Dihydrofolate reductase tetrahydrofolate conversion

I I 3. The answer is c. (Hardman, pp 1243-1247.) Antimetabolites of folic acid such as methotrexate, which is an important cancer chemotherapeutic agent, exert their effect by inhibiting the catalytic activity of the enzyme dihydrofolate reductase. The enzyme functions to keep folic acid in a reduced state. The first step in the reaction is the reduction of folic acid to 7,8-dihydrofolic acid (FH2), which requires the cofactor nicotinamide adenine dinucleotide phosphate (NADPH). The second step is the conversion of FH2 to 5,6,7,8-tetrahydrofolic acid (FH ). This part of the reduction reaction requires nicotinamide adenine dinucleotide (NADH) or NADPH. The reduced forms of folic acid are involved in one-carbon transfer reactions that are required during the synthesis of purines and pyrimidine thymidylate. The affinity of methotrexate for dihydrofolate reductase is much greater than for the substrates of folic acid and FH2. The action of... 

Trimethoprim is a pyrimidine derivative (diaminopyrimidine) related to antimalarial drug pyrimethamine, which selectively inhibits bacterial dihydrofolate reductase, necessary for the conversion of dihydrofolate to tetrahydrofolic acid. Sulfonamides act by inhibiting the incorporation of PABA into dihydrofolate by bacteria. A combination of... 

It acts by inhibiting dihydrofolate reductase. It inhibits conversion of dihydrofolic acid to tetrahydrofolic which is essential for purine synthesis and amino acid interconversions. It primarily affects DNA synthesis but also RNA and protein synthesis. It has cell cycle specific action and kills cells in S phase. It is readily absorbed from gastrointestinal tract but larger doses are absorbed incompletely, little drug is metabolised and it is excreted largely unchanged in urine. 

Conversion of dUMP to dTMP is catalyzed by thy-midylate synthase. A one-carbon unit at the hydroxymethyl (—CH2OH) oxidation level (see Fig. 18-17) is transferred from Af5,Af10-methylenetetrahydrofolate to dUMP, then reduced to a methyl group (Fig. 22-44). The reduction occurs at the expense of oxidation of tetrahydrofolate to dihydrofolate, which is unusual in tetrahydrofolate-requiring reactions. (The mechanism of this reaction is shown in Fig. 22-50.) The dihydrofolate is reduced to tetrahydrofolate by dihydrofolate reductase—a regeneration that is essential for the many processes that require tetrahydrofolate. In plants and at least one protist, thymidylate synthase and dihy-drofolate reductase reside on a single bifunctional protein. 

Antimetabolites that are used to prevent the formation of DNA may be classified as antifolates, purine antimetabolites and pyrimidine antimetabolites (Table 7.5). Antifolates are believed to inhibit dihydrofolate reductase (DHFR). This enzyme is responsible for catalysing the conversion of dihydro-folic acid (DHF or FH2) to tetrahydrofolic acid (THF or FH4), which occurs in... 

Cells making DNA must also be able to make deoxythymidine triphosphate (dTTP). The key step in the synthesis of dTTP is the conversion of dUMP to dTMP via thymidylate synthase. The reaction requires a source of N5,Nw-methylene tetrahydrofolate (see Sec. 15.7, Fig. 15-19) to provide the methyl group. In this reaction, the tetrahydrofolate is oxidized to dihydrofolate. Dihydrofolate must be reduced to tetrahydrofolate via the enzyme dihydrofolate reductase so that more Af5,A,l0-methylene tetrahydrofolate can be made from serine in a reaction catalyzed by serine hydroxymethyltransferase. These three reactions, which are essential for the formation of dTMP, are shown below. 

Fig. 12.7 Pathways of folate metabolism and use in microbial cells (upper) and mammalian cells (lower). Bacterial and protozoal cells must synthesize dihydrofolic acid (DHF) from p-aminobenzoic acid (PABA). DHF is converted to tetrahydrofolic acid (THF) by the enzyme dihydrofolate reductase (DHFR). THF supplies single carbon units for various pathways including DNA, RNA and methionine synthesis. Mammalian cells do not make DHF, it is supplied from the diet, conversion to THF occurs via a DHFR enzyme as in microbial cells.

Trimethoprim is a diaminopyrimidine structure which has proved to be a highly selective, orally active, antibacterial, and antimalarial agent. Unlike the sulfonamides, it acts against dihydrofolate reductase—the enzyme which carries out the conversion of folic acid to tetrahydrofolate. The overall effect, however, is the same as with sulfonamides—the inhibition of DNA synthesis and cell growth. 

This enzyme also catalyzes conversion of dihydrofolate (FH2) to tetrahydrofolate (FH4), and folic acid contains a pteridine ring system (see the discussion of one-carbon metabolism in Chapter 27). However, regeneration of tetrahydrobiopterin by the dihydrofolate reductase reaction, however, is too slow to support normal rates of phenylalanine hydroxylation. 

Methotrexate, a common antimetabolite, was introduced several decades ago for the treatment of psoriasis and remains an effective therapeutic approach. It is a synthetic analogue of folic acid that acts as a competitive inhibitor of the enzyme dihydrofolate reductase, that is responsible for the conversion of dihydrofolate to tetrahydrofolate. Tetrahydrofolate is an essential cofactor for the synthesis of thymidy-late and purine nucleotides required for DNA and RNA synthesis. Methotrexate inhibits replication and function of T and B cells and suppresses secretion of various cytokines such as IL-1, IFN-y,... 

Several drugs (e.g., sulfasalazine, trimethoprim-sulfamethoxazole, and methotrexate) have been reported to cause a fohc acid deficiency megaloblastic anemia. These drugs either interfere with folate absorption or inhibit the dihydrofolate reductase enzyme necessary for conversion of dihydrofolate to its active tetrahydrofolate form (see Chap. 102, on drug-induced blood dyscrasias). 

This drug inhibits dihydrofolate reductase (DHFR) in mammalian cells. The conversion of folic acid to tetrahydrofolate is inhibited, resulting in decreased nucleotide synthesis. Thus, cellular replication and protein synthesis are inhibited. 

Folic acid (Fig. 6) is the precursor of a number of coenzymes vital for the synthesis of many important molecules. These derivatives of folic acid, referred to collectively as active formate and active formaldehyde , are responsible for the donation of one carbon fragments in the enzymatic synthesis of a number of essential molecules. In the formation of methionine from homocysteine, the folic acid coenzyme donates the S-methyl group, and in the conversion of glycine to serine it is necessary for the formation of the hydroxymethyl group. Folic add is converted into its active coenzyme forms by an initial two step reduction to tetra-hydrofolic add (Fig. 6) by means of two enzymes, folic reductase and dihydrofolic reductase. Conversion of tetrahydrofolic acid (THF) to an active coenzyme folinic acid subsequently occurs by ad tion of an Ns formyl group (Fig. 6). The formation of similar compounds such as an Nio formyl derivative, or the bridged Ns,Nio-methylenetetrahydrofolic acid, also leads to active coenzymes. 

Trimethoprim, however, is a competitive inhibitor of dihydrofolate reductase . The accumulation of dihydrofolate, through continuing biosynthesis and reoxidation of tetrahydrofolate, tends to increase the metabolite antimetabolite ratio and diminishes the effectiveness of the blockade. Conjoint application of a sulfonamide, however, removes the source of new dlhydrofolate and Improves the effectiveness of the inhibition. In practice the simultaneous use of the 2 inhibitors results in a 5-10-fold potentiation, broadening of the spectrum of action, a decreased liability to the development of resistance, and a conversion of bacteriostatic to bactericidal effects . 

The importance of the sulphonamides has decreased as a result of increased bacterial resistance and they have been replaced by compounds with higher therapeutic indices and activity. The bios)mthetic pathway for tetrahy-drofolate provides an additional point for selective attack on bacteria. The conversion of dihydrofolic add to tetra-hydrofolate (coenzyme F) requires dihydrofolate reductase. Trimetoprim (Fig. 22.43), a sulfone, is stmcturally similar to dihydrofolate (see Fig. 22.35) and therefore competitively inhibits the formation of tetrahydrofolate, ultimately affecting the biosynthesis of proteins and nudeic adds. 

In acute and chronic urinary tract infection, the combination of trimethoprim and sulfamethoxazole (Bactrim, Septra) exerts a truly synergistic effect on bacteria. The sulfonamide inhibits the utilization of p-amino-benzoic acid in the synthesis of folic acid (Figure 2.3), whereas trimethoprim, by inhibiting dihydrofolic acid reductase, blocks the conversion of dihydrofolic acid to tetrahydrofolic acid, which is essential to bacteria in the denovo synthesis of purines, pyrimidines, and certain amino acids. Because mammalian organisms do not synthesize folic acid and therefore need it as a vitamin in their daily diets, trimethoprim-sulfamethoxazole does not interfere with the metabolism of mammalian cells. 

The combination of trimethoprim and sulfamethoxazole (usually five parts sulfamethoxazole to one part trimethoprim) interferes with the synthesis of active folic acid by means of two separate reactions. In the first, sulfonamides compete with PABA and prevent its conversion to dihydro-folic acid. In the second, trimethoprim, by inhibiting the activity of dihydrofolic acid reductase, prevents the conversion of dihydrofolic acid into tetrahydrofolic acid, which is necessary for the synthesis of DNA. These reactions are summarized in Figure 90. 

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