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Methylmalonic Aciduria and Homocystinuria, cblF type, via the LMBRD1 Gene

Summary and Pricing

Test Method

Exome Sequencing with CNV Detection
Test Code Test Copy GenesTest CPT Code Gene CPT Codes Copy CPT Codes Base Price
LMBRD1 81479 81479,81479 $990
Test Code Test Copy Genes Test CPT Code Gene CPT Codes Copy CPT Code Base Price
11837LMBRD181479 81479,81479 $990 Order Options and Pricing

Pricing Comments

Our favored testing approach is exome based NextGen sequencing with CNV analysis. This will allow cost effective reflexing to PGxome or other exome based tests. However, if full gene Sanger sequencing is desired for STAT turnaround time, insurance, or other reasons, please see link below for Test Code, pricing, and turnaround time information. If the Sanger option is selected, CNV detection may be ordered through Test #600.

An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.

Click here for costs to reflex to whole PGxome (if original test is on PGxome Sequencing platform).

Click here for costs to reflex to whole PGnome (if original test is on PGnome Sequencing platform).

The Sanger Sequencing method for this test is NY State approved.

For Sanger Sequencing click here.

Turnaround Time

3 weeks on average for standard orders or 2 weeks on average for STAT orders.

Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.

Targeted Testing

For ordering sequencing of targeted known variants, go to our Targeted Variants page.


Genetic Counselors


  • McKenna Kyriss, PhD

Clinical Features and Genetics

Clinical Features

Cobalamin (Cbl or vitamin B12) is an important cofactor in homocysteine metabolism and in branched-chain amino acid and odd-chain fatty acid catabolism. A series of inherited inborn errors of cobalamin metabolism have been identified, designated cblA through cblG. In CblF deficiency, cobalamin accumulates in lysosomes and cannot be used to synthesize the cofactors adenosylcobalamin (AdoCbl) and methylcobalamin (MeCbl). As a result, methylmalonyl CoA mutase cannot convert L-methylmalonyl-CoA to succinyl CoA, and methionine synthase cannot convert homocysteine to methionine. Patients have elevated homocysteine and methylmalonic acid concentrations in blood and urine, and some patients with increased propionylcarnitine concentrations are identified through newborn screening (Rutsch et al. 2009; Carrillo-Carrasco et al. 2013; Watkins and Rosenblatt 2014). Clinical presentation is variable, but includes being small for gestational age, poor feeding, failure to thrive, developmental delay, and persistent stomatitis (Gailus et al. 2010; Rutsch et al. 2009). Hematological abnormalities are common and include macrocytic anemia, neutropenia, thrombocytopenia, and pancytopenia. Two patients have been reported to have minor craniofacial abnormalities (including pegged teeth and bifid incisors), and four patients have been described with congenital heart defects (Rutsch et al. 2009).


The cblF disorder is inherited in an autosomal recessive manner, and is caused by pathogenic variants in the LMBRD1 gene. The LMBRD1 gene consists of 16 coding exons and encodes the 540 amino acid LMBD1 protein that localizes to lysosomal membranes. This protein shares some homology with the lipocalin-1 interacting membrane receptor (LIMR), and while the exact function of LMBD1 protein remains unknown, it has been hypothesized to act as a lysosomal exporter for cobalamin (Rutsch et al. 2009; Watkins and Rosenblatt 2014). The great majority of LMBRD1 pathogenic variants identified to date include small frameshift deletions detectable by sequencing. Furthermore, there appears to be a common European founder mutation, c.1056delG (p.L352fsX18) in exon 11. In one recent study of 12 unrelated patients with cblF defect, 18 of 24 alleles carried this particular mutation (Rutsch et al. 2009).

Clinical Sensitivity - Sequencing with CNV PGxome

In the largest published study of patients with cblF deficiency, all 12 affected patients were found to have LMBRD1 pathogenic variants in either a compound heterozygous or homozygous state (Rutsch et al. 2009).

The sensitivity of duplication/deletion testing for this rare disorder appears to be low. Only one pathogenic gross deletion spanning more than 6.7 kb and encompassing exon 2 has been reported (Miousse et al. 2011).

Testing Strategy

This test provides full coverage of all coding exons of the LMBRD1 gene plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define full coverage as >20X NGS reads or Sanger sequencing. PGnome panels typically provide slightly increased coverage over the PGxome equivalent. PGnome sequencing panels have the added benefit of additional analysis and reporting of deep intronic regions (where applicable).

Dependent on the sequencing backbone selected for this testing, discounted reflex testing to any other similar backbone-based test is available (i.e., PGxome panel to whole PGxome; PGnome panel to whole PGnome).

Indications for Test

Candidates for this test are patients with biochemical findings and/or clinical symptoms consistent with cblF deficiency, including infants with a positive newborn screen. Testing is also indicated for family members of patients with known LMBRD1 mutations. We will also sequence the LMBRD1 gene to determine carrier status.


Official Gene Symbol OMIM ID
LMBRD1 612625
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT


Name Inheritance OMIM ID
Methylmalonic Aciduria and Homocystinuria, cblF Type AR 277380


  • Carrillo-Carrasco N. et al. 2013. Disorders of Intracellular Cobalamin Metabolism. In: Pagon RA, Adam MP, Ardinger HH, Bird TD, Dolan CR, Fong C-T, Smith RJ, and Stephens K, editors. GeneReviews(), Seattle (WA): University of Washington, Seattle. PubMed ID: 20301503
  • Gailus et al. 2010. PubMed ID: 20127417
  • Miousse et al. 2011. PubMed ID: 21303734
  • Rutsch et al. 2009. PubMed ID: 19136951
  • Watkins and Rosenblatt. 2014. Inherited Disorders of Folate and Cobalamin Transport and Metabolism. In: Valle D, Beaudet A.L., Vogelstein B, et al., editors. New York, NY: McGraw-Hill. OMMBID.


Ordering Options

We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.

myPrevent - Online Ordering

  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • PGnome sequencing panels can be ordered via the myPrevent portal only at this time.

Requisition Form

  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.

For Requisition Forms, visit our Forms page

If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.

Specimen Types

Specimen Requirements and Shipping Details

PGxome (Exome) Sequencing Panel

PGnome (Genome) Sequencing Panel

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View Ordering Instructions

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2) Select Additional Test Options

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Note: acceptable specimen types are whole blood and DNA from whole blood only.
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