Introduction Cobalamin (vitamin B 12 ) is a coenzyme for the enzymes of intermediate metabolism, methionine synthase, and methylmalonyl-CoA mutase, and deficiency of the vitamin leads to potentially lethal manifestations such as megaloblastic anemia and severe combined degeneration of the central nervous system. Cobalamin deficiency, which is one of the most common vitamin-deficiency diseases, is most often due to failure at a step in the complicated and highly specific gastrointestinal uptake mechanisms for dietary cobalamin rather than an insufficient supply from food. 1 Intrinsic factor (IF) is a glycoprotein produced in the gastric epithelium. It tightly binds to cobalamin in the gastrointestestinal tract, and in the distal small intestine the IF-cobalamin complex is recognized by cubilin, a multiligand apical membrane protein that participates in endocytosis of the complex. 2,3 IF is subsequently degraded in enterocyte lysosomes, and cobalamin is secreted into plasma in complex with transcobalamin-II. 4 Cubilin is a large membrane protein (460 kDa) with a unique set of extracellular protein modules comprising 8 tandem epidermal growth factor domains followed by 27 tandem CUB domains (initially found in complement components C1r/C1s, Uegf, and bone morphogenic protein-1) harboring the IF-cobalamin binding site (CUB domains 5-8). 5,6 Although cubilin has no apparent transmembrane segment or cytoplasmic tail, several studies have shown that binding of IF-cobalamin to cubilin leads to endocytosis of the ligand and recycling of the receptor. 2,3 Besides expression and function in the intestine, cubilin has many-fold higher expression in the apical membrane of kidney proximal tubule and rodent yolk sac epithelial cells. 2,3,7,8 Consistent with this pattern of expression, cubilin is involved in reabsorption of several specific nutrient-carrying proteins from renal glomerular filtrate, including albumin, 9 transferrin, 10 vitamin D-binding protein, 11 and apolipoprotein AI, 12,13 and cubilin has a crucial but not-yet-defined role in early embryonic development of rodents. 14 Evidence to date indicates that the mechanism of cubilin-mediated endocytosis is the same in the various cubilin-expressing epithelia. 2 Accordingly, IF-cobalamin is effectively endocytosed in a cubilin-dependent manner in the proximal tubule 15 and yolk sac, 16 and because these tissues have higher density of cubilin in apical membranes and less luminal proteolytic activity than intestine, they have been the preferred tissues for studying cubilin function. 2,8,[14][15][16] However, it should be noted that ligands other than IF-cobalamin are likely to be physiologically more important in the kidney and yolk sac because little or no gastric IF circulates in plasma. An Inside Blood analysis of this article appears in the front of this issue.Reprints: Søren K. Moestrup, Institute of Medical Biochemistry, University of Aarhus, 8000 Aarhus C, Denmark; e-mail: skm@biobase.dk.The publication costs of this article were defrayed in part by page charge ...