Homocysteine methylene tetrahydrofolate reductase

Supplements of 400 Ig/d of folate begun before conception result in a significant reduction in the incidence of neural mbe defects as found in spina bifida. Elevated blood homocysteine is an associated risk factor for atherosclerosis, thrombosis, and hypertension. The condition is due to impaired abihty to form methyl-tetrahydrofolate by methylene-tetrahydrofolate reductase, causing functional folate deficiency and resulting in failure to remethylate homocysteine to methionine. People with the causative abnormal variant of methylene-tetrahydrofolate reductase do not develop hyperhomocysteinemia if they have a relatively high intake of folate, but it is not yet known whether this affects the incidence of cardiovascular disease. 

Kaye JM, Stanton KG, McCann VJ, Vasikaran VB, Taylors RR, van Bockxmeer FM. 2002. Homocysteine, folate, methylene tetrahydrofolate reductase genotype and vascular morbidity in diabetic subjects. Clin Sci 102 631-637. 

There is some evidence that riboflavin status affects the stability of the thermolab ile variant of methylene tetrahydrofolate reductase (Section 10.3.2.1), and that supplements of riboflavin may lower plasma homocysteine (Section 10.3.4.2) in people who are homozygous for the variant enzyme (McNulty et al., 2002). 

This functional deficiency of folate is exacerbated by the associated low concentrations of methionine and S-adenosyl methioitine, although most tissues (apart from the central nervous system) also have betaine-homocysteine methyltransferase that may be adequate to maintain tissue pools of methionine. Under normal conditions S-adenosyl methioitine inhibits methylene-tetrahydrofolate reductase and prevents the formation of further methyl-tetrahydrofolate. Relief of this inhibition results in increased reduction of one-carbon substituted tetrahydrofolates to methyl-tetrahydrofolate. 

As shown in Figure 10.9, the overall reaction of methionine synthetase is the transfer of the methyl group from methyl-tetrahydrofolate to homocysteine. However, the enzyme also requires S-adenosyl methionine and a flavoprotein reducing system in addition to the cobalamin prosthetic group. A common polymorphism of methionine synthetase, in which aspartate is replaced by glycine, is associated with elevated plasma homocysteine in some cases, although it is less important than methylene-tetrahydrofolate reductase polymorphisms (Section 10.3.2.1 Harmon etal., 1999). 

Supplements of400 /xg per day of folic acid, begun before conception, halve the risk of neural tube defect (Section 10.9.4), and similar supplements reduce the plasma concentration of homocysteine in people homozygous for the ther-molabile variant of methylene-tetrahydrofolate reductase (Section 10.3.4.2), although it is not known whether or not this will reduce their risk of cardiovascular disease. A number of manufacturers voluntarily enrich foods with folic acid. In the United States and other countries, there is mandatory enrichment of cereal products with folic acid. 

Hanson, H. Q. et al., C677T and A1298C polymorphisms of methylene tetrahydrofolate reductase gene Incidence and effect of combined genotypes on plasma fasting and post-methionine load homocysteine in vascular disease, Clin. Chem., 47, 661-666, 2001. 

Elevated blood homocysteine is a significant risk factor for atherosclerosis, thrombosis and hypertension, independent of factors such as dietary lipids and plasma lipoproteins (section 7.3.2). About 10-15% of the population, and almost 30% of people with ischaemic heart disease, have an abnormal variant of methylene-tetrahydrofolate reductase (Figure 11.23) that is unstable and loses activity faster than normal. 

Folate supplements of 400 Ig/day reduce the incidence of spina bifida and neural tube defect about 1% of pregnant women are at risk. Similar supplements lower plasma homocysteine in people with the abnormal variant of methylene tetrahydrofolate reductase (section 11.3.3) between 10% and 20% of the population are homozygous for the abnormal gene. 

Riboflavin in the form of FAD is an essential coenzyme for 5,10-methylene tetrahydrofolate reductase, a key enzyme of the folate pathway, which catalyzes the interconversion of 5,10-methylene-tetrahydrofolate and 5-methyltetrahydrofolate. Of the known single nucleotide polymorphisms affecting this enzyme, the best known are the C699T and A1298C variants. The former confer thermolability and potentially reduced enzyme activity in the TT homozygote. Marginal riboflavin status may, in some situations, be associated with increased plasma homocysteine levels (possibly predictive of increased... 

Methylation of homocysteine by 5-methyltetrahydrofolate-homocysteine methyl reductase depends on an adequate supply of 5-methyltetrahydrofoIate. The unmethylated folate is recycled in a cobalamin-dependent pathway, by remethylation to 5,10-methylene-tetrahydrofolate, and subsequent reduction to 5-methyltetrahydrofolate. The transferase enzyme, also named 5,10-methyltretrahydrofolate reductase catalyzes the whole cycle [3,91]. S-adenosylmethionine and 5-methyltetrahydrofolate are the most important methyl unit donors in biological system. S-adenosylmethionine is reported to regulate methylation and transsulfuration pathways in the homocysteine metabolism [3,91]. 

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