Folate requirements

Several reactions of IMP biosynthesis require folate derivatives and glutamine. Consequently, antifolate drugs and glutamine analogs inhibit purine biosynthesis. 

There are two major disposal pathways for homocysteine. Conversion to methionine requires folate and vitamin B12-derived cofactors. The formation of cysteine requires vitamin B6(pyridoxine). 

Folic acid is obtained primarily from yeasts and leafy vegetables as well as animal liver. Animal cannot synthesize PABA nor attach glutamate residues to pteroic acid, thus, requiring folate intake in the diet. 

C. The only pyrimidine that requires folate for its synthesis is thymine (dUMP — dTMP). Folate is required for incorporation of carbons 2 and 8 into all purine molecules. 

THFs or structural analogues thereof (methanopterin) are universally required for the maintenance of Cl metabolism. Cl synthones play an indispensable role for the biosynthesis of nucleic acid components and of methionine. Even when eubacteria are supplied with exogenous sources of all metabolites whose biosynthesis requires folate-type cofactors, they require the coenzyme for the initiation of protein biosynthesis. 

As reviewed in detail by Rosenberg and Godwin (R18), folate absorption has been measured by three basically different methods (1) measurement of rises in blood folate after an oral dose, (2) measurement of folate compounds in urine after an oral dose, and (3) administration of isotopically labeled folate by mouth followed by measurement of isotope appearing in plasma and excreted in urine and feees. Folate in plasma and urine is assayed with bacteria, usually strains of Lactobacillus casei or Streptococcus faecalis, which require folate for growth. They differ somewhat in the forms of folate they can utilize, but in general these microbiological assays measure unconjugated folate in either their reduced or unreduced forms. 

Figure 29.6 Pathways for the metabolism of homocysteine. Normal transsulfuration requires cystathionine P-synthase with vitamin Bg as cofactor. Reme-thylation requires 5,10-methylenetetrahydrofolate reductase and methionine synthase. The latter requires folate as cosubstrate and vitamin Bi2 (cobalamin) as cofactor. An alternative remethylation pathway also exists using the cobalamin independent betaine-homocysteine methyltransferase (Robinson 2000).

Dimethylglycine is formed by endogenous demethylation of betaine, a choline metabolite, with concomitant methylation of homocysteine to methionine. DMG is then converted to sarcosine by oxidative demethylation catalyzed by DMG-dehydrogenase, a flavin-containing enzyme requiring folate as a cofactor. Increased excretion of DMG has been observed in individuals with folate deficiency or receiving large doses of betaine as a... 

These metabolites all require folate cofactors for further conversion and are restored to normal levels by the addition of dietary methionine (Krebs et al., 1976 Silverman and Pitney, 1958 ... 

The exploitation of subtle differences between the cellular metabolism in bacteria and mammalian host presents a niche for achieving selective toxidty. One such difference which has been exploited successfidly to produce a usefiil dass of antibiotics is the difference in the synthesis of tetrahydrofolate. Both bacterial and mammalian cells require folate in the form of tetrahydrofolate as a co-factor for thymidylate synthesis. Mammalian cells are incapable of synthesising folate and have spedalised mechanisms for transporting folate from the diet into cells. On the contrary, most bacterial cells do not possess a similar transport mechanism and are incapable of utilising... 

Fohc acid is a precursor of several important enzyme cofactors required for the synthesis of nucleic acids (qv) and the metaboHsm of certain amino acids. Fohc acid deficiency results in an inabiUty to produce deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and certain proteins (qv). Megaloblastic anemia is a common symptom of folate deficiency owing to rapid red blood cell turnover and the high metaboHc requirement of hematopoietic tissue. One of the clinical signs of acute folate deficiency includes a red and painhil tongue. Vitamin B 2 folate share a common metaboHc pathway, the methionine synthase reaction. Therefore a differential diagnosis is required to measure foHc acid deficiency because both foHc acid and vitamin B 2 deficiency cause... 

The amount of foHc acid required for daily iatake is estimated based oa the minimum amouat required to maintain a certaia level of semm folate. The recommeaded dietary allowance (RDA) for foHc acid accounts for daily losses and makes allowances for variation ia iadividual aeeds and bioavailabiUty from food sources (85). The U.S. recommended daily allowance for adults is 400 p.g and for pregnant women is 800 ]1 (Table 4). 

Mechanistic aspects of the action of folate-requiring enzymes involve one-carbon unit transfer at the oxidation level of formaldehyde, formate and methyl (78ACR314, 8OMI2I6OO) and are exemplified in pyrimidine and purine biosynthesis. A more complex mechanism has to be suggested for the methyl transfer from 5-methyl-THF (322) to homocysteine, since this transmethylation reaction is cobalamine-dependent to form methionine in E. coli. 

Since the end products of pyrimidine catabolism are highly water-soluble, pyrimidine overproduction results in few clinical signs or symptoms. In hypemricemia associated with severe overproduction of PRPP, there is overproduction of pyrimidine nucleotides and increased excretion of p-alanine. Since A, A -methyl-ene-tetrahydrofolate is required for thymidylate synthesis, disorders of folate and vitamin Bjj metabofism result in deficiencies of TMP. 

Vitamins such as thiamin, biotin, and vitamin Bj2 are often added. Once again, the requirements of anaerobes are somewhat greater, and a more extensive range of vitamins that includes pantothenate, folate, and nicotinate is generally employed. In some cases, additions of low concentrations of peptones, yeast extract, casamino acids or rumen fluid may be used, though in higher concentrations, metabolic ambiguities may be introduced since these compounds may serve as additional carbon sources. 

Folates carry one-carbon groups in transfer reactions required for purine and thymidylic acid synthesis. Dihydrofolate reductase is the enzyme responsible for supplying reduced folates intracellularly for thymidylate and purine synthesis. 

In mammals and in the majority of bacteria, cobalamin regulates DNA synthesis indirectly through its effect on a step in folate metabolism, catalyzing the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate via two methyl transfer reactions. This cytoplasmic reaction is catalyzed by methionine synthase (5-methyltetrahydrofolate-homocysteine methyl-transferase), which requires methyl cobalamin (MeCbl) (253), one of the two known coenzyme forms of the complex, as its cofactor. 5 -Deoxyadenosyl cobalamin (AdoCbl) (254), the other coenzyme form of cobalamin, occurs within mitochondria. This compound is a cofactor for the enzyme methylmalonyl-CoA mutase, which is responsible for the conversion of T-methylmalonyl CoA to succinyl CoA. This reaction is involved in the metabolism of odd chain fatty acids via propionic acid, as well as amino acids isoleucine, methionine, threonine, and valine. 

FAO/WHO (Food and Agriculture Organization/World Health Organization) (1988) Requirements of Vitamin A, Iron, Folate and Vitamin B12. Joint Expert Consultation Report. FAO Food and Nutrition Series 23, FAO, Rome. 

Another important vitamin is folate, which is required for purine and pyrimidine nucleotide synthesis. Since folate and its derivatives are generally lipo-phobic anions, they do not traverse biological membranes via simple diffusion but rather have to be taken up into the cells by specific transport processes... 

TK), 5-FU is activated to 5-fluorodeoxyuridine monophosphate (5-FdUMP). Potent inhibition of thymidylate synthase (TS) by 5-FdUMP is considered critical for 5-FU cytotoxicity. TS catalyzes the rate-limiting step of DNA synthesis, such as the conversion of dUMP into dTMP. Optimal TS function requires the formation of a covalent ternary complex consisting of TS, the folate cofactor 5,10-methylenetetra-hydrofolate (CH2THF), and 5-FdUMP. Inadequate cellular levels of 5,10-methyle-netetrahydrofolate reduce the stability of the ternary complex and consequently the inhibition of TS by 5-FdUMP. For this reason, 5-FU is administered in association with folinic acid, a precursor of 5,10-methylenetetrahydrofolate [40]. 

Fig. 14.10 Folate metabolism and role of MTHFR. Genetically reduced MTHFR activity affects the distribution between folate species required for protein and DNA synthesis. Higher availabil ity of 5,10-methylenetetrahydrofolate (CH2THF) potentiates the TS inhibition by 5-FdUMP, the active metabolite of 5-FU. Hey, homocysteine Met, methionine CH3HF, 5-methyltetrahydrofolate TS, thymidylate synthase 5-FdUMP, fluorodeoxyuridine monophosphate.

Methionine synthase deficiency (cobalamin-E disease) produces homocystinuria without methylmalonic aciduria 677 Cobalamin-c disease remethylation of homocysteine to methionine also requires an activated form of vitamin B12 677 Hereditary folate malabsorption presents with megaloblastic anemia, seizures and neurological deterioration 678... 

The fibroblasts do not convert cyanocobalamin or hydroxocobalamin to methylcobalamin or adenosyl-cobalamin, resulting in diminished activity of both N5-methyltetrahydrofolate homocysteine methyltransferase and methylmalonyl-CoA mutase. Supplementation with hydroxocobalamin rectifies the aberrant biochemistry. The precise nature of the underlying defect remains obscure. Diagnosis should be suspected in a child with homocystinuria, methylmalonic aciduria, megaloblastic anemia, hypomethioninemia and normal blood levels of folate and vitamin B12. A definitive diagnosis requires demonstration of these abnormalities in fibroblasts. Prenatal diagnosis is possible. 

J. R. Bertino, P. F. Nixon, and A. Nahas, Mechanism of uptake of folate monoglutamates and their metabolism. In Folic Acid Biochemistry and Physiology in Relation to Human Nutrition Requirements, National Academy of Sciences, Washington, D. C. 1977, p. 178. 

There are many causes of the clinical condition referred to as anaemia. One particular type, whose cause can be traced to a genuine metabolic defect is megaloblastic anaemia and is due to a deficiency of the vitamins B12 (cobalamin) and/or folate. These vitamins are required for normal cell division in all tissues, but the rapid production of red cells makes them more susceptible to deficiency. In megaloblastic anaemia the blood haemoglobin concentration falls the synthesis of haem is not impaired. Examination of the blood reveals the appearance of larger then normal cells called macrocytes and megaloblasts are found in the bone marrow. 

These one-carbon groups, which are required for the synthesis of purines, thymidine nucleotides and for the interconversion some amino acids, are attached to THF at nitrogen-5 (N5), nitrogen-10 (N10) or both N5and N10. Active forms of folate are derived metabolically from THF so a deficiency of the parent compound will affect a number of pathways which use any form of THF. 

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. 

Figure 5.10 The interconversion of folate metabolites. /V5,/V10-methenylTHFis required for purine synthesis. /V5,/V10-methylene THF and /V10-formylTHF are required for deoxythymidylate (pyrimidine) synthesis...

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