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Clinically, elevated copper levels and their carrier protein CP are significant predictors of adverse outcomes, including mortality, in patients with HF [202]

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From precorrin-6B to precorrin-8 [edit] The enzyme CobL has two active sites, one catalysing two methyl group additions and the other the decarboxylation of the CH 2 COOH group on ring D, so that this substituent becomes a simple methyl group: [21] precorrin-6B + 2 S-adenosyl methionine precorrin-8X + 2 S-adenosyl-L-homocysteine + CO 2 From precorrin-8 to hydrogenobyrinic acid [edit] The enzyme CobH catalyzes a rearrangement reaction, with the result that the methyl group that had been added to ring C is isomerised to its final location, an example of intramolecular transfer: [22] precorrin-8X hydrogenobyrinate From hydrogenobyrinic acid to hydrogenobyrinic acid a,c-diamide [edit] The next enzyme in the pathway, CobB, selectively converts two of the eight carboxylic acid groups into their primary amides

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