Folate metabolism accumulation

Both the sulfonamides and trimethoprim interfere with bacterial folate metabolism. For purine synthesis tetrahydrofolate is required. It is also a cofactor for the methylation of various amino acids. The formation of dihydrofolate from para-aminobenzoic acid (PABA) is catalyzed by dihydropteroate synthetase. Dihydrofolate is further reduced to tetrahydrofolate by dihydrofolate reductase. Micro organisms require extracellular PABA to form folic acid. Sulfonamides are analogues of PABA. They can enter into the synthesis of folic acid and take the place of PABA. They then competitively inhibit dihydrofolate synthetase resulting in an accumulation of PABA and deficient tetrahydrofolate formation. On the other hand trimethoprim inhibits dihydrofolate... 

It is the role of jV5-methyl THF which is key to understanding the involvement of cobalamin in megaloblastic anaemia. The metabolic requirement for N-methyl THF is to maintain a supply of the amino acid methionine, the precursor of S-adenosyl methionine (SAM), which is required for a number of methylation reactions. The transfer of the methyl group from jV5-methyl THF to homocysteine is cobalamin-dependent, so in B12 deficiency states, the production of SAM is reduced. Furthermore, the reaction which brings about the formation of Ns-methyl THF from N5,N10-methylene THF is irreversible and controlled by feedback inhibition by SAM. Thus, if B12 is unavailable, SAM concentration falls and Ah -methyl THF accumulates and THF cannot be re-formed. The accumulation of AT-methyl THF is sometimes referred to as the methyl trap because a functional deficiency of folate is created. 

Evidence that a diet rich in fruits and vegetables may protect against coronary heart disease is accumulating. It is unclear exactly which substances in fruits and vegetables are responsible for the observed inverse association with cardiovascular disease. The inverse association may be attributed to folate, antioxidant vitamins, or other constituents such as fiber, potassium, fla-vonoids, or other phytochemicals. The protective effect of folate may be attributed to its role as a cosubstrate in homocysteine metabolism (Eichholzer et al., 2001). 

Although catabolism of histidine is not a major source of substituted folate, the reaction is of interest because it has been exploited as a means of assessing folate nutritional stams. In folate deficiency, the activity of the formimi-notransferase is impaired by lack of cofactor. After a loading dose of histidine, there is impaired oxidative metabolism of histidine and accumulation of FIGLU, which is excreted in the urine (Section 10.10.4). 

Unlike most enzymes utilizing or metabolizing tetrahydrofolate, methionine synthetase has equal activity toward methyl-tetrahydrofolate mono- and polyglutamates. As discussed in Section 10.2.2, demethylation of methyl-tetrahydrofolate is essendal for the polyglutamylation and intracellular accumulation of folate. 

The ability to metabolize a test dose of histidine provides a sensitive functional test of folate nutritional status as shown in Figure 10.6, forrnirninoglu-tamate (FIGLU) is an intermediate in histidine catabolism and is metabolized by the tetrahydrofolate-dependent enzyme FIGLU forrnirninotransferase. In folate deficiency, the activity of this enzyme is impaired, and FIGLU accumulates and is excreted in the urine, especially after a test dose of histidine - the FIGLU test. 

Vitamin B]2 deficiency results in impairment in the activities of the Bj2-re< iJiring enzymes. This impairment prevents synthesis of the enzyme s products and forces the accumulation of reactants in the cell. Inhibition of methionine synthase prevents the synthesis of methionine and the regeneration of tetrahydrofolatc. This inhibition results in interruption of the methylation cycle, which involves S-ade-nosylmethionine. The inhibition also results in an impairment of folate-mediated metabolism, because of the failure to regenerate Hjfolate from S-methyl-Hjfolate. The major effect of B 2 deficiency is an impairment of growth, particularly of rapidly growing cells such as immature red blood cells. Bu deficiency also results in the buildup of homocy steine in the cell and bloodstream. 

Deficiency of folate or vitamin Bn can cause hematological changes similar to hereditary orotic aciduria. Folate is directly involved in thymidylic acid synthesis and indirectly involved in vitamin Bn synthesis. Orotic aciduria without the characteristic hematological abnormalities occurs in disorders of the urea cycle that lead to accumulation of carbamoyl phosphate in mitochondria (e.g., ornithine transcarbamoylase deficiency see Chapter 17). The carbamoyl phosphate exits from the mitochondria and augments cytosolic pyrimidine biosynthesis. Treatment with allopurinol or 6-azauridine also produces orotic aciduria as a result of inhibition of orotidine-5 phosphate decarboxylase by their metabolic products. 

One patient has been found with this deficiency (All). Hie patient, an infant, was mentally retarded, had a megaloblastic anemia and abnormally high levels of serum and erythrocyte folate. In spite of the high serum folate concentration there was a marked rise in the reticulocyte count when the patient was treated with folate. It was thought that the patient had impaired utilization of -methyltetrahydrofolate. Assay of liver W -methyltetrahy-drofolate transferase showed it to be reduced. It was suggested that folate accumulated at the N -methyltetrahydrofolate block and could therefore not be further utilized. Treatment with pteroylglutamic acid provided a means of producing active folate up to the point of the block. Unfortunately this patient was also treated with pyridoxine, and it is not clear which vitamin was responsible for the reticulocyte response. Further studies are required to determine the precise nature of this metabolic disorder. 

Methionine metabolism is very dependent on both FH4 and vitamin B12. Homocysteine is derived from methionine metabolism and can be converted back into methionine by using both methyl-FH4 and vitamin B12. This is the only reaction in which methyl-FH4 can donate the methyl group. If the enzyme that catalyzes this reaction is defective, or if vitamin B12 or FH4 levels are insufficient, homocysteine will accumulate. Elevated homocysteine levels have been linked to cardiovascular and neurologic disease. A vitamin B12 deficiency can be brought about by the lack of intrinsic factor, a gastric protein required for the absorption of dietary B12. A consequence of vitamin B12 deficiency is the accumulation of methyl-FH4 and a decrease in other folate derivatives. This is known as the... 

C. Pharmacodynamics Vitamin B is essential in two reactions conversion of methyl-malonyl-CoA to succinyl-CoA and conversion of homocysteine to methionine. The second reaction is linked to folic acid metabolism and synthesis of deoxythymidylate (dTMP Figure 33-2, reaction 2), a precursor required for DNA synthesis. In vitamin B,2 deficiency, folates accumulate as AP-methyltetrahydrofolate the supply of tetrahydrofolate is depleted and the production of red blood cells slows. Administration of folic acid to patients with vitamin Bj deficiency helps refill the tetrahydrofolate pool (Figure 33-2, reaction 3) and partially or fully corrects the anemia. However, the exogenous folic acid does not correct the neurologic defects of vitamin Bj2 deficiency. 

The reduction of methylene-tetrahydrofolate to methyl-tetrahydrofolate is irreversible, and the major source of folate for tissues is methyl-tetrahydrofolate. The only metabolic role of methyl-tetrahydrofolate is the methylation of homocysteine to methionine, and this is the only way in which methyl-tetrahydrofolate can be demethylated to yield free folate in tissues. Methionine synthetase thus provides the link between the physiological functions of folate and vitamin Impairment of methionine synthetase activity in vitamin deficiency will result in the accumulation of methyl-tetrahydrofolate, which can neither be utilized for any other one-carbon transfer reactions nor be demethylated to provide free folate. There is therefore functional deficiency of folate, secondary to the deficiency of vitamin B ... 

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