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Determining the overall success of a vitamin B6 supplementation program
Diagnosis and evaluation of hypophosphatasia
Vitamin B6 is a complex of 6 vitamers: pyridoxal, pyridoxol, pyridoxamine, and their 5'-phosphate esters. Due to its role as a cofactor in a number of enzymatic reactions, pyridoxal phosphate (PLP) has been determined to be the biologically active form of vitamin B6.
Vitamin B6 deficiency is a potential cause of burning mouth syndrome and a possible potentiating factor for carpal tunnel and tarsal tunnel syndromes. Persons who present chronic, progressive nerve compression disorders may be deficient in vitamin B6 and should be evaluated. Vitamin B6 deficiency is associated with symptoms of scaling of the skin, severe gingivitis, irritability, weakness, depression, dizziness, peripheral neuropathy, and seizures. In the pediatric population, deficiencies have been characterized by diarrhea, anemia, and seizures.
Markedly elevated PLP in conjunction with low levels of pyridoxic acid (PA) are observed in cases of hypophosphatasia, a disorder characterized by low levels of alkaline phosphatase and a range of skeletal abnormalities.
Levels for fasting individuals falling in the range of 3 to 30 mcg/L for pyridoxic acid (PA) and 5 to 50 mcg/L for pyridoxal 5-phosphate (PLP) are indicative of adequate nutrition.
The following are interpretative guidelines based upon PLP and PA results:
-If PLP is >100 mcg/L and PA is < or =30:
-The increased pyridoxal 5-phosphate is suggestive of hypophosphatasia. Consider analysis of serum alkaline phosphatase isoenzymes (ALKI / Alkaline Phosphatase, Total and Isoenzymes, Serum) and urinary phosphoethanolamine (AAPD / Amino Acids, Quantitative, Random, Urine)
-If PLP is >100 mcg/L and PA is 31 to 100 mcg/L; or PLP is 81 to 100 mcg/L and PA is < or =30 mcg/L:
-The increased pyridoxal 5-phosphate is likely related to dietary supplementation; however a mild expression of hypophosphatasia cannot be excluded. Consider analysis of serum alkaline phosphatase isoenzymes (ALKI / Alkaline Phosphatase, Total and Isoenzymes, Serum) and urinary phosphoethanolamine (AAPD / Amino Acids, Quantitative, Random, Urine).
-If PLP is 51 to 80 mcg/L or PLP is 81 to 100 mcg/L and PA is >30; or PLP is >100 mcg/L and PA is >100 mcg/L:
-The elevated pyridoxal 5-phosphate is likely due to dietary supplementation.
Reference ranges were established using healthy fasting volunteers who abstained from vitamin supplementation for 24 hour prior to draw. Vitamin supplementation and nonfasting may result in elevated plasma vitamin concentrations.
1. Kimura M, Kanehira K, Yokoi K: Highly sensitive and simple liquid chromatographic determination in plasma of B6 vitamins, especially pyridoxal 5'-phosphate. J Chromatogr A 1996;722(1-2):296-301
2. Ball GFM: Vitamins: Their Role in the Human Body. Oxford, UK, Blackwell Publishing, 2004, pp 310-325
3. Mackey AD, Davis SR, Gregory JF III: Vitamin B6. In Modern Nutrition in Health and Disease. 10th edition. Edited by ME Shils, M Shike, AC Ross, et al. Philadelphia, PA, Lippincott Williams and Wilkins, 2006, pp 452-461