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1.
J Ethnopharmacol ; 103(3): 319-26, 2006 Feb 20.
Article in English | MEDLINE | ID: mdl-16198079

ABSTRACT

In traditional medicine in Mali, extracts derived from Mitragyna inermis (Willd.) O. Kuntze (Family: Rubiaceae) are commonly used to treat malaria. The antimalarial activity and the lack of genotoxicity in vitro and in vivo have been demonstrated in previous studies. Acute and chronic evaluation of the toxicity of the hydroethanolic extract of Mitragyna inermis leaves was performed in this study, according to the recommendations (cahier de l'Agence no. 3) of the French Drug Office. Two dosages (300 mg/kg and 3 g/kg) were given in one single administration by gavage to male and female rats. No animal died and no behavioral signs of acute toxicity were observed. Chronic toxicity studies over 28 days showed no changes in body weight and no macroscopic abnormality in the 14 organs examined after the animals were sacrificed. With the 3 g/kg/d drug dosage (100-fold higher than those proposed in man), only slight histological abnormalities were observed. Statistically significant differences, compared to control animals, in the weight of some organs and the values of some haematological or biochemical parameters were observed. However, these values always remained in the range given by the breeder for naive animals of the same strain. These investigations thus seemed to indicate the safety of repeated oral administration (up to 3 g/kg/d) of the hydroethanolic extract of Mitragyna inermis leaves, which can therefore be continuously used with safety by the African population in traditional treatment of malaria.


Subject(s)
Antimalarials/pharmacology , Medicine, African Traditional , Mitragyna , Plant Extracts/pharmacology , Animals , Antimalarials/administration & dosage , Antimalarials/toxicity , Female , Intubation, Gastrointestinal , Male , Mali , Plant Extracts/administration & dosage , Plant Extracts/toxicity , Plant Leaves , Rats , Rats, Wistar
2.
Parasitology ; 129(Pt 5): 525-35, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15552398

ABSTRACT

Malaria is a major health concern particularly in Africa which has about 90% of the worldwide annual clinical cases. The increasing number of drug-resistant Plasmodium falciparum justifies the search for new drugs in this field. Antimalarial activity of 2-substituted 6-nitro- and 6-amino-benzothiazoles and their anthranilic acids has been tested. An in vitro study has been performed on W2 and 3D7 strains of P. falciparum and on clinical isolates from malaria-infected patients. Toxicity has been assessed on THP1 human monocytic cells. For the most active drug candidates, the in vitro study was followed by in vivo assays on P. berghei-infected mice and by in vitro assays in order to determine the stage-dependency and the mechanism of action. Of 39 derivatives tested in vitro, 2 had specific antimalarial properties. Each compound was active on all stages of the parasite, but one was markedly active on mature schizonts, while the other was more active on young schizont forms. Both drugs were also active on mitochondrial membrane potential. In vivo data confirmed efficiency with a sustained decrease of parasitaemia. Products A12 and C7 may be considered as potential antimalarial worthy of further chemical and biological research.


Subject(s)
Antimalarials/pharmacology , Malaria, Falciparum/drug therapy , Plasmodium falciparum/drug effects , Thiazoles/pharmacology , Adolescent , Aged , Animals , Antimalarials/therapeutic use , Antimalarials/toxicity , Benzothiazoles , Cell Line , Dose-Response Relationship, Drug , Drug Resistance , Female , Humans , Life Cycle Stages/drug effects , Malaria/drug therapy , Mice , Mice, Inbred BALB C , Monocytes/drug effects , Parasitic Sensitivity Tests , Plasmodium berghei/drug effects , Thiazoles/therapeutic use , Thiazoles/toxicity
3.
J Ethnopharmacol ; 86(2-3): 143-7, 2003 Jun.
Article in English | MEDLINE | ID: mdl-12738078

ABSTRACT

In Burkina Faso, most people in particular, in rural areas, use traditional medicine and medicinal plants to treat usual diseases. In the course of new antimalarial compounds, an ethnobotanical survey has been conducted in different regions. Seven plants, often cited by traditional practitioners and not chemically investigated, have been selected for an antiplasmodial screening: Pavetta crassipes (K. Schum), Acanthospermum hispidum (DC), Terminalia macroptera (Guill. et Perr), Cassia siamea (Lam), Ficus sycomorus (L), Fadogia agrestis (Schweinf. Ex Hiern) and Crossopteryx febrifuga (AFZ. Ex G. Don) Benth. Basic, chloroform, methanol, water-methanol and aqueous crude extracts have been prepared and tested on Plasmodium falciparum chloroquine-resistant W2 strain. A significant activity has been observed with alkaloid extract of P. crassipes (IC(50)<4 microg/ml), of A. hispidum, C. febrifuga, and F. agrestis (4

Subject(s)
Antimalarials/therapeutic use , Ethnobotany , Malaria, Falciparum/drug therapy , Medicine, Traditional , Phytotherapy , Plants, Medicinal , Plasmodium falciparum/drug effects , Animals , Antimalarials/isolation & purification , Burkina Faso , Female , Humans , Malaria, Falciparum/diagnosis , Male , Middle Aged
4.
Parasitol Res ; 90(4): 314-7, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12684889

ABSTRACT

In the course of the search for new antimalarial compounds, a study of plants traditionally used against malaria in Burkina Faso was made. An ethnobotanical study permitted the identification of plants currently used by the traditional healers and herbalists. Two plants among them were selected for further study: Pavetta crassipes (K. Schum) and Acanthospermum hispidum (DC). Alkaloid extracts of these plants were tested in vitro against two reference clones of Plasmodium falciparum: the W2 chloroquine-resistant and the D6 chloroquine-sensitive strains. Significant inhibitory activity was observed with Pavetta crassipes (IC(50)=1.23 microg/ml) and A. hispidum (IC(50)=5.02 microg/ml). Antiplasmodial activity was also evaluated against six Plasmodium falciparum isolates from children between 4 and 10 years old. The IC(50) values for the alkaloid extracts were in the range 25-670 ng/ml. These results indicated that P. falciparum wild strains were more sensitive to the alkaloid extracts than strains maintained in continuous culture. Moreover, the alkaloid extracts exhibit good in vitro antimalarial activity and weak cytotoxicity against three human cell lines (THP1, normal melanocytes, HTB-66). Isolation and structural determination are now necessary in order to precisely determine the active compounds.


Subject(s)
Alkaloids/pharmacology , Antimalarials/pharmacology , Asteraceae/chemistry , Medicine, African Traditional , Plant Extracts/pharmacology , Plasmodium falciparum/drug effects , Rubiaceae/chemistry , Animals , Burkina Faso , Cell Line , Child , Child, Preschool , Chloroquine/pharmacology , Drug Resistance , Humans , Inhibitory Concentration 50 , Malaria, Falciparum/parasitology , Parasitic Sensitivity Tests , Plant Leaves/chemistry , Plant Stems/chemistry , Plasmodium falciparum/isolation & purification
5.
Parasitol Res ; 88(2): 165-71, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11936507

ABSTRACT

In Mali, where malaria is endemic, plants are extensively used for treating periodic fevers and malaria. According to the advice of traditional medicine, plants are often mixed during the preparation of febrifugal decoctions. In previous studies, we demonstrated the potent in vitro antimalarial activity of extracts isolated from four plants commonly used in traditional remedies: Mitragyna inermis (Willd.) O. Kuntze, Rubiaceae, Nauclea latifolia (Sm.), Rubiaceae, Guiera senegalensis (Gmel.), Combretaceae, and Feretia apodanthera (Del.), Rubiaceae. In the present work, we evaluate the potent in vitro synergistic antimalarial interaction between these extracts, using standard isobologram analysis. Then, we evaluate their cytotoxicity on human monocytes and their mutagenic activity on an in vitro system of two beta-carboline alkaloids isolated from Guiera senegalensis (harman and tetrahydroharman). Three combinations demonstrate a strong, synergistic, inhibitory effect on in vitro plasmodial development and are devoid of cytotoxicity towards human cells. These results justify their use in association in traditional medicine. Moreover, tetrahydroharman, isolated from G. senegalensis, presents interesting antimalarial activity, no cytotoxicity and is not genotoxic in the Salmonella Ames test with and without metabolic activation.


Subject(s)
Antimalarials/toxicity , Harmine/analogs & derivatives , Medicine, African Traditional , Plant Extracts/toxicity , Plasmodium falciparum/drug effects , Animals , Antimalarials/classification , Antimalarials/pharmacology , Cell Culture Techniques , Chloroquine/pharmacology , Cytotoxins/metabolism , Cytotoxins/toxicity , Drug Synergism , Fluorescent Dyes , Harmine/pharmacology , Humans , Life Cycle Stages , Mali , Mutagenesis , Plant Extracts/pharmacology , Plant Extracts/therapeutic use , Plants, Medicinal
6.
Parasite ; 8(4): 335-41, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11802270

ABSTRACT

Amphotericin B is used for the treatment of systemic mycoses and visceral leishmaniasis. The objective of our study was to evaluate the impact of catalase, ascorbic acid and ketoconazole on the amphotericin B toxicity towards Leishmania promastigotes membrane by two flow cytometric tests, the membrane potential assay using a cationic dye, [DiOC5(3)], and the membrane permeability test using propidium iodide. The collapse of membrane potential appeared at amphotericin B concentrations weaker than those assessed by the membrane permeability test. The binding of amphotericin B to membrane sterol was not modified by catalase or ascorbic acid whereas amphotericin B-induced growth inhibition could be modulated by these products. The permeabilizing effect of amphotericin B on parasite membrane was strongly reduced in the presence of ketoconazole. These results confirmed the pore hypothesis of amphotericin B action and suggested that flow cytometric methods constituted a valuable alternative to conventional methods for assessing the effect of drugs on cellular membrane and evaluating parasite susceptibility to polyene antibiotics.


Subject(s)
Amphotericin B/pharmacology , Antiprotozoal Agents/pharmacology , Leishmania infantum/drug effects , Leishmaniasis, Visceral/drug therapy , Mycoses/drug therapy , Amphotericin B/metabolism , Animals , Antifungal Agents/pharmacology , Antioxidants/pharmacology , Antiprotozoal Agents/metabolism , Ascorbic Acid/pharmacology , Catalase/pharmacology , Cell Membrane/drug effects , Cell Membrane/physiology , Cell Membrane Permeability/drug effects , Flow Cytometry , Ketoconazole/pharmacology , Leishmania infantum/growth & development , Leishmania infantum/physiology , Membrane Potentials/drug effects , Parasitic Sensitivity Tests/methods
7.
Phytother Res ; 14(8): 608-11, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11113997

ABSTRACT

The toxicity and the genotoxicity of antimalarial alkaloid rich extracts derived from two plants used in traditional medicine in Mali (Mitragyna inermis (Willd.) O. Kuntze Rubiaceae and Nauclea latifolia (Sm.) Rubiaceae) were evaluated on in vitro and in vivo systems. The results demonstrated that an alkaloid rich extract derived from M. inermis induced a strong inhibition of protein synthesis in mammalian cells but did not exhibit mutagenic or genotoxic activity. An alkaloid rich extract derived from N. latifolia could interact in vitro with DNA of bacteria and mammalian cells, leading to G2-M cell cycle arrest and heritable DNA-damage, as well as inducing in vivo single-strand breaks in liver, kidney and blood cells.


Subject(s)
Alkaloids/toxicity , Antimalarials/toxicity , DNA Damage , Monocytes/drug effects , Plant Extracts/toxicity , Plants, Medicinal/toxicity , Animals , Carbocyanines/chemistry , Comet Assay , Flow Cytometry , Humans , Kidney/chemistry , Kinetics , Liver/chemistry , Lymphocytes/chemistry , Mali , Medicine, African Traditional , Membrane Potentials , Mice , Microscopy, Fluorescence , Monocytes/cytology , Mutagenicity Tests , Salmonella typhimurium/drug effects , Salmonella typhimurium/genetics
8.
Antimicrob Agents Chemother ; 44(11): 3074-8, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11036025

ABSTRACT

A flow cytometric technique was developed for detection of amastigotes of the protozoan Leishmania infantum in human nonadherent monocyte-derived macrophages. The cells were fixed and permeabilized with paraformaldehyde-ethanol, and intracellular amastigotes were labeled with Leishmania lipophosphoglycan-specific monoclonal antibody. Results showed that flow cytometry provided accurate quantification of the infection rates in human macrophages compared to the rates obtained by the conventional microscopic technique, with the advantage that a large number of cells could be analyzed rapidly. The results demonstrated, moreover, that labeling of intracellular amastigotes could reliably be used to evaluate the antileishmanial activities of conventional drugs such as meglumine antimoniate, amphotericin B, pentamidine, and allopurinol. They also established that various Leishmania species (L. mexicana, L. donovani) could be detected by this technique in other host-cell models such as mouse peritoneal macrophages and suggested that the flow cytometric method could be a valid alternative to the conventional method.


Subject(s)
Antiprotozoal Agents/pharmacology , Flow Cytometry/methods , Leishmania infantum/isolation & purification , Macrophages/parasitology , Animals , Humans , Macrophages/drug effects , Monocytes/cytology , Parasitic Sensitivity Tests , Quality Control , Reproducibility of Results
9.
Pharmazie ; 55(8): 572-6, 2000 Aug.
Article in English | MEDLINE | ID: mdl-10989833

ABSTRACT

Some new pyrazolo[3,4-b]pyrazines and related heterocycles were synthesized and evaluated for their antifungal and antiparasitic activities. The key intermediate, 6-amino-3-methyl-1-phenyl-1H-pyrazolo[3,4-b]pyrazine-5-carbonitrile (3) was obtained in a one-pot synthesis via the reaction of 5-amino-3-methyl-4-nitroso-1-phenylpyrazole 2 with malononitrile.


Subject(s)
Antifungal Agents/chemical synthesis , Parasites/drug effects , Pyrazines/chemical synthesis , Pyrazoles/chemical synthesis , Animals , Antifungal Agents/pharmacology , Fungi/drug effects , Leishmania/drug effects , Magnetic Resonance Spectroscopy , Microbial Sensitivity Tests , Pyrazines/pharmacology , Pyrazoles/pharmacology , Spectrophotometry, Infrared , Trichomonas vaginalis/drug effects
10.
Planta Med ; 66(4): 343-7, 2000 May.
Article in English | MEDLINE | ID: mdl-10865451

ABSTRACT

The in vitro antileishmanial activity of three saponins isolated from ivy, alpha-hederin, beta-hederin and hederacolchiside A1, was investigated on Leishmania infantum. The assessment of possible targets (membrane integrity, membrane potential, DNA synthesis and protein content) was performed in both Leishmania promastigotes and human monocytes (THP1 cells). Results observed in Leishmania showed that the saponins exhibited a strong antiproliferative activity on all stages of development of the parasite by altering membrane integrity and potential: hederacolchiside A1 appeared to be the most active compound against both promastigotes and amastigotes. Results observed in THP1 cells demonstrated that the saponins exerted also a potent antiproliferative activity against human monocytes, by producing a significant DNA synthesis inhibition. The ratio between antileishmanial activity on amastigotes and toxicity to human cells suggested that the saponins could be considered as possible antileishmanial drugs.


Subject(s)
Antiprotozoal Agents/pharmacology , Leishmania infantum/drug effects , Oleanolic Acid/analogs & derivatives , Saponins/pharmacology , Animals , Cell Division/drug effects , Cell Line , Humans
11.
Planta Med ; 66(4): 368-71, 2000 May.
Article in English | MEDLINE | ID: mdl-10865459

ABSTRACT

Two new triterpenoid saponins, glinosides A and B, isolated from the aerial parts of Glinus oppositifolius, have been characterized by 1D, 2D, NMR and high-resolution mass spectral (HRMS) techniques. Their structures were established respectively as 16-O-(beta-arabinopyranosyl)-3-oxo-12,16 beta,21 beta,22-tetrahydroxyhopane for glinoside A and 16-O-(beta-arabinopyranosyl)-3-oxo-12,16 beta,22-trihydroxyhopane for glinoside B. Results presented evidence that fractions had a better antiplasmodial activity (IC50 = 31.80 micrograms/ml) than pure glinoside A (IC50 = 42.30 micrograms/ml).


Subject(s)
Antiprotozoal Agents/chemistry , Antiprotozoal Agents/pharmacology , Plants, Medicinal/chemistry , Triterpenes/chemistry , Triterpenes/pharmacology , Animals , Molecular Structure , Plasmodium falciparum/drug effects , Saponins/chemistry , Saponins/pharmacology
12.
Phytother Res ; 14(1): 45-7, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10641048

ABSTRACT

Mitragyna inermis (De Willd.) O. Kuntze Rubiaceae, Nauclea latifolia (Sm.) Rubiaceae, Glinus oppositofolius (Linn) Molluginaceae and Trichilia roka (Forsk.) Chiv. Meliaceae were investigated for their in vitro antimalarial activity. Leaves, roots and stem barks were submitted to aqueous, hydromethano and chloroform extractions and antimalarial activity was evaluated by microscopic and flow cytometric analysis. The results present evidence that the alkaloids contained in chloroform extracts and ursolic acid, purified from the hydromethanol extract of M. inermis induced a significant decrease of parasite proliferation. However, aqueous extracts, traditionally used for medication did not show high antimalarial activity. Statistical comparison between microscopic and cytometric analysis demonstrated the validity of this new technique for the screening of active antimalarial compounds isolated from plants.


Subject(s)
Antimalarials/pharmacology , Medicine, African Traditional , Plant Extracts/pharmacology , Animals , Macrophages, Peritoneal/drug effects , Mali , Mice , Mice, Inbred BALB C , Plasmodium falciparum/drug effects
13.
Pharm Biol ; 38(3): 176-80, 2000.
Article in English | MEDLINE | ID: mdl-21214458

ABSTRACT

Two sesquiterpene alcohols, [11 R]-eudesm-4(14)-en-5ß,11,12-triol ( 1 ) and [11R]-eudesm-4(14)-en-5a,11-12-triol ( 2 ), from Jasonia glutinosa aerial parts (Asteraceae), have been tested using an in vitro technique against Leishmania donovani (promastigote forms) and Plasmodium falciparum . Sesquiterpene 1 was not effective at the assayed concentrations. Sesquiterpene 2 was found to be active against Leishmania donovani and Plasmodium falciparum .

14.
J Antimicrob Chemother ; 44(1): 71-6, 1999 Jul.
Article in English | MEDLINE | ID: mdl-10459812

ABSTRACT

Amphotericin B susceptibility was measured by a flow cytometric membrane potential assay in Leishmania infantum promastigotes isolated from 11 immunocompetent children treated with liposomal amphotericin B and 19 HIV-infected young adults treated with intralipid amphotericin B. Susceptibility levels were measured by the 90% inhibitory concentrations (IC90) representing the concentrations of drug that induced a 90% decrease in membrane potential compared with the control culture. In immunocompetent children, treatment was fully effective whatever the susceptibility of isolates to amphotericin B. In immunocompromised adults, on the contrary, unresponsiveness and relapses could be observed in all cases and IC90 increased in the course of successive treatments: a decrease of amphotericin B susceptibility in both promastigote and amastigote forms could be observed in a patient who had six relapses. These results suggest that the success of amphotericin B treatment depends greatly on patient immunity status, and indicate that successive relapses could enhance emergence of amphotericin B resistant isolates. The results demonstrate that the flow cytometric membrane potential assay can be used as an easy and reliable tool for studying the evolution of interactions between amphotericin B and the parasite membrane during long-term treatments.


Subject(s)
Amphotericin B/pharmacology , Antiprotozoal Agents/pharmacology , Immunocompromised Host , Leishmania infantum/drug effects , Leishmaniasis, Visceral/parasitology , Acquired Immunodeficiency Syndrome/complications , Adult , Amphotericin B/therapeutic use , Animals , Antiprotozoal Agents/therapeutic use , Child, Preschool , Drug Resistance , Fat Emulsions, Intravenous/therapeutic use , Flow Cytometry , Humans , Immunocompetence , Infant , Leishmania infantum/growth & development , Leishmaniasis, Visceral/drug therapy , Membrane Potentials/drug effects , Monocytes/drug effects , Monocytes/parasitology
15.
Exp Parasitol ; 87(1): 1-7, 1997 Sep.
Article in English | MEDLINE | ID: mdl-9287952

ABSTRACT

The capacity of flow-cytometric techniques to detect drug-specific biochemical targets and side effects in Leishmania infantum promastigotes was estimated by assessing the effects of three antileishmanial drugs (pentamidine, allopurinol, and amphotericin B) on parasite metabolism. Cell cycle and total protein content were estimated by staining cells with propidium iodide and fluorescein isothiocyanate, nonprotein thiols were stained by mercury orange, and membrane potential was measured by the accumulation of 3,3'-dipenthyloxacarbocyanine iodide inside the cell. Results showed that dynamic studies in parasites treated with subtoxic concentrations of drugs allowed the detection of drug-specific targets: pentamidine primarily affected nonprotein thiol contents and DNA synthesis, allopurinol primarily affected intracellular protein contents, and amphotericin B primarily affected membrane potential. Moreover, the assessment of cellular functions in parasites treated with increasing concentrations of drugs certified the capacity of these techniques to establish dose-response curves and to permit the detection of side effects.


Subject(s)
Allopurinol/pharmacology , Amphotericin B/pharmacology , Antiprotozoal Agents/pharmacology , Flow Cytometry , Leishmania infantum/drug effects , Pentamidine/pharmacology , Animals , Carbocyanines , Cell Cycle/drug effects , Coloring Agents , DNA, Protozoan/analysis , DNA, Protozoan/drug effects , Dose-Response Relationship, Drug , Fluorescein-5-isothiocyanate , Fluorescent Dyes , Leishmania infantum/cytology , Leishmania infantum/physiology , Membrane Potentials/drug effects , Phenylmercury Compounds , Propidium , Protozoan Proteins/analysis , Protozoan Proteins/drug effects , Sulfhydryl Compounds/analysis , Sulfhydryl Reagents
16.
Cytometry ; 28(2): 165-9, 1997 Jun 01.
Article in English | MEDLINE | ID: mdl-9181307

ABSTRACT

Flow cytometry was used for measuring the effects of amphotericin B on the membrane of Leishmania infantum strains. The technique was adapted from the rapid flow cytometric membrane potential assay developed by Ordonez and Wehman (Cytometry 22:154-157, 1995) for evaluating antibiotic-susceptibility of Candida species. The study consisted of measuring membrane potential changes induced by amphotericin B in 3 initial strains and 12 laboratory-generated variants adapted to grow with amphotericin B. Results showed that, after 3 h of incubation, amphotericin B induced a dose-related decrease of membrane potential that reached its maximal level at the same concentrations that inhibited parasite growth. These results suggest that the flow cytometric membrane potential assay could be used to assess the susceptibility of Leishmania promastigotes to amphotericin B.


Subject(s)
Amphotericin B/pharmacology , Antiprotozoal Agents/pharmacology , Flow Cytometry/methods , Leishmania infantum/drug effects , Membrane Potentials/drug effects , Animals , Carbocyanines/chemistry , Dose-Response Relationship, Drug , Fluorescent Dyes/chemistry , Leishmania infantum/physiology , Time Factors
17.
Prenat Diagn ; 16(7): 623-8, 1996 Jul.
Article in English | MEDLINE | ID: mdl-8843471

ABSTRACT

In this study we have measured the concentration of 24 amino acids and total homocysteine in amniotic fluids obtained between the tenth and 32nd week of gestation from pregnancies not at risk for metabolic diseases. These results are used as reference values to which are compared values obtained from pregnancies at risk for citrullinaemia, argininosuccinic aciduria, HHH (hyperornithinaemia, hyperammonaemia and homocitrullinaemia) syndrome, cobalamin metabolism disorders (CblC or CblD), and sulphite oxidase deficiency. We discuss the helpfulness of amino acid analysis in amniotic fluid for prenatal diagnosis of aminoacidopathies.


Subject(s)
Amino Acid Metabolism, Inborn Errors/diagnosis , Amino Acids, Sulfur/analysis , Amniotic Fluid/chemistry , Argininosuccinic Acid/analysis , Citrulline/analysis , Ornithine/analysis , Prenatal Diagnosis/methods , Amino Acids, Sulfur/metabolism , Argininosuccinic Acid/metabolism , Chromatography, Ion Exchange , Citrulline/metabolism , Female , Gestational Age , Humans , Ornithine/metabolism , Oxidoreductases Acting on Sulfur Group Donors/deficiency , Pregnancy , Reference Values , Vitamin B 12/metabolism
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