins including vitamin B6 has been shown to reduce blood homocysteine levels. OBJECTIVES: To assess the efficacy of vitamin B6 supplementation in reducing the risk of developing cognitive impairment by older healthy people, or improving cognitive functioning of people with cognitive decline and dementia, whether or not vitamin B6 deficiency has been diagnosed. SEARCH STRATEGY: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group was searched on 20 May 2003 using the terms: vitamin B6, pyridoxine, pyridoxamine, pyridoxal. For relevant trials on healthy elderly people MEDLINE, EMBASE and CENTRAL were searched using the previously mentioned terms as well as the term cognit * SELECTION CRITERIA: All unconfounded, double-blind randomized controlled trials in which the intervention with vitamin B6 was compared with placebo for healthy older people or people with cognitive decline or dementia. The primary outcome of interest was the efficacy of vitamin B6 supplementation on cognitive function. DATA COLLECTION AND ANALYSIS: The two reviewers independently evaluated all studies identified as possibly meeting the criteria for inclusion. O

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: To assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002). SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the trial quality and extracted the data independently. MAIN RESULTS: Twenty-eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: The objective of this review was to assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: October 2001. SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Twenty-three trials were included. These trials were of variable quality. Nausea treatments were different anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin) and P6 acupressure. For hyperemesis gravidarum five trials were identified testing treatments with oral ginger root extract, oral corticosteroids or injected adrenocorticotropic hormone (ACTH) and intravenous diazepam. Based on 13 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.17, 95% confidence interval 0.13 to 0.21). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: The objective of this review was to assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Twenty trials were included. These trials were of variable quality. Nausea treatments were different anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin) and P6 acupressure. For hyperemesis gravidarum two trials were identified using treatments with ginger root and ACTH (adrenocorticotropic hormone) injections. Based on 13 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.17, 95% confidence interval 0. 13 to 0.21). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak.

Background and Purpose: The effects of B-vitamin combinations on the prevention of cardiovascular diseases, such as myocardial infarction (MI) and stroke, remain controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) over three decades to evaluate the association between B-vitamin combinations and mortality and arterial thrombotic outcomes. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for RCTs with minimal duration over 24 months published between January 1996 and November 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects models were used in this meta-analysis to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Results: Thirteen randomized trials enrolling 68,363 participants across both primary and secondary prevention populations were included. B-vitamin combinations were associated with a nonsignificant reduction in stroke and 3-point major adverse cardiovascular events (MACE) (stroke: RR 0.91, 95% CI 0.81-1.04; MACE: RR 0.93, 95% CI 0.86-1.01). No significant effects were observed for all-cause mortality (RR 1.01, 95% CI 0.96-1.06), cardiovascular mortality (RR 0.97, 95% CI 0.88-1.07), or MI (RR 0.97, 95% CI 0.91-1.03). In primary prevention populations, B-vitamin combinations were associated with significant reductions in stroke (RR 0.79, 95% CI 0.68-0.93) and MACE (RR 0.80, 95% CI 0.69-0.92). A modest reduction in MACE was also observed in secondary prevention populations (RR 0.91, 95% CI 0.83-0.99). Between-study heterogeneity was minimal to low for ischemic outcomes, supporting the robustness of these estimates, whereas substantial heterogeneity was observed for mortality outcomes in secondary prevention populations. Conclusions: The evidence is limited by heterogeneity in trial populations, vitamin formulations and doses, and outcome definitions, with substantial between-study inconsistency for mortality outcomes and imprecision in subgroup estimates derived from a small number of contributing trials. Overall, B-vitamin combinations d

OBJECTIVE: Hyperhomocysteinemia (Hcy) independently predicts coronary heart disease (CHD) and adverse cardiovascular events. Although folic acid plays a key role in Hcy metabolism, the effect of combined B-vitamin supplementation (folic acid, VB6, and VB12) on clinical outcomes in CHD remains uncertain. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted from inception through April 2025 using MeSH terms including "folic acid," "vitamin B6," "vitamin B12," "coronary heart disease," and "homocysteine." A random-effects model was used for meta-analysis. RESULTS: Thirteen studies involving 14,539 participants were included in the meta-analysis (7,338 patients treated with folic acid combined with vitamin B complex and 7,301 controls). Combined B-vitamin supplementation significantly reduced serum Hcy levels [mean difference: -2.36; 95% confidence interval (CI): (-3.09 to -1.62); p < 0.01] compared with any single-nutrient regimen. The incidence of vascular restenosis was lower in the intervention group than in the control group (risk ratio: 0.65; 95% CI: 0.44-0.95; p < 0.05). However, no significant differences were observed in the incidence of major cardiovascular events (p = 0.78) or cardiovascular-related mortality (risk ratio: 0.96; 95% CI: 0.85-1.07; p = 0.44). CONCLUSION: Combined B-vitamin supplementation effectively lowers serum Hcy levels and the incidence of vascular restenosis in patients with CHD. However, its impact on cardiovascular events and mortality remains inconclusive. Plain Language Summary: Meta-analysis of 13 RCTs (n = 14,539): combined B vitamins lower serum HcyCombined B-vitamin supplementation lowers vascular restenosis in CHD patientsExerts no significant impact on major CV events or mortalityHcy-lowering appears CHD-specific; broader CV benefits remain unproven.

BACKGROUND AND AIMS: We have evaluated the efficacy and tolerability of two food supplements (FS) containing flavonoids (naringin and hesperidin); same doses of B3, B6, B9 and B12 vitamins, and two different doses of a blend of Mentha spicata leaf extract and Amaranthus caudatus seed flour, in subjects with borderline high total (TC) and low-density lipoprotein cholesterol (LDL-C) levels. METHODS AND RESULTS: 114 Participants (18-70 years) with TC levels 200-239 mg/dL, (5.18-6.19 mmol/L) and LDL-C (<159 mg/dL) were randomised into three groups to receive for 90 days the lowest (n = 38, Treatment A), the highest dose of the FS (n = 38 - Treatment B), or placebo (n = 38). Treatment B was associated with a significant reduction in LDL-C (∼31.5 mg/dL;-22%) and TC (∼19.5 mg/dL; -9%), along with an increase in high-density lipoprotein cholesterol (HDL-C). The greater efficacy of Treatment B containing the highest dose of vegetable extracts is likely attributable to its higher M. spicata extract content, as judged by high-resolution mass spectrometry analysis of the preparation. CONCLUSION: The combination of different FS ingredients with different mechanisms of action can be a valuable strategy for improving lipid profiles in subjects with borderline high TC and LDL-C levels.

Bromelain is a proteolytic enzyme found in pineapple fruit. This study was conducted to evaluate the effects of bromelain supplementation on disease activity and quality of life (QoL) in patients with ulcerative colitis (UC). Seventy individuals with mild-to-moderate UC participated in a randomized, triple-blind clinical trial. Participants were randomly assigned to receive either maltodextrin as a placebo or 400 mg of bromelain daily for eight weeks. QoL and Simple Clinical Colitis Activity Index (SCCAI) scores were assessed. All results were analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches. The only demographic factor that differed between the two groups statistically significantly was gender (p = 0.01). Additionally, the mean difference in vitamin B6 consumption variations between the bromelain and placebo groups was significant (0.39 ± 0.86 vs. -0.44 ± 1.43; p < 0.001). There was no considerable difference detected for the other nutrients. The bromelain group had considerably higher changes in their SCCAI score in comparison with the placebo group (-3.29 ± 2.17 vs. -1.11 ± 1.71; p < 0.001). There was no considerable difference in changes in QoL questionnaire scores between the intervention and control groups (3.76 ± 6.18 vs. 3.91 ± 4.30; p = 0.90). After correcting for baseline, the findings remained significant for the SCCAI variable but not for the QoL variable (p < 0.001 and p = 0.99). In UC patients, the severity of the disease is reduced by bromelain supplementation, which is an alternative therapy.Trial registration: The study protocol received approval from the Ethics Committee at Iran University of Medical Sciences "IR.IUMS.REC.1402.125" and was registered with the Iranian Clinical Trials Registry "IRCT20191105045340N2" on 09/07/2023. © 2025. The Author(s).

BACKGROUND: Glaucoma is a leading cause of irreversible blindness, characterized by progressive degeneration of retinal ganglion cells. Current treatments primarily lower intraocular pressure but do not directly provide neuroprotection. Preclinical studies from our group have identified dysfunction in one-carbon metabolism as a contributor to glaucomatous neurodegeneration in rodent models. The Interventional Vitamin Mix Glaucoma Study will evaluate whether 12 months of supplementation with key one-carbon metabolism cofactors and precursors (vitamins B6, B9, B12, and choline) can improve inner retinal function and provide neuroprotection compared with standard care alone. METHODS: The Interventional Vitamin Mix Glaucoma Study is a Phase 2a, open-label, randomized, two-arm clinical trial. Participants will be assigned in a one-to-one ratio to receive either daily one-carbon metabolism supplementation plus standard care or standard care alone. The study will enroll 80 patients with primary open-angle glaucoma, normal tension glaucoma, or pseudoexfoliation glaucoma, each with mild-to-moderate visual field loss in at least one eye. Recruitment will take place from March 2025 to March 2026 at St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden. The primary outcome is change in the photopic negative response measured by full-field electroretinography. Secondary outcomes include changes in visual field parameters, retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness. Exploratory outcomes will include changes in blood-based metabolomic and DNA methylation profiles. DISCUSSION: One-carbon metabolism-based supplementation has been shown to reduce retinal ganglion cell loss in rodent models of glaucoma. This trial will investigate whether such supplementation improves retinal function and confers neuroprotection in patients with glaucoma. The use of full-field electroretinography as the primary outcome aims to detect early functional improvements in the retina. If successful, this approach could support a low-cost, widely available neuroprotective strategy to be used alongside existing intraocular pressure-lowering therapies. T

IMPORTANCE: Treatments for men seeking fertility care are limited. Antioxidant supplements have been widely studied as a new treatment option, but these studies have had conflicting results. OBJECTIVE: To assess whether treatment of men seeking fertility care with an antioxidant supplement can improve semen quality and pregnancy rates compared with a placebo. DESIGN, SETTING, AND PARTICIPANTS: The SUMMER trial was a multicenter, double-blind, placebo-controlled randomized clinical trial conducted in 21 hospitals and private fertility clinics in the Netherlands. Male patients in these centers were enrolled between May 2018 and February 2024, and follow-up of the primary outcome was completed in December 2024. Eligible participants were men aged 18 to 50 years with female partners aged 18 to 43 years, who sought fertility care and were advised to undergo expectant management, treatment with intrauterine insemination, in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Couples treated with ovulation induction only or IVF for bilateral tubal pathology were excluded. The men were randomly assigned to receive an antioxidant supplement or a placebo. Intention-to-treat analysis was performed for all outcomes. INTERVENTIONS: The antioxidant supplement (Impryl) was a tablet to be taken daily for 6 months. It contained betaine (200 mg), L-cystine (200 mg), niacin (16 mg), zinc (10 mg), vitamin B6 (1.4 mg), vitamin B2 (1.4 mg), folic acid (400 µg), and vitamin B12 (2.5 µg). The placebo tablet and its packaging were identical to those of the antioxidant supplement. All participating couples received standard infertility care. MAIN OUTCOMES AND MEASURES: The primary outcome was ongoing pregnancy conceived within 6 months after randomization. Secondary outcomes included semen parameters, sperm DNA fragmentation, fertilization and embryo utilization rates after IVF or ICSI, biochemical and clinical pregnancy rates, first-trimester pregnancy loss, ectopic pregnancy rate, cumulative number of pregnancies, time to pregnancy, and adverse events. RESULTS: A total of 1171 men (median [IQR] age, 34 [31-38] years; female partners' median [IQR] age, 32 [30-35] year

CONTEXT: Elevated homocysteine levels are associated with brain atrophy and dementia, with B vitamin supplementation a possible low-cost intervention to help mitigate the deleterious impacts on brain health. However, prior meta-analyses have produced inconsistent results, with unexplained heterogeneity, while the quality of evidence has not been assessed. OBJECTIVE: This systematic review, meta-analysis, and meta-regression sought to quantify the effect of B vitamin supplementation on global cognitive function in older adults. DATA SOURCES: PubMed, Embase, PsychInfo, Scopus, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) from inception to June 20, 2024. DATA EXTRACTION: Eligible RCTs were derived from populations aged ≥60 years, with interventions of 26 weeks or longer comprising vitamin(s) B6, B9, or B12 of any dose or administration route, compared with placebo or usual dementia care. Studies must also have quantified global cognitive function at baseline and at end of treatment. DATA ANALYSIS: Seventeen RCTs, including 5275 participants, were identified. A small to moderate improvement (Hedges' g = 0.423; 95% CI: 0.188 to 0.657) in global cognitive function after supplementation was observed with considerable heterogeneity (I2 = 92.71; Grading of Recommendations, Assessment, Development, and Evaluations [GRADE] = very low certainty). A meta-regression identified that statistical outliers and single-blinded studies contributed to the pooled g and heterogeneity. Omitting these studies resulted in a small effect (g = 0.110; 95% CI: 0.034 to 0.186), with negligible heterogeneity (I2 = 15.39; GRADE = high certainty). The effect size did not differ between classifications of cognitive impairment (ie, intact cognition, mild cognitive impairment, and dementia) in subgroup analysis (P = .729). CONCLUSION: The pooled findings indicated there is high-certainty evidence that vitamin B6, B9, or B12 supplementation has a very small benefit on global cognitive function in older adults. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42024553717. © The Author(s) 2025. Published by Oxford University Press on behalf of th

BACKGROUND: Levetiracetam commonly causes neuropsychiatric adverse events (NPAEs) in pediatric patients, including irritability and aggression. This study evaluated pyridoxine supplementation for reducing levetiracetam-related NPAEs in children and adolescents with epilepsy. METHODS: We conducted a prospective, double-blind, randomized, placebo-controlled trial at Phramongkutklao Hospital, Thailand (January-June 2024). Participants aged 1-18 years with levetiracetam-related NPAEs were randomly assigned in a 1:1 ratio to receive either pyridoxine (10 mg/kg/day, maximum 200 mg) or placebo for 8 weeks. The primary outcome was change in behavioral symptoms using a validated 30-item questionnaire (score range 30-90). Secondary outcomes included treatment adherence, time to behavioral improvement, and adverse events. Sample size (n = 102) was calculated to detect a 20 % difference in behavioral improvement with 80 % power. RESULTS: 102 patients were randomized (pyridoxine n = 51, placebo n = 51). Baseline characteristics-including age, sex, seizure type, and number of concomitant ASMs-were comparable between groups. The mean age was 9.2 vs 8.3 years (p = 0.363), and 52.9 % vs 51.0 % were female in the pyridoxine and placebo groups, respectively. Most participants (56.9 %) were on dual therapy, with a median of two ASMs in both groups (p = 0.94). Both groups showed significant behavioral improvement over 8 weeks: the pyridoxine group from 14.79 ± 6.87 to 11.54 ± 6.22 (p < 0.001); placebo group from 15.65 ± 8.26 to 10.47 ± 8.22 (p < 0.001). No significant between-group difference existed at week 8 (p = 0.468). However, multivariate analysis of behavioral change scores from baseline to week 8 revealed significantly greater improvement in the pyridoxine group (adjusted OR = 2.31, 95 % CI: 1.15-4.63, p = 0.020). No serious adverse events occurred in either group. CONCLUSION: While pyridoxine did not significantly reduce behavioral scores compared to placebo at the study endpoint, the greater improvement in change scores over time suggests potential benefit in mitigating levetiracetam-associated NPAEs. Pyridoxine may serve as safe adjunctive therapy for patients who have be

Poststroke cognitive decline is a major form of disability in stroke survivors. Although dietary interventions have shown potential in improving cognitive outcomes in stroke-free populations, their effects on stroke survivors remain unclear. This review aimed to evaluate associations between diet and cognitive function in stroke survivors. MEDLINE, Embase, Scopus, and CINHAL were searched for studies from inception to 16 December, 2024. Eligible articles were observational and interventional studies on adult stroke survivors that evaluated the association/effect of any nutritional exposure/intervention on cognitive performance and dementia risk. Studies were excluded when an intervention was combined with nonnutritional treatment. Random-effects meta-analysis was used for similar randomized clinical trials. This review included 20 clinical trials and 14 observational studies assessing the intake of energy and proteins and a variety of single nutrients, as well as dietary patterns, single foods, and phytochemicals. Meta-analyses revealed a positive effect of energy-protein supplementation on global cognition [standardized mean difference (SMD): 0.62; 95% confidence interval (CI): 0.15, 1.08; P = 0.009], and a negative effect of B-vitamins (folic acid, vitamin B6, and vitamin B12) (SMD: -0.40; 95% CI: -0.72, -0.08; P = 0.02). Adherence to the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay and plant-based diets, as well as higher consumption of fruits, milk, coffee, vitamin E, and selenium, were related to better cognitive outcomes; no significant association was observed for adherence to DASH and Mediterranean diets and consumption of vitamins D and C. Butter and sugar intake and calcium supplementation were associated with negative cognitive outcomes. Mixed results were seen for omega (ω)-3, tea, and plant extracts. The available evidence indicates that energy-protein supplementation may benefit cognition after stroke, whereas B-vitamin supplementation has no effect. The substantial heterogeneity among studies hinders conclusions about other dietary strategies. This review was registered with PROSPERO as CRD4

Background: A nutritional supplement based on medicinal plants (saffron and ashwagandha), tryptophan, and vitamin B6 could contribute to alleviating/improving mood and associated disorders. The aim of this study was to evaluate the potential benefits of this combination supplement. During the study period, participants underwent a period of forced home confinement due to the COVID-19 pandemic, which represented an unexpected impact factor. Methods: This open-label prospective trial enrolled a cohort of female employees who reported mild to moderate anxiety. The primary objective was to evaluate changes in the level of anxiety using the adapted Hamilton Anxiety Rating Scale (HARS) after 12 weeks of regular supplementation with Safromotive (two tablets daily, for 12 weeks). The secondary objectives were to evaluate health-related quality of life (HRQoL) and tolerability. Results: In total, 46 women with a mean age of 45.0 (6.5) years were included. A statistically significant improvement in HARS was observed, with a 7.5-unit decrease from baseline to 12 weeks (p < 0.0001) and from 4 to 12 weeks of supplement intake (p=0.0058). However, no significant changes were found during the lockdown period (between weeks 8 and 12 of the study). No relationship was found between women's sociodemographic characteristics and the HARS total score. A significant reduction in the HRQoL questionnaire score of 1.2 units was observed between baselines and 12 weeks of treatment (p=0.0273). At the end of the study, 78.6% of the women reported consistency the supplement intake during the study course. Conclusion: This nutritional supplement composed of saffron, ashwagandha, tryptophan, and vitamin B6 appears to improve anxiety and HRQoL, but confinement could have impacted the evolution of the outcome.

Homocysteine is an amino acid derived from methionine which is metabolized via vitamin B6 (pyridoxine)- and vitamin B12 (cobalamin)-dependent pathways. Supplementation of B vitamins has been shown to effectively reduce plasma homocysteine levels. Previous research has also demonstrated an association between lower plasma homocysteine levels and decreased risk of myocardial infarction, stroke, and venous thromboembolism. However, whether supplementation of B vitamins is associated with risk reduction in thromboembolic events and confers clinical benefits remains inconclusive. This review examines clinical trials published over the past 29 years to assess the effects of B vitamin supplementation on thrombotic risk reduction and homocysteine metabolism. The findings from these studies are inconsistent, and the impact of B vitamins on thrombosis prevention remains uncertain. Given the conflicting evidence, further clinical and translational research is necessary to clarify the role of B vitamin supplementation in thrombosis risk reduction.

BACKGROUND: Drug resistance poses a formidable challenge in managing acute manic episodes in bipolar I disorder, leading to suboptimal treatment outcomes. This study investigates the efficacy of folate and vitamin B6 supplementation as an adjunct to sodium valproate in improving treatment responses for patients experiencing acute mania. METHODS: In a randomized, double-blind, placebo-controlled trial, 43 patients diagnosed with bipolar I disorder presenting with acute manic episodes were enrolled. Participants were randomly assigned to three groups: one receiving folate (5 mg/day) plus vitamin B6 (80 mg/day), a second group receiving folate alone (5 mg/day), and a third group receiving placebo. Evaluations were conducted at baseline and after 3 and 6 weeks using the Mini-Mental State Examination (MMSE) and the Young Mania Rating Scale (YMRS). RESULTS: All groups demonstrated significant clinical improvements after the treatment period; however, the trends in MMSE scores showed no significant differences (p = 0.068). Notably, the reduction in YMRS scores significantly varied across groups (p < 0.001, effect size = 0.342), with the folate group demonstrating a significantly greater decrease compared to both the folate/B6 (p = 0.003) and placebo groups (p < 0.001). Recovery rates revealed that 80% of patients receiving folate showed over a 50% decrease in YMRS scores after 3 weeks, markedly higher than the other groups (p = 0.001). CONCLUSIONS: Our findings support the short-term use of folate as a beneficial adjunct in treating acute manic episodes in bipolar I disorder. However, the addition of vitamin B6 did not yield additional advantages. These results may inform future treatment guidelines targeting acute mania in bipolar disorder, advocating for folate supplementation as a potential strategy to enhance therapeutic outcomes. © 2025 The Author(s). Brain and Behavior published by Wiley Periodicals LLC. A randomized multi-arm open labelled comparative clinical trial report of Pankajakasthuri DiabetEaze powder, a novel polyherbal formulation on the nutritional management and glycemic control in type 2 diabetic and prediabetic patients. Sasidharan S(1)(2), Nair

BACKGROUND AND AIMS: Recently Diabetes Mellitus (DM) has been associated with heightened susceptibility to malnutrition, suggesting that augmenting nutritional intake stands out as a potent therapeutic strategy for addressing malnutrition in individuals with DM. The aim of this clinical investigation was to evaluate the effect of DiabetEaze powder, a polyherbal nutritional formulation developed by us for nutritional management and glycaemic control, on patients with diabetic and prediabetic conditions. METHODS: A total of 143 type II diabetic (T2D) patients who were managing their diabetic condition through modern medicine, AYUSH medicine, lifestyle modification and 68 pre-diabetic patients, aged between 40 and 65 years, were randomly assigned into six groups: control, modern, AYUSH, lifestyle, prediabetic control and prediabetic trial. The treatment groups were administered 5 g of DiabetEaze powder two times a day after food for 6 months. Microminerals, vitamins, glycaemic parameters, Quality of Life (QoL), hematology, lipid profiles, Renal Function Test (RFT) and Liver Function Test (LFL) parameters, and electrolytes were evaluated at Day 0, Day 90, and Day 180. RESULTS: Out of 211 enrolled patients, 189 individuals successfully completed the entire 180-day duration of the study, indicating a retention rate of approximately 89.6 %. In our study, we observed a statistically significant elevation in the levels of vitamin D, B2, and B6 across all treatment groups. Besides, the treatment groups displayed a notable increase in zinc and manganese levels compared to the other minerals tested. Notably, the treatment groups demonstrated distinct mineral and vitamin profiles. In terms of metabolic markers, significant reductions in Fasting Blood Sugar (FBS)/Post Prandial Blood Sugar (PPBS) were observed across the modern, AYUSH, and lifestyle groups, while the modern group also showed a marked decrease in glycated haemoglobin (HbA1c) levels. Furthermore, overall QoL among the tested groups was also statistically significant. The consistent maintenance of normal LFT and RFT parameters and electrolyte levels across trial groups throughout the study duration indicates that

PURPOSE: In the current study we evaluated a blend of ingredients containing mulberry leaf extract (to lower postprandial glucose of the evening meal), tryptophan (facilitator of the sleep initiation) to benefit sleep initiation and quality in adults with self-reported difficulties with sleep initiation. METHODS: Forty-three adults aged between 25 and 50 years enrolled in a randomized, crossover, double-blind, controlled trial. Participants received standardized meals with a glycemic load of 55 ± 10% and were assigned to receive treatment comprising a combination of mulberry leaf extract (750 mg), whey protein containing 120 mg tryptophan, zinc (1.35 mg), magnesium (12.6 mg), vitamin B3 (1.93 mg) and B6 (0.135 mg) and control (4 g wheat protein hydrolysate). Each intervention phase lasted 14 days separated by a washout period of 28 days. The primary outcomes were actigraphy-measured sleep onset latency and sleep efficiency. Secondary outcomes included continuous glycemic responses, mood, and cognition. RESULTS: A linear mixed model intention-to-treat analysis conducted on 42 participants found that the treatment reduced sleep onset latency (actigraphy: -3.82 mins, p = 0.026; self-report: -3.09 mins, p = 0.048). Treatment significantly reduced evening meal's postprandial glucose response (incremental area under the curve, mmol/L*min) at 1 hour by 21% (p < 0.001), incremental maximum concentration by 16% (p = < 0.001) and nocturnal glucose variation over the 14-day period. Participants on treatment reported improved sleep quality (Karolinska Sleepiness Scale, -0.17, p = 0.041) and feeling more relaxed (Brief Mood Introspection Scale, -0.4, p = 0.003) the next morning compared to when taking the control. Additionally, the treatment improved the vigor dimension on the Profile of Mood Scale (0.8, p = 0.038). No effects were observed on the cognitive performance. Lowering postprandial glucose significantly mediated the treatment effect of lowering sleep onset latency and lower nocturnal glucose variation was also associated with improved sleep quality and next-day positive mood. CONCLUSION: The evening meal supplement benefited sleep initiation and quality, and also i

CONTEXT: There are various therapeutic approaches available to reduce homocysteine (Hcy) levels. However, it remains unclear which intervention is more effective for healthy adults. OBJECTIVES: A systematic review and network meta-analysis (NMA) were conducted to comprehensively investigate the efficacy of different nutritional supplements in reducing Hcy levels in healthy adults. DATA SOURCES: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from inception to July 2023. DATA EXTRACTION: The lead author, year of publication, sample size, population characteristics, intervention measures, duration, and mean difference of Hcy levels from baseline to endline were extracted. DATA ANALYSIS: Data were pooled using a random-effects model. Network meta-analysis was conducted by integrating direct and indirect evidence. A total of 16 studies were included in this analysis. The nutritional supplement combination that achieved the highest ranking (surface under the cumulative ranking curve [SUCRA] = 75.8) was superior compared with a single supplement. Among similar or closely dosed folic acid (FA) supplements, 800 μg FA (SUCRA = 93.7) was the most effective option. When comparing various doses of different supplements, 1 mg of FA plus 7.2 mg of vitamin B6 (B6) plus 20 μg of vitamin B12 (B12; SUCRA = 83.9) ranked first and 800 μg of FA (SUCRA = 78.3) ranked second. In comparison with placebo or no-treatment control groups, interventions such as 1 mg of FA plus 7.2 mg of B6 plus 20 μg of B12 (mean difference [MD] = -1.03; 95% CI -1.71 to -0.36), 400 μg of FA plus 400 μg of B12 (MD = -0.87; 95% CI -1.46 to -0.27), and 800 μg of FA (MD = -0.84; 95% CI -1.12 to -0.56) were more effective in reducing Hcy levels. The random-effects summary MD for all interventions compared with placebo was -0.59 (95% CI -0.71 to -0.48; P < .0001). CONCLUSIONS: The NMA demonstrated that the combination of FA with other vitamins is more effective in reducing Hcy levels, particularly when the dose of FA is close to 800 μg. The combination of 1 mg of FA, 7.2 mg of B6, and 20 μg of B12 is considered the most favorable option. SYSTEMATIC REVIEW REGISTRATION: PROSPERO re

This study aimed to determine the dietary pyridoxine requirement of Pacific white shrimp (Penaeus vannamei) fed a soybean meal-based diet. Seven experimental diets were prepared with graded pyridoxine supplementation at 0, 25, 50, 75, 100, 125, and 150 mg/kg diet (Con, P25, P50, P75, P100, P125, and P150, respectively). An additional negative control diet (Con-) was formulated by adding 0.4% tetracycline hydrochloride to verify microbial synthesis of pyridoxine. Juvenile shrimp (initial weight: 0.38 g) were randomly assigned to eight diets with quadruplicate tanks and fed the diets for 45 days. Growth performance and feed utilization were increased with dietary pyridoxine supplementation up to P75, whereas higher supplementation levels resulted in reduced responses (P < 0.001). Hepatopancreas pyridoxine concentration was gradually increased with increment in dietary pyridoxine levels (P < 0.001), reaching a plateau from P75 to P150, and remained lower in Con- group than in Con group. Non-specific immune response, including lysozyme, anti-protease and nitroblue tetrazolium activities and antioxidant capacities including superoxide dismutase and glutathione peroxidase were significantly increased by dietary pyridoxine supplementation (P < 0.05). Digestive enzyme activities, intestinal morphological indices, and hepatopancreatic F- and B-cell prevalence were also positively influenced by dietary pyridoxine supplementation (P < 0.05). Gene expression analysis showed increased transcription of cystathionine-γ-lyase, cystathionine-β-synthase, pyridoxal kinase, crustin, and penaeidine in response to pyridoxine supplementation. Based on a broken-line regression analysis of weight gain, the dietary pyridoxine requirement was estimated to be 69.0 mg/kg diet. Copyright: © 2026 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Vitamin B6 is an essential metabolite required by all living organisms and participates in numerous cellular biochemical reactions. Unlike mammals, plants can synthesize this compound de novo, and therefore, serve as an excellent nutritional source for the vitamin. Although the biosynthesis pathway in plants has been well understood for nearly two decades, the regulatory mechanisms that control vitamin B6 levels remain largely unknown. Here, we describe a novel set of Arabidopsis mutants that display distinct phenotypic and molecular characteristics and are likely affected in either the biosynthesis or homeostasis of vitamin B6. We propose that these new mutants will serve as valuable tools for uncovering the unknown regulatory steps governing vitamin B6 levels in plants. © 2026 The Author(s). The FEBS Journal published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.

BACKGROUND: Trofinetide (TROF) remains the first and only FDA-approved pharmacologic treatment for Rett syndrome (RTT). There is limited real-world evidence on TROF use, restarts, dosing patterns and predictors of non-persistence. This study evaluated long-term treatment patterns and baseline predictors of non-persistence among RTT individuals initiating TROF. METHODS: A retrospective claims analysis of linked IQVIA Anonymized Patient Level Data and TROF pharmacy data (1 January 2021 to 30 September 2024) was performed. RTT individuals initiating 1st TROF prescription (RX) between 1 April 2023 and 31 March 2024 with ≥6 months of pre- and post-index continuous enrollment were classified as persistent (gap ≤90 days) and non-persistent. Median (IQR) time on treatment was analyzed, and Kaplan-Meier assessed time to non-persistence. Restarts among non-persistent were examined. Dosing patterns such as mean dose in milligrams (mg) and percentage target daily dose (%TDD) at each RX were evaluated. Predictors of non-persistence were assessed using logistic regression. RESULTS: Among 1,175 TROF initiators, 54.9% were persistent and 45.1% were non-persistent; 7.6% of non-persistent individuals restarted. Mean ± SD age was 14.7 ± 10.8 vs. 16.5 ± 11.6 years and median ± IQR time on TROF was 14.3 ± 4.6 vs. 3.0 ± 3.8 months, respectively. Over 75% remained on treatment beyond 3 months, and more than half continued through study follow-up. Mean twice daily (BID) TROF dose was lower among persistent (7422.0 mg) vs. non-persistent (7850.8 mg) at RX1 and increased to 7953.7 mg vs 8423.4 mg, respectively at RX2. Thereafter, the persistent individuals maintained stable dosing, while the non-persistent showed greater fluctuation over time. Similar patterns were observed for %TDD. Older age and history of infectious disorders were significantly associated with non-persistence. CONCLUSIONS: In this real-world analysis, more than half of RTT individuals remained persistent on TROF for ≥14 months. Stable dosing patterns were observed among persistent individuals, while greater dose variability was observed among non-persistent individuals. Thus, these findings may provide guidance to cli

Environmental contamination through heavy metals poses significant health risks and cause detrimental effects on embryonic development of humans and animals. This study investigates the teratogenic effects induced by lead - one of poisonous heavy metals, and rescuing potential of combined dose of vitamin B6 and vitamin B12 in golden black breed of domestic chicken embryos. Experiments were carried out on 200 fertilized eggs. Eggs were weighed and distributed into four groups (50 eggs each). 1. Control group 0.1 mL of patent drinking water 2. Vit-B6 + Vit-B12 combination group 0.05 mL of 0.1 mg/kg vitamin B6 solution + 0.05 mL of 0.1 mg/kg vitamin B12 solution in patent drinking water. 3. Lead acetate group 0.1 mL of 5 mg/kg lead acetate solution in patent drinking water. 4. Lead acetate and Vit-B6 + Vit-B12 combination group 0.1 mL of solution containing 5 mg/kg lead acetate, 0.1 mg/kg vitamin B6 and 0.1 mg/kg vitamin B12 solution in patent drinking water. Recovery of embryos was performed on 14th day of incubation and embryos were preserved for further studies. Significant teratogenic effects were observed in lead treated group compared to control group. Microcephaly, exopthalomus eye, abnormal beak development, skewed spine, reduced neck length and torticollis were observed in lead treated group. Appendicular abnormalities include forelimb and hind limb amelia, meromelia in hind limbs. In some chick embryos agenesis and irregular development of claws was noted. Mortality rate was higher in lead group compared to control group. This study highlights vitamin B6 and vitamin B12 ameliorative effects against lead induced developmental abnormalities in chick embryo. © 2026 Published by Elsevier B.V.

Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive metabolic epilepsy classically presenting with refractory neonatal seizures that respond to pharmacological doses of pyridoxine (vitamin B6). Although traditionally regarded as a neonatal disorder, later presentations are increasingly recognised. We report an adolescent patient with long-standing treatment-resistant epilepsy and learning disability who was ultimately diagnosed with PDE. Whole genome sequencing identified compound-heterozygous pathogenic variants in ALDH7A1 The diagnosis was further supported by elevated urinary and plasma α-aminoadipic semialdehyde levels. Initiation of pyridoxine therapy combined with lysine-reduction treatment resulted in sustained seizure control and allowed gradual withdrawal of conventional antiseizure medications. This case highlights the importance of considering PDE in older children and adolescents with refractory epilepsy and neurodevelopmental impairment and demonstrates the value of integrating genomic and metabolic investigations to establish a definitive diagnosis. © BMJ Publishing Group Limited 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.

For decades, the clinical management of urolithiasis has emphasized dietary oxalate restriction. However, this review synthesizes over 40 years of research demonstrating that endogenous production, driven by specific metabolic precursors, plays the dominant role in oxalogenesis. Utilizing acute and chronic rat models, we quantified the conversion of glyoxylate, glycolate, ethylene glycol, hydroxypyruvate, and hydroxyproline into urinary oxalate. These studies establish a clear hierarchy of lithogenicity, with glyoxylate and glycolate emerging as the most potent precursors. Importantly, we identify Vitamin B6 (pyridoxine) deficiency as a critical metabolic "gatekeeper" that markedly amplifies oxalate synthesis. Deficiency states were found to increase precursor-to-oxalate conversion rates by up to 25-fold by suppressing hepatic alanine-glyoxylate aminotransferase (AGT) activity. Collectively, these findings support a paradigm shift in stone prevention: moving beyond dietary oxalate restriction toward managing precursor load and optimizing Vitamin B6 status. © 2026. The Author(s).

Vitamin B6 is an essential cofactor of numerous enzymes, and beer may contribute substantially to its dietary intake. While vitamin B6 occurs predominantly as glycosides in plants, data on the complete vitamer profile in beer remain scarce. Here, a novel SIDA LC-MS/MS method was developed for the native quantification of pyridoxine, pyridoxal, pyridoxamine, 4-pyridoxic acid, pyridoxine-5'-β-glucoside, pyridoxine-5'-β-maltoside, and pyridoxine-5-β-cellobioside. The method was validated for linearity, precision, recovery, and limits of quantification (0.20-12.9 μg/L) and detection. Analysis of 65 beers revealed total vitamin B6 concentrations ranging from 95.3 to 1020 μg/L, including multiple B6 glycosides. Variations in vitamin B6 composition were primarily associated with raw materials rather than with brewing technology. No significant differences were observed between alcohol-free and corresponding full-strength beers, whereas wheat beers showed vitamin B6 contents significantly lower than those of lager beers. Bock beer exhibited the highest concentrations. This study provides a comprehensive analytical basis for future investigations of vitamin B6 during brewing.

The objective of this study was to (1) investigate the impact of commonly used heat treatment methods - water bath cooking (WBC), convection oven roasting (OCR), grilling (G), and pan frying (PF) - on the concentrations and retention of various forms of selected B vitamins (B1, B2, B3, B5, B6, and B12) in goose breast muscle, and (2) assess the extent to which a 100 g portion of goose meat, both with and without skin, contributes to meeting the Nutrient Reference Values-Requirements (NRV-R) for these vitamins in the adults. The material used in the study comprised 36 breast muscles of 17-week-old White Koluda® geese. The contents of B vitamins were determined using liquid chromatography. Significantly lower thermal losses were found in skinless meat (P ≤ 0.05). This meat contained significantly (P ≤ 0.05) more niacin, nicotinamide, and vitamin B6. Meat with skin contained more thiamine monophosphate, nicotinic acid, pyridoxal, pyridoxine, and vitamin B12 (P ≤ 0.05). Heat treatment techniques significantly affected the total content of thiamine, riboflavin, nicotinic acid, vitamin B6, pyridoxal, pyridoxamine, and vitamin B12. Significant differences in retention were observed only in niacin, nicotinamide, vitamin B6, and pyridoxine. A portion of 100 g of goose breast meat covers the largest extent NRV-R of an adult for niacin (average 31.7 %) and the smallest for thiamin (0.66 %), regardless of the presence of skin or type of heat treatment. The findings described can be helpful to consumers in making informed dietary choices and in developing nutrient composition tables and computer programs for nutritionists, food labeling, evaluation, and diet planning. However, it is not possible to identify a single heat treatment at which individual B vitamins would achieve the greatest retention.

Gyrate atrophy is a rare autosomal recessive chorioretinal dystrophy caused by ornithine aminotransferase deficiency, resulting in toxic accumulation of plasma ornithine and progressive retinal degeneration. We describe a 20-year-old male, born to consanguineous parents, who presented with progressive diminution of vision, nyctalopia, and peripheral visual field loss. Fundus examination revealed sharply demarcated, scalloped areas of midperipheral chorioretinal atrophy with relative macular sparing. Optical coherence tomography demonstrated cystoid macular edema, whereas plasma ornithine levels were markedly elevated. The patient was treated with dietary protein restriction and pyridoxine supplementation, with biochemical improvement and stabilization of visual function. Early recognition, metabolic monitoring, and evaluation of pyridoxine responsiveness may delay visual deterioration and improve visual prognosis in gyrate atrophy. Publisher: RésuméL’atrophie gyrée est une dystrophie choriorétinienne autosomique récessive rare causée par un déficit en ornithine aminotransférase, entraînant une accumulation toxique d’ornithine plasmatique et une dégénérescence rétinienne progressive. Nous rapportons le cas d’un homme de 20 ans, issu d’un mariage consanguin, présentant une baisse progressive de la vision, une nyctalopie et une constriction du champ visuel périphérique. L’examen du fond d’œil a montré des zones d’atrophie choriorétinienne médio-périphérique nettement délimitées et festonnées avec respect relatif de la macula. La tomographie par cohérence optique a révélé un œdème maculaire cystoïde, tandis que les taux plasmatiques d’ornithine étaient fortement élevés. Le patient a été traité par restriction protéique alimentaire et supplémentation en pyridoxine, avec amélioration biologique et stabilisation de la fonction visuelle. Une reconnaissance précoce, une surveillance métabolique et l’évaluation de la réponse à la pyridoxine peuvent retarder la détérioration visuelle et améliorer le pronostic visuel.

BACKGROUND: Several lines of evidence suggest that vitamin B6 has potential as an antidepressant. It plays a crucial coenzyme role in the synthesis of the neurotransmitters serotonin, gamma-aminobutyric acid (GABA) and dopamine, which are central to mood regulation, and it has been shown that increasing availably of vitamin B6 above normal levels increases concentrations of serotonin and GABA. Furthermore, epidemiological evidence points to vitamin B6 deficiency as a risk factor for depression, and to high vitamin B6 levels as protective. Therefore, we asked whether taking 100 mg vitamin B6 as pyridoxine daily for 1 month would reduce depression symptoms, measured with the Depression, Anxiety and Stress Scales (DASS) questionnaire, which also assesses anxiety and stress. METHODS: We recruited 267 participants from the general population (215 female) and double blind randomised them to receive either placebo, vitamin B6 or vitamin B12 (1000 µg). Using baseline DASS scores, we divided participants into a group classified as having mild or more severe depression symptoms at baseline (N = 58) and a larger group classified as non-depressed. RESULTS: Only within the former group, vitamin B6 produced a selective reduction in depression symptoms compared to placebo or vitamin B12 with a very large effect size (partial η 2 = 0.20). We also found evidence that participants whose DASS depression scores narrowly failed to meet criterion for moderate depression (N = 52) experienced a slightly smaller but still statistically substantial reduction in symptoms (partial η 2 = 0.17). We repeated the analysis procedure for anxiety and stress scores but found no significant effects. CONCLUSIONS: We have shown that high-dose vitamin B6 has therapeutic potential for depression, and large-scale clinical trials with patients should now be conducted to determine whether these findings from our mostly female sample generalise to males, to quantify the dose-response relationship, and to evaluate its potential as an adjunct to existing treatments versus monotherapy, and to elucidate which factors, for example, presence of inflammation, predict responsiveness to the intervention.

BACKGROUND & AIMS: Increased intestinal permeability and proinflammatory status have been linked with increased risk of autoimmune diseases such as type 1 diabetes. The contribution of dietary composition to gut maturation in infants consuming complementary foods remains unclear. The aim was to assess whether intake of different nutrients is associated with the level of intestinal permeability and gut inflammation markers of infants aged 6-12 months. METHODS: This was a secondary analysis using existing cohort data from a randomized controlled trial, the Early Dietary Intervention and Later Signs of Beta-Cell Autoimmunity (EDIA) Study (N = 73). Weighed 3-day food records were collected at 6, 9, and 12 months of age. At the same age points, lactulose/mannitol tests (N = 72) were performed for assessment of intestinal permeability, and stool samples (N = 72) collected for analysis of gut inflammation markers calprotectin and human β-defensin-2 (HBD-2). Generalized estimation equations (GEE) were used to assess associations between repeated measures of energy-adjusted nutrient intakes with intestinal permeability, calprotectin, and HBD-2. RESULTS: Higher intake of saturated fat was associated with higher intestinal permeability, calprotectin, and HBD-2, while higher intake of dietary fibre, pyridoxine (vitamin B6), iron, magnesium, and potassium were associated with lower permeability, calprotectin, and HBD-2. The nutrients with inverse associations were intercorrelated with each other. Additionally, the intercorrelated nutrients correlated negatively with the proportion of total energy intake from breast milk, which was associated with higher permeability and inflammation markers. Adjusting models for the proportion of energy from breast milk attenuated many of the associations of nutrients, especially with permeability, but the intake of dietary fibre remained associated with lower calprotectin and HBD-2, and intake of potassium with lower calprotectin and permeability. CONCLUSION: While breastfeeding remains a major determinant of gut maturation, consumption of complementary foods higher in intercorrelated nutrients including dietary fibre and potassium is assoc

BACKGROUND: Peripheral neuropathy associated with vitamin B6 (pyridoxine) is dose and duration dependent. High-dose vitamin B6 products associated with adverse neurological effects are available in Australia, prompting recent regulatory action to reschedule products containing ≥50 mg pyridoxine to schedule 3 (pharmacist only). AIMS: This study examined real-world consumer purchasing behaviours of vitamin B6 products in Australian pharmacies to identify high-risk purchasing patterns (e.g. large doses, multiple products, stockpiling behaviours). METHODS: Sales data from the IQVIA Consumer Health Basket Database (1 August 2022-31 July 2025), representing ~75% of national pharmacy-based complementary medicines sales were analysed. Listed medicines on the Australian Register of Therapeutic Goods providing a daily dose of ≥5 mg total equivalent pyridoxine were included (n = 792). Analysis included unit sales, combined total maximum daily dosage per transaction and duplicate purchases as a proxy for ongoing use. RESULTS: A total of 20.32 million products (≥5 mg) were sold across 15.8 million transactions. Products containing 10-49 mg dominated sales with 11.0 million (54.20%) unit sales, and ≥50 mg doses accounted for 3.40 million (16.75%) units and 3.4 million (21.63%) of all transactions. Multiple products or duplicate purchases occurred in 1.2 million (7.73%) and 1.58 million (9.17%) transactions respectively. Sales were otherwise stable, except for the 2023 withdrawal of >100 mg products. CONCLUSION: Large volumes of vitamin B6 products containing doses above the recommended intake continue to be purchased in Australia, including through combinations of lower-dose products that will not be affected by proposed rescheduling. The implementation period for scheduling extends the potential for stockpiling, meaning that high-risk exposure will persist without strengthened risk communication. © 2026 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

Podophyllotoxin (PPT), a natural lignan with well-established antitumor efficacy and well-documented ovarian toxicity, was first investigated for its potential testicular toxicity in male Sprague-Dawley rats, following the guidance of the Toxicological Evidence Chain (TEC) framework. Through an integrated approach combining physiological and pathological phenotyping, targeted metabolomics of intestinal contents, serum, and testicular tissues, testicular transcriptomics, and 16S rDNA sequencing of gut microbiota, we systematically delineated the injury evidence chain induced by PPT. Oral administration of PPT (20 mg/kg/day for 4 days) elicited marked systemic toxicity, including reduced body weight and food intake, alongside clinical signs such as nasal hemorrhage and diarrhea. Testicular toxicity was evident from decreased testicular weight and organ index, histopathological impairments-including seminiferous tubule distortion, fibrosis, and germ cell apoptosis-and compromised sperm quality. Serum levels of testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were significantly suppressed. Concurrently, colonic injury was observed alongside gut dysbiosis, characterized by a reduction in Lactobacillus and enrichment of Proteus and Escherichia-Shigella. Multi-tissue metabolomics consistently identified disruption of vitamin B6 metabolism, with downregulation of pyridoxine, pyridoxamine, and 4-pyridoxic acid, while transcriptomic analysis revealed suppression of steroidogenic genes (Star, Cyp11a1, Cyp17a1). These findings collectively indicate that PPT induces testicular injury via the microbiota-gut-testis (MGT) axis.

INTRODUCTION: Deficiency of pyridoxal-5'-phosphate, the clinically measured and active form of pyridoxine (vitamin B6), is prevalent among those with alcohol use disorder. However, unlike thiamine, pyridoxal-5'-phosphate is not routinely repleted. Evidence is presented that its repletion would improve outcomes of alcohol withdrawal syndrome and promote long-term abstinence. PYRIDOXAL-5′-PHOSPHATE DEFICIENCY CAN CAUSE A CLINICALLY CONSEQUENTIAL GLUTAMATERGIC/GABAERGIC SIGNALING IMBALANCE: Excessive excitatory glutamatergic signaling and inadequate inhibitory GABAergic signaling are central to the pathophysiology of alcohol withdrawal syndrome. Pyridoxal-5'-phosphate is an essential cofactor for the rate-limiting enzyme in the conversion of glutamate to GABA, glutamic acid decarboxylase. Therefore, pyridoxal-5'-phosphate deficiency would be expected to exacerbate the signaling imbalance that underlies alcohol withdrawal syndrome, worsening symptoms and treatment response. This is supported by the finding that pyridoxal-5'-phosphate deficiency-whether in animal models or other clinical conditions, including nutritional pyridoxine insufficiency, isoniazid toxicity, and certain inborn errors of metabolism-can create a glutamatergic/GABAergic imbalance severe enough to cause anticonvulsant-refractory status epilepticus. MECHANISMS OF PYRIDOXAL-5′-PHOSPHATE DEFICIENCY IN ALCOHOL USE DISORDER: Pyridoxal-5'-phosphate deficiency in alcohol use disorder occurs in part because alcohol is oxidized by alcohol dehydrogenase to acetaldehyde, which displaces pyridoxal-5'-phosphate from binding proteins, exposing it to hydrolysis by phosphatases. Hepatic disease promotes deficiency through increased phosphatase activity. Other mechanisms, including poor nutritional intake, likely contribute. PYRIDOXAL-5′-PHOSPHATE DEFICIENCY MAY SURREPTITIOUSLY PRECIPITATE OR EXACERBATE CLINICAL MANIFESTATIONS OF ALCOHOL WITHDRAWAL: In a small study of individuals with alcohol use disorder, pyridoxine deficiency was more prevalent in those who had an alcohol withdrawal seizure than in those who had not. More notably, among patients treated for alcohol withdrawal with the phenothiazine promazine-a

Erythropoietin-stimulating agent-resistant anemia (ESA-RA) is observed in a significant number of hemodialysis (HD) patients. However, the underlying mechanisms remain unclear. We report two HD patients in whom vitamin B6 (VB6) deficiency was thought to be the cause of ESA-RA, and oral administration of pyridoxal phosphate hydrate led to prompt elevation of hemoglobin levels. VB6 is crucial for heme biosynthesis. HD removes VB6 from the serum. Therefore, patients undergoing HD are theoretically prone to VB6 deficiency anemia. However, reports of VB6 deficiency anemia in HD patients are scarce, and we speculate that this is an under-recognized cause of ESA-RA.

Yarrowia lipolytica is a food-compatible yeast with strong potential for sustainable B-vitamin enrichment of functional food ingredients. This study evaluated the effects of glucose, xylose, mixed, and lignocellulosic sugars, as well as diverse nitrogen sources, on yeast growth and B-vitamin yields in controlled fermentations. Glucose with yeast extract led to the highest biomass and intracellular accumulation of thiamine (B1), niacin (B3), and pyridoxine (B6), while mixed sugars supported maximal intracellular folate (B9) content. Intracellular B-vitamin levels were consistently higher with yeast extract than with defined nitrogen sources. Cobalamin (B12) was detected in biomass under all substrate and nitrogen conditions; based on current knowledge of Y. lipolytica metabolism and the presence of trace B12 in yeast extract, these observations are consistent with uptake and retention from the medium rather than de novo biosynthesis. Results indicate that nutrient formulation, particularly the use of renewable sugars and organic nitrogen, can be strategically tuned to generate Y. lipolytica biomass with distinct B-vitamin profiles suited to different food fortification scenarios. The demonstrated use of commercial lignocellulosic sugar streams underscores the compatibility of this process with food-grade industrial substrates and circular-economy concepts, providing a practical basis for deploying B-vitamin-enriched yeast as a functional ingredient in plant-based beverages, cereal products and other fortified foods. © 2026 The Authors.

BACKGROUND: B vitamins play key roles in one-carbon metabolism, DNA synthesis and methylation, and redox regulation. Their potential association with cancer risk remains debated due to heterogeneous findings and methodological limitations across studies. OBJECTIVE: This structured narrative review aimed to summarize and clinically contextualize the available evidence on the relationship between the intake of vitamins B2 (riboflavin), B6 (pyridoxine), B12 (cobalamin) and folate (vitamin B9) and the risk of selected cancers. METHODS: A structured literature search was performed in PubMed up to 2 September 2025. Evidence was synthesized narratively, prioritizing meta-analyses (including dose-response meta-analyses) of observational studies, and including randomized controlled trials on B-vitamin supplementation when clinically relevant. Methodological quality and risk of bias were appraised narratively focusing on key domains such as exposure assessment, confounding, selection bias, and outcome assessment. RESULTS: Most evidence derives from observational studies assessing dietary intake and circulating biomarkers. Riboflavin and vitamin B6 intake were generally associated with a reduced risk of colorectal cancer in several meta-analyses, including dose-response analyses. Vitamin B12 showed inconsistent associations across cancer sites, with concerns regarding confounding by diet and baseline nutritional status. Folate intake and folic acid supplementation showed mixed findings, with some evidence suggesting protective effects in specific populations, while randomized trials raised concerns about potential adverse effects in selected contexts and dosages. Overall, heterogeneity across studies was substantial, partly explained by differences in exposure definitions, baseline folate fortification policies, and co-interventions. CONCLUSION: Available evidence suggests potentially protective associations for riboflavin and vitamin B6-particularly for colorectal cancer-whereas findings for vitamin B12 and folate remain inconsistent and context-dependent. Given relevant methodological limitations and potential biases, further well-designed prospective studies and targete

This study evaluated the effects of supplementation levels of a blend of vitamin B complex offered to weaned beef calves in a 42-day preconditioning program. Sixty-three Angus × Hereford calves were stratified by body weight (BW; 252 ± 3.7 kg) after weaning (d0) and allocated into 21 pens (3 calves/pen). Pens were randomly assigned to one of three treatments: (1) Control, (2) VitB1g, or (3) VitB2g. Calves assigned to vitamin B supplementation received vitamin B complex (1 vs. 2 g/calf daily; Vivalto, Selko USA; containing pantothenic acid [B5], pyridoxine [B6], folic acid [B9], biotin [B7], cyanocobalamin [B12]) mixed with 1.3 kg of dried distillers' grains (DDG), while calves in the Control group received only DDG. All calves had free-choice access to chopped alfalfa-grass hay and limited whole corn. Body weights and blood samples were collected from all calves on days 0, 1, 3, 7, 14, 21, and 42 relative to weaning to evaluate plasma cortisol and acute-phase proteins. Vitamin B7 concentration was measured on days 0, 14 and 42. Pen was the experimental unit, and data were analyzed as repeated measures using the MIXED procedure in SAS. No effects of treatment, day, and the interaction (P ≥ 0.23) were observed for any of the growth performance variables analyzed. At weaning, all calves had similar (P ≥ 0.91) plasma vitamin B7 concentrations, and with two weeks of supplementation, on d14, calves assigned to VitB2g treatment had greater (P ≤ 0.005) vitamin B7 concentration than calves assigned to VitB1g and Control treatments, which had similar vitamin B7 concentrations (P = 0.79). At the end of the preconditioning phase, on d42, calves assigned to VitB2g had greater (P ≤ 0.02) vitamin B7 concentrations than calves assigned to VitB1g and Control treatments, which continued to remain similar (P = 0.17). A tendency for a treatment × day (P = 0.08) for cortisol concentration was observed. Cortisol concentrations were similar at weaning (P ≥ 0.89). Interestingly, at the end of the supplementation, calves supplemented with vitamin B complex, regardless of vitamin level supplementation, had lower cortisol concentration (P ≤ 0.05) than calves assigned to the Control treatm

This study aimed to investigate the associations between dietary intake of vitamins and the DMFT index (Decayed, Missing, and Filled Teeth). This cross-sectional study utilized baseline data collected from the Oral Health Branch of the Rafsanjan Cohort Study (OHBRCS). OHBRCS is a part of Rafsanjan Cohort Study (RCS) that begun from 2015 in Rafsanjan in the southeast of Iran. The baseline phase of RCS ended in 2017. The RCS enrolled 9,991 individuals aged 35-70 years from both genders. A comprehensive full-mouth examination was performed to determine the DMFT index. Dietary intakes of vitamins A, E, K, D, C, and B-complex (thiamin, riboflavin, niacin, pyridoxine [B6], folate, cobalamin [B12], pantothenic acid, and choline) were assessed using a validated food frequency questionnaire. Univariable and multivariable linear regression analyses were employed to evaluate the association between vitamin intake and the DMFT index, adjusting for potential confounders. Among 3040 included individuals, the adjusted model showed that the dietary intake > median of Vitamin A (Unstd. B = -0.65 (-1.26, -0.03), p = 0.04), β_carotene (Unstd. B = -0.82 (-1.44, -0.20), p = 0.009), Vitamin K (Unstd. B = -0.72 (-1.33, -0.11), p = 0.02), and thiamin (Unstd. B = -0.84 (-1.47, -0.22), p = 0.008) compared with dietary intake ≤ median, were inversely associated with the DMFT index among males (p < 0.05). Furthermore, the dietary intake > median of lutein_zeaxanthin was inversely associated with the DMFT index, among females (Unstd. B = -0.92 (-1.71, -0.14), p = 0.021). Higher dietary intake of Vitamin A, β_carotene, Vitamin K and thiamin among males and lutein_zeaxanthin among females was associated with lower DMFT scores. However, due to the cross-sectional design, causality cannot be inferred, highlighting the need for future longitudinal studies. © 2026. The Author(s).

Vitamin B6 (pyridoxine) is an essential water-soluble vitamin that functions as a precursor to pyridoxal 5′-phosphate, a coenzyme involved in more than 100 enzymatic reactions related to amino acid, carbohydrate, and lipid metabolism, neurotransmitter synthesis, and numerous physiologic processes. Although vitamin B6 deficiency is uncommon, it may occur in association with certain medical conditions, medications, nutritional inadequacy, and inherited metabolic disorders. Pyridoxine also has important therapeutic applications in the management of vitamin B6–dependent syndromes, selected toxicologic emergencies, and pregnancy-associated nausea and vomiting. This activity reviews the pharmacology, clinical indications, dosing, administration, adverse effects, toxicity, monitoring, and drug interactions associated with vitamin B6. Participants will gain knowledge to identify deficiency and toxicity states, evaluate appropriate therapeutic uses, apply evidence-based monitoring and safety considerations, and collaborate effectively within the interprofessional healthcare team to optimize patient outcomes.

Pyridoxal 5'-phosphate (PLP) is a nutrient required by all life. As an essential cofactor, PLP powers enzymatic reactions in primary and secondary metabolism. Microbes can obtain PLP through either de novo PLP biosynthesis or the salvage of exogenous vitamin B6. Vitamin B6 exists in multiple forms (vitamers) in the natural environment, but the effect of mixed B6 vitamer supplementation on microbial physiology has not been explored. In this study, the ability of Salmonella enterica to obtain PLP during growth in media containing various ratios of B6 vitamers is examined. The data show that the B6 vitamer, pyridoxine (PN), can inhibit the salvage of B6 vitamers, pyridoxamine and pyridoxal, by S. enterica pdxH mutants. Genetic analyses were performed to determine the mechanism by which PN disrupts pyridoxamine and pyridoxal salvage. Mutants resistant to PN inhibition during the salvage of pyridoxamine were isolated and found to encode variants of B6 kinase (PdxK) with altered activity toward the B6 vitamer substrates. Suppressor analysis suggests that PN inhibition is, at least, partially due to competitive inhibition of the pyridoxamine kinase activity of PdxK by PN. Additionally, the data indicate that pyridoxine 5'-phosphate (PNP)-mediated toxicity also contributes to growth inhibition by PN. IMPORTANCE: Without successful acquisition and utilization of vitamin B6, microbes cannot survive or perform their essential roles in human health and the natural environment. Vitamin B6 exists in multiple forms (vitamers) in the natural world, but the effect of B6 vitamer mixtures on microbial growth has not been analyzed. This work shows that the B6 vitamers are not necessarily interchangeable sources of PLP, and they may have distinct effects on microbial physiology.

BACKGROUND: Pediatric postinfectious bronchiolitis obliterans (PIBO) is a long-term sequela of severe lower respiratory tract infection. However, the underlying pathogenic mechanisms within the airways remain poorly understood. METHODS: Bronchoalveolar lavage fluid (BALF) from six children with PIBO and three control children was subjected to transcriptomic, proteomics and untargeted metabolomics analyses. Integrated analysis identified key differentially expressed candidates, among which protein candidates were subsequently validated by ELISAs. RESULTS: Transcriptomic analysis revealed altered pathways in the BALF of children with PIBO, including pathways related to epithelial differentiation, inflammatory responses, and metabolic processes involving amino acids, purines, lipids, and vitamins. Proteomic analysis further revealed epithelial injury, inflammatory activation, tissue remodeling, and metabolic dysregulation in PIBO patients. Protein-protein interaction (PPI) network analysis identified CXCL8 (interleukin-8, IL-8) as the central hub. Integrative transcriptomic-proteomic correlation analysis further revealed that CXCL8 transcript levels were correlated with the greatest number of differentially expressed proteins (DEPs). Subsequent ELISA validation confirmed elevated CXCL8 protein levels in children with PIBO, which were positively correlated with the predicted FEV1%. Furthermore, 54 proteins, including KRT19, OSM, ADAM8, and PADI2, were significantly correlated with CXCL8 expression. These proteins spanned epithelial, inflammatory, remodeling, and metabolic processes, indicating a clinically relevant network. Untargeted metabolomics analysis revealed alterations in purine, cofactors, and amino acid metabolism, with pyridoxine (vitamin B6) as the most significantly altered metabolite. Integrated multiomic analysis revealed widespread correlations between differentially expressed metabolites and proteins. Notably, putative pyridoxine expression was negatively correlated with the expression of CXCL8 and other key inflammatory proteins, which is consistent with the evidence of disrupted vitamin metabolism observed by transcriptomics. In vitro experiments

INTRODUCTION: Primary Hyperoxaluria type 1 (PH1) is a rare and severe autosomal recessive disorder with genotype/phenotype correlation. The RNA interfering therapy lumasiran has revolutionized its prognosis but with heterogeneous response amongst patients. Here, we assessed a possible association between genotype and lumasiran response. METHODS: In the ongoing French DAILY-LUMA cohort evaluating real-life efficacy and safety of lumasiran, we collected data at treatment initiation and at months three, six and 12 of treatment. The main outcomes were composite criteria, namely normalization and/or reduction over 30% from baseline in the urinary ratio of oxalate and creatinine (UOx/Creat) or in blood oxalate levels (POx) in patients with estimated glomerular filtration rate (eGFR) over or under 30 mL/min/1.73 m2, respectively. The primary endpoint was the proportion of patients reaching this criterion at three months, and secondary endpoints were the same analysis at six and 12 months. Genotype was classified into three groups depending on the vitamin B6 response: resistance, sensitivity, uncertain response (Ile244Thr variant of alanine-glyoxylate aminotransferase). RESULTS: In total, 76 patients (54 children) were included, at a median (inter quartile range) age at lumasiran initiation of 13 (4-33) years with 24 patients on dialysis. After three months of treatment, 73% of patients met the primary endpoint (% calculated on available data). There was no significant association between the underlying genotype and lumasiran response, albeit with a trend towards a lesser response in vitamin B6- sensitive forms. The only significant determinants found to be associated with the primary outcome were age at diagnosis and age at lumasiran initiation, the best response being observed in pediatric patients. CONCLUSIONS: Our study suggests a better response to lumasiran in children independent of the underlying genotype. In patients with pyridoxine sensitivity, we suggest continuing or initiating pyridoxine even after lumasiran initiation. After lumasiran initiation, a close follow-up and re-evaluation should be systematically performed.

Purpose To quantify seven dietary vitamins and estimate their mean daily intakes and major food sources among Cuban adults through the country's first Total Diet Study.Methods Standardized 24-hour dietary recalls were collected from 450 adults across Western, Central, and Eastern Cuba between October 2020 and March 2021. Foods were classified into 16 groups, prepared as consumed, homogenized, and analyzed using validated high-performance liquid chromatography with ultraviolet and fluorescence detection. Vitamin concentrations were combined with mean food consumption to estimate daily intakes, which were compared with nutritional reference values.Results Estimated mean daily intakes were 831 µg retinol equivalents for vitamin A, 6.8 mg α-tocopherol equivalents for vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 32 mg niacin equivalents, 2.7 mg pyridoxine, and 220 µg dietary folate equivalents. Mean intakes of thiamine, riboflavin, niacin, and pyridoxine exceeded the adult reference values used in the study, whereas vitamin E and folate reached 68% and 55% of their respective benchmarks. Dairy products, vegetables, fruits, and fish were major vitamin A sources; meats and legumes contributed substantially to thiamine intake, and vegetables and legumes were the leading folate sources.Conclusion The reported mean intake estimates identify vitamin E and folate as priorities for dietary improvement in Cuba. Promoting nutrient-rich foods and evaluating selective fortification could help address these gaps. These population mean estimates do not establish individual nutritional adequacy or deficiency prevalence; further assessment of usual intake distributions and nutritional biomarkers is warranted. © 2026. Springer-Verlag GmbH Germany, part of Springer Nature.

Isoniazid (INH) is a potent bactericidal antibiotic used to treat tuberculosis (TB). INH therapy carries a risk of acute or chronic toxicity. Acute toxicity manifests as neurological symptoms, specifically seizures. Consumption of as little as 2 g of INH can predispose a patient to acute toxicity. Patients with certain risk factors or prolonged INH use can develop chronic toxicity, which can manifest as hepatotoxicity and peripheral neuropathy. Two recognized syndromes of hepatotoxicity include: Mild hepatotoxicity, manifesting as transient, asymptomatic elevations in serum aminotransferase levels. Severe acute hepatitis, which can be fatal. Peripheral neuropathy is secondary to vitamin B6 (pyridoxine) deficiency, although its prevalence is relatively low.

A young adult female presented with recurrent sputum smear-positive pulmonary tuberculosis (TB) despite completing four prior courses of standard first-line anti-tubercular therapy. She presented with progressive breathlessness, productive cough and intermittent fever. Imaging revealed bilateral upper lobe fibrocavitary disease with cystic bronchiectasis. Repeated molecular testing confirmed Mycobacterium tuberculosis without rifampicin or isoniazid resistance. Therapeutic drug monitoring (TDM), though not routinely recommended in TB management, was undertaken in view of recurrent disease and showed undetectable rifampicin and subtherapeutic isoniazid concentrations, pointing towards impaired absorption or altered pharmacokinetics as the likely cause of recurrence. The patient was treated with a higher-dose fixed-dose combination regimen supplemented with pyridoxine, probiotics, vitamin D and nutritional support. After 6 months, she showed symptomatic improvement, weight gain, sputum conversion and reduced respiratory symptoms. This case emphasises the importance of identifying alternative causes of recurrence and supports the role of TDM in patients with recurrent drug-sensitive TB. © BMJ Publishing Group Limited 2026. No commercial re-use. See rights and permissions. Published by BMJ Group.

Toxoplasma gondii infection remodels the gut microbiome, yet its impact on microbial vitamin biosynthetic potential and host redox metabolism remains unclear. Here, we integrated mouse gut metagenomes with publicly available metagenome-assembled genomes (MAGs) to construct a genome-resolved atlas of B-vitamin and vitamin K2 biosynthesis. From 45,697 MAGs, we curated 4,771 representative genomes, of which 2,682 met high-quality criteria (completeness ≥90%, contamination <5%). Functional annotation identified 229,717 vitamin-related genes corresponding to 177 Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologs across de novo pathways for eight B vitamins, thiamine (B1), riboflavin (B2), niacin (B3), pantothenate (B5), pyridoxine (B6), biotin (B7), folate (B9), cobalamin (B12), and vitamin K2. Among the high-quality genomes, 1,665 encoded complete de novo pathways for at least one vitamin, highlighting functional specialization and community-level complementarity. Transcripts per million-normalized metagenomic read counts revealed significant differences in KEGG ortholog abundances across six of the nine vitamin pathways. Reanalysis of metagenomic data from infected mice (acute, chronic, and control; n = 10 per group) revealed a stage-dependent reduction in α-diversity of vitamin biosynthesis pathways during acute infection, and a clear β-diversity separation from chronic and control groups. Core niacin biosynthesis genes (nadB, nadA, nadC) displayed phylum-specific redistribution, indicating selective remodeling of microbial NAD+ precursor production under infection-induced metabolic stress. These results suggest that T. gondii infection disrupts cooperative vitamin biosynthetic networks while specifically modulating niacin pathways linked to host NAD+ metabolism. IMPORTANCE: Gut microbes can synthesize essential vitamins, but how infection alters this function is poorly understood. By integrating mouse gut metagenomes with genome-resolved microbial data, we show that Toxoplasma gondii infection reshapes the vitamin biosynthetic potential of the gut microbiome in a stage-dependent manner. Acute infection reduces the diversity of vitamin biosynthesis pathways

Background/Objectives: Micronutrient deficiencies are common in inflammatory bowel disease (IBD) and contribute to anemia, impaired wound healing, neurologic injury, and adverse disease outcomes. Major societies, including ESPEN, ACG, and ECCO, recommend nutritional and micronutrient assessment in patients with IBD, yet few studies describe how comprehensively these recommendations are applied during hospitalization. This study aimed to characterize inpatient testing practices for vitamins B1, B6, B12, and zinc in hospitalized IBD patients, quantify deficiency frequency among those tested, and identify gaps between guideline-recommended and actual micronutrient assessment. Methods: A retrospective chart review was performed on adults with Crohn's disease (CD) or ulcerative colitis (UC) hospitalized for an IBD flare at a tertiary care center. Demographics, comorbidities, and deficiency-associated clinical features were recorded. Yield was defined as the proportion of tested patients meeting institutional deficiency thresholds. Yield for each non-B12 micronutrient was compared with B12 as an internal benchmark. Results: Among 356 patients (285 CD, 71 UC), inpatient micronutrient testing was markedly imbalanced: B12 was tested in 97.2%, whereas B6, B1, and zinc were tested in only 34.8%, 30.6%, and 18.8%, respectively. Among those tested, deficiencies were common: B6 40.3%, zinc 32.8%, B1 22.9%, and B12 9.0%. Each non-B12 micronutrient yielded deficiency significantly more often per test than B12 (all p < 0.001), a testing-yield mismatch interpreted cautiously given selective testing of non-B12 nutrients. Deficiency frequencies did not differ significantly between CD and UC. Clinical contexts included tachycardia and edema (B1); elevated inflammatory markers and thromboembolism history (B6); anemia and neuropathy (B12); and diarrhea and hypoalbuminemia (zinc). Conclusions: Inpatient micronutrient assessment in IBD is heavily skewed toward B12, with B1, B6, and zinc under-tested despite a substantially higher yield of identified deficiency per test. This testing-yield mismatch represents a measurable implementation gap between guideline-recommended comprehensive ass

Vitamin supplements are frequently utilized as adjunctive therapies in epilepsy care, yet the potential for toxic drug-nutrient interactions remains poorly defined. Using a pentylenetetrazol (PTZ) zebrafish seizure model, we conducted an exploratory screening of a multivitamin formulation containing vitamins B6, B9, D3, and E, together with CoQ10, in combination with common antiseizure medications (ASMs). This screening identified a severe, unexpected lethal interaction between pyridoxine (PN) and valproic acid (VPA). Co-exposure resulted in rapid, dose- and time-dependent mortality in both larval and adult zebrafish. Mechanistic investigations indicated that the calcium-dependent apoptosis, rather than necroptosis, contributes substantially to this toxicity. In vivo calcium imaging revealed marked cytosolic Ca2+ accumulation, which was alleviated by calcium chelation and by pharmacological inhibition of endoplasmic reticulum Ca2+ release through inositol 1,4,5-trisphosphate receptors and ryanodine receptors. PN/VPA co-exposure also caused pronounced cardiac dysfunction, characterized by reduced heart rate, ejection fraction, and cardiac output, together with apoptotic signals in cardiac tissue. Notably, no comparable cytotoxicity was observed in cultured zebrafish cardiomyocytes or mammalian cell lines, suggesting that organism-level or tissue-integrated factors may contribute to the observed toxicity. Supplemental pyridoxal 5'-phosphate (PLP) effectively rescued PN/VPA-induced mortality, supporting the possible involvement of altered vitamin B6/PLP-related cellular processes. Together, these results identify a previously unrecognized PN/VPA hazard and highlight the zebrafish as a sensitive in vivo platform for detecting complex drug-nutrient toxicities.

BACKGROUND: Acute alcohol intoxication (AAI) is a common emergency with no specific antidote. Metadoxine has shown potential but lacks sufficient real-world evidence, particularly in Chinese populations. OBJECTIVES: To evaluate the clinical efficacy and safety of metadoxine in patients with acute alcohol intoxication. METHODS: This single-center retrospective cohort study included 124 patients with AAI admitted to an emergency department between January and December 2024. Patients were divided into metadoxine plus conventional treatment (n=62) or conventional treatment alone (n=62) after propensity score matching. Primary outcomes were time to consciousness recovery (Glasgow Coma Scale ≥14) and treatment effectiveness rate (symptom improvement within 6 hours without treatment escalation). Secondary outcomes included time to symptom relief, emergency stay, time to vital sign stabilization, blood ethanol decline rate, adverse reactions, and liver function changes. RESULTS: Metadoxine significantly shortened consciousness recovery time (3.05±1.45 vs. 5.65±1.58 hours, mean difference -2.60 hours, 95% CI: -3.14 to -2.06, p < 0.001) and improved treatment effectiveness rate (93.5% vs. 77.4%, OR=4.04, 95% CI: 1.30-12.56, p = 0.011). All secondary outcomes were significantly better in the metadoxine group (p < 0.001 for time-related outcomes and blood ethanol decline). No significant differences were observed in adverse reactions (9.68% vs. 6.45%, p = 0.510) or post-treatment liver enzyme abnormalities (12.90% vs. 16.13%, p = 0.610). Subgroup analysis showed a significant interaction by initial Glasgow Coma Scale (p = 0.037), indicating greater efficacy in patients with moderate-to-severe impairment. CONCLUSION: Metadoxine, when added to conventional supportive therapy, significantly accelerates consciousness recovery and improves clinical outcomes in acute alcohol intoxication without increasing short-term adverse events. The benefit appears more pronounced in patients with lower Glasgow Coma Scale scores.