1What is folic acid also referred to as?
Vitamin B9, a water-soluble vitamin
2What are the three components of folic acid?
Pteridine (2-amino-4-hydroxy-pteridine / pterin), PABA (para-aminobenzoic acid), and Glutamic Acid
3What is the chemical name for the pteridine part of folic acid?
2-amino-4-hydroxy-pteridine (pterin)
4What are the dietary sources of folate?
Green leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, fruits (bananas, melons, lemons), yeast, mushrooms, meat and liver, and fortified foods
5Can the human body synthesize folate?
No, it must be obtained from dietary sources
6Where is dietary folate absorbed?
In the small intestine, in the upper jejunum
7What is the RNI of folate for an adult?
400 µg/day DFE (dietary folate equivalent)
8What is the RNI of folate in pregnancy?
600 µg/day DFE
9What is the RNI of folate during lactation?
500 µg/day DFE
10What are the key functions of folic acid?
Supports cell growth and DNA synthesis, promotes healthy red blood cell production, is crucial for fetal development, and supports tissue and organ health
11How is folic acid activated in the enterocyte?
Folate is reduced to dihydrofolate (DHF) and then to tetrahydrofolate (THF) by dihydrofolate reductase using NADPH
12Which enzyme converts folic acid to DHF and then to THF?
Dihydrofolate reductase (DHFR)
13What cofactor is used by dihydrofolate reductase to activate folate?
NADPH + H+
14How is tetrahydrofolate (THF) formed from folic acid?
By addition of four hydrogen atoms to the 5, 6, 7 and 8 positions in the pteridine ring
15What is the biologically active form of folate?
Tetrahydrofolate (THF)
16What is the main role of THF?
It acts as a carrier of one-carbon residues in one-carbon metabolism
17What are the six one-carbon groups carried by THF?
Formyl (-CHO), formimino (-CH=NH), methenyl (-CH=), methylene (-CH2-), hydroxymethyl (-CH2OH), and methyl (-CH3)
18From which donors does THF receive one-carbon fragments?
Serine, glycine, and histidine
19What is N10-formyl-THF required for?
Purine synthesis
20What is N5,N10-methylene-THF required for?
Conversion of dUMP to dTMP (thymidine monophosphate) and serine-glycine interconversion
21What is N5-methyl-THF used for?
It donates a methyl group for conversion of homocysteine to methionine, a reaction that requires vitamin B12
22What is N5-formimino-THF involved in?
Histidine metabolism
23What is the methyl group in N5-methyl-THF used for?
Synthesis of active methionine used in transmethylation reactions
24What transmethylation reactions require SAM derived from methionine?
Synthesis of choline, epinephrine, creatine, etc.
25What is the biochemical basis of megaloblastic / macrocytic anemia in folate deficiency?
Inhibition of DNA synthesis during erythropoiesis, delaying nuclear maturation and cell division while cytoplasmic maturation continues normally, so haemopoietic precursor nuclei appear abnormally large and immature
26What are the symptoms of folic acid deficiency due to defective DNA synthesis?
Fatigue and weakness, pallor, glossitis, and megaloblastic / macrocytic anemia
27Why does folate deficiency cause elevated homocysteine?
N5-methyl-THF cannot donate its methyl group to convert homocysteine to methionine
28What does high homocysteine cause?
Oxidative stress, endothelial damage, and enhanced thrombogenicity, increasing risk of myocardial infarction and stroke
29What fetal defect is caused by folic acid deficiency in pregnant women?
Neural tube defects such as spina bifida due to improper closure of the neural tube
30What characterizes neural tube defects in terms of folate and homocysteine?
Elevated homocysteine and decreased folic acid levels in pregnant women
31How can neural tube defects be prevented?
Periconceptual supplementation with folate reduces the risk
32Why are sulfonamides selective against bacteria and not humans?
Humans cannot synthesize folic acid and must rely on dietary sources, while bacteria synthesize it; sulfonamides are PABA analogs and do not interfere with human purine synthesis
33How do sulfonamides work as antibacterial antifolates?
Because of structural similarity to PABA, they compete for bacterial dihydropteroate synthase, so THF cannot be converted to purines needed for bacterial DNA synthesis and the bacterial cell cannot divide
34What is the target enzyme of sulfonamides?
Dihydropteroate synthase (DHPS) in bacteria
35How does methotrexate work in cancer treatment?
It is a folic acid analogue that inhibits dihydrofolate reductase (DHFR), limiting THF available for purine synthesis and slowing DNA replication in mammalian cells
36Why is methotrexate toxic to normal cells?
It is toxic to all dividing cells, not only cancer cells
37What are the targets of antifolates in malaria?
Dihydropteroate synthase (DHPS), inhibited by sulfa drugs, and dihydrofolate reductase (DHFR), inhibited by pyrimethamine and trimethoprim
38Why are antifolates used in combination in malaria?
Combinations of inhibitors acting against different targets have a synergistic effect and help prevent drug resistance