synthesize small amounts of it, and the body effectively scavenges and recycles it in the kidneys during production of urine.
Genetic disorders such as multiple carboxylase deficiency (MCD) (which includes biotinidase deficiency and holocarboxylase synthetase deficiency)[1] can also lead to inborn or late-onset forms of biotin deficiency.[2] In all cases – dietary, genetic, or otherwise – supplementation with biotin is the primary (and usually only)[3] method of treatment.[1][4] The prognosis for congenital MCD is good if biotin supplementation is begun quickly after birth and carried on throughout the patients life.[5]
The average dietary intake of biotin ranges between 35 and 70 micrograms/day in the western population.[2]
Signs and symptoms
Physical
Rashes including red, patchy ones near openings[6] (e.g. erythematous periorofacial macular rash)[7]
Total parenteral nutrition without biotin supplementation: Several cases[13] of biotin deficiency in patients receiving prolonged total parenteral nutrition (TPN) therapy without added biotin have been reported. Therefore, all patients receiving TPN must also receive biotin at the recommended daily dose, especially if TPN therapy is expected to last more than 1 week. All hospital pharmacies currently include biotin in TPN preparations.[2]
Protein deficiency (not certain): A shortage of proteins involved in biotin homeostasis can cause biotin deficiency. The main problems involved in biotin homeostasis are HCS, BTD (biotinidase deficiency) and SMVT[14]
Anticonvulsant therapy: Prolonged use of certain drugs (especially highly common prescription anti-seizure medications such as
intestinal mucosa
. Evidence suggests that these anticonvulsants accelerate biotin catabolism, which means that it's necessary for people to take supplemental biotin, in addition to the usual minimum daily requirements, if they're treated with anticonvulsant medication(s) that have been linked to biotin deficiency.
Smoking: Recent studies[14] suggest that smoking can lead to marginal biotin deficiency because it speeds up biotin catabolism (especially in women).[19]
Excessive alcohol consumption[20] (causes a significant reduction in plasma biotin levels)
transposable elements and some genes. Normally, the amount of biotin in the body is regulated by dietary intake, biotin transporters (monocarboxylate transporter 1 and sodium-dependent multivitamin transporter), peptidyl hydrolase biotinidase (BTD), and the protein ligase holocarboxylase synthetase. When any of these regulatory factors are inhibited, biotin deficiency could occur.[23]
Diagnosis
The only reliable method for determining biotin deficiency is the abundance of biotinylated 3-methylcrotonyl-CoA carboxylase and propionyl-CoA carboxylase in
3-hydroxyisovaleric acid in urine can (unreliably) detect biotin-deficient patients.[24]
Treatment
In the United States, biotin supplements are readily available without a prescription[25] in amounts ranging from 300 to 10,000 micrograms.[26] 30 micrograms daily is identified as Adequate Intake for men and women 19 years and older. 35 micrograms daily is required for lactating women.[27]
Most healthy individuals meet these recommended intakes, however many still take up to 500 to 1,000 micrograms of biotin daily.[28]
Epidemiology
Deficiency is rare[2] in locations where egg-white enriched or ketogenic diets are common.[29] Pregnancy, however, alters biomarkers of biotin[30] and despite a regular biotin intake, approximately half of the pregnant women in the U.S. are marginally biotin deficient.[14]
Dobrowolski SF, Angeletti J, Banas RA, Naylor EW (February 2003). "Real time PCR assays to detect common mutations in the biotinidase gene and application of mutational analysis to newborn screening for biotinidase deficiency". Mol. Genet. Metab. 78 (2): 100–7.
Genc GA, Sivri-Kalkanoğlu HS, Dursun A, Aydin HI, Tokatli A, Sennaroglu L, Belgin E, Wolf B, Coşkun T (February 2007). "Audiologic findings in children with biotinidase deficiency in Turkey". Int. J. Pediatr. Otorhinolaryngol. 71 (2): 333–9.
González EC, Marrero N, Frómeta A, Herrera D, Castells E, Pérez PL (July 2006). "Qualitative colorimetric ultramicroassay for the detection of biotinidase deficiency in newborns". Clin. Chim. Acta. 369 (1): 35–9.
Higuchi R, Mizukoshi M, Koyama H, Kitano N, Koike M (February 1998). "Intractable diaper dermatitis as an early sign of biotin deficiency". Acta Paediatr. 87 (2): 228–9.
László A, Schuler EA, Sallay E, Endreffy E, Somogyi C, Várkonyi A, Havass Z, Jansen KP, Wolf B (2003). "Neonatal screening for biotinidase deficiency in Hungary: clinical, biochemical and molecular studies". J. Inherit. Metab. Dis. 26 (7): 693–8.
Möslinger D, Mühl A, Suormala T, Baumgartner R, Stöckler-Ipsiroglu S (December 2003). "Molecular characterisation and neuropsychological outcome of 21 patients with profound biotinidase deficiency detected by newborn screening and family studies". Eur. J. Pediatr. 162 (Suppl 1): S46–9.
Schulpis KH, Gavrili S, Tjamouranis J, Karikas GA, Kapiki A, Costalos C (May 2003). "The effect of neonatal jaundice on biotinidase activity". Early Hum. Dev. 72 (1): 15–24.
Thompson, J, Manore M, Sheeshka J (2010). "Nutrients involved in energy metabolism and blood health". In Bennett G, Swieg C, et al. (eds.). Nutrition: A functional Approach. Toronto: Pearson Canada. p. 353.
Velázquez A (1997). "Biotin deficiency in protein-energy malnutrition: implications for nutritional homeostasis and individuality". Nutrition. 13 (11–12): 991–2.
Wolf B (2001). "Disorders of biotin metabolism". In Scriver CR, Beaudet AL, et al. (eds.). The metabolic & molecular bases of inherited disease. New York: McGraw-Hill. pp. 3935–62.
