Oral Treatment of Pernicious Anæmia with a Vitamin B₁₂/L~Glutamic Acid Mixture

Abstract

ACCORDING to Castle¹, pernicious anæmia is due to failure of the stomach to secrete a high-molecular-weight, non-dialysable protein (intrinsic factor) which facilitates the absorption of pure vitamin B₁₂ (extrinsic factor), which is present in food. For reasons already given elsewhere, we believe that this concept is incorrect, and that pernicious anæmia is actually due to a failure of gastric proteolysis². More recently, we have suggested that the enzyme which is specifically responsible for the breakdown of the bound (that is, naturally occurring) forms of vitamin B₁₂ is probably an exopeptidase³. Originally, to test our concept, we prepared vitamin B₁₂-peptide complexes both from fermentations of Streptomyces griseus and a Propionibacterium. The vitamin in both preparations was present in a ‘free’ state, that is, able to stimulate the growth of micro-organisms, and together with its associated peptide (molecular weight about 2,000) was dialysable. The preparations have been tested for their effectiveness in the oral treatment of pernicious anæmia (see above references) and one of them (H.P.P/l) has been shown to be by far the most potent oral agent yet available for this condition⁴. In addition, no refractoriness to therapy has developed, as yet, in any of the patients so treated.