Folic Acid

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Folic Acid

• I am not responsible for errors
• Nosaj

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• This is a deficiency of normal sized erythrocytes

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• Normocytic
• Deficiency of normal sized erythrocytes
• Iron Deficiency
• Hemorrhage
• Hemolysis
• Anemia of chronic disease (autoimmune disease,
  cancer etc.

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• This is a deficiency of hemoglobin leading to
  small sized erythrocytes.

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• Microcytic
• Causes include Iron deficiency

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• This is a condition where the erythrocytes are
  larger than normal.

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• Megaloblastic
• Causes
• Folic acid
• Cobalamin (cyanocobalamin)

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• This is a decreased ability of the bone marrow to
  make new erythrocytes.

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• Aplastic Anemia

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• Defective Hemoglobins

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• Sickling Disease (Sickle Cell Anemia)
• Thalessemias

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• Folic acid was discovered by who?

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• Professor Snell (U of Texas)
• Dr. Snell ate a lot of spinach and now his farts
  smell really bad. Spinach because folic acid was
  named after folium or leaf from spinach.

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• What is the recommended dose of Folic acid for
  women contemplating pregnancy?

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• 0.4mg (400 µg) to 1 mg (1,000 µg)
• Why are women recommended to take this vitamin?

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• Women are recommened to take this vitamin to
  prevent neural tube defects (NTDs) such as spina
  bifida and anencephaly.

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• The commercial form of folic acid is comprised of
  what?

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• Pteridine ring
• p-aminobenzoate
• glutamate

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• Dietary polyglutamates are cleaved to the
  monoglutamate vitamin by a

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• ?-L-glutamylcarboxy peptidase commonly called
• conjugase

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• Folic acid and tetrahydrofolate are absorbed as
  the _________ form

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• Monoglutamate

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• What does methotrexate do?

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• Methotrexate inhibits the conversion of Folic
  acid to tetrahydrofolate (THF, FH4)

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• How many forms of folic acid are cofactors?

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• Four forms.

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• 5,10-methylene THF (N5,N10-methylene THF)
• What does this form of the cofactor do?

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• N5,N10-methylene THF
• Methylation of dUMP forming dTMP
• Synthesis of serine from glycine.
• I bet the some guy in a lab named this dump after
  taking a shit.

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• What does the 10-formyl THF form of folic acid do?

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• 10-formyl THF
• Conversion aminoimidazole carboxamide fibotide
  (AICAR) to Formamidoimidazole carbxamide ribotide
  (FAICAR) in purine biosynthesis.

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• 5,10 methenyl THF

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• Synthesis of formylglycine ribotide (FGAR) from
  glycine amide ribotide (GAR) in purine
  biosynthesis.

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• 5 methyl THF (N5-methyl THF)

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• Methylation of homocysteine forming methionine
• Important
• This is the one cofactor form which is not
  interchangeable with any of the other cofactor
  structures.
• It is the predominant

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• This cofactor of folic acid undergoes methylation
  of homocysteine forming methionine.

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• 5 methyl THF (N5-methyl THF)
• Methylation of homocysteine forming methionine.
• This is the one cofactor form which is not
  interchangeable with any of the other cofactor
  structures.

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• This is the administered form of folic acid
  following methotrexate therapy to return
  tetrahydrofolate activity to normal levels in
  benign tissues.

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• 5-Formyl THF (Folinic acid, citrovorum factor)

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• What is the leading cause of folic acid
  deficiency in the United States

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• Alcoholism

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• True or False
• Sunlight can destroy ultraviolet light (sunlight)
  destroys body stores of folate.

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• Possible
• Based on correlation that more problems are seen
  with fair skinned individuals living in sunny
  areas.

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• What is the order of cofactors starting with THF
  and ending With THF

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• THF
• N10 formyl THF
• N5,N10 Methenyl THF
• N5,N10 Methylene - THF
• N5 Methyl- THF
• THF

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• Its a good question because it is heat labile
  and is destroyed in the cooking process.

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• What are the commercial forms of folic acid

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• Folic acid
• Sodium Folate
• Leucovorin Calcium (5 formyl THF, folinic acid,
  citrovorum factor)

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• True or False
• Folic acid has an RDA.

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• True
• RDA
• Dietary Folate Equivalent (DFE)

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• What is the RDA for Folic Acid?

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• RDA
• Adults 400 mcg DFE/DAY
• Pregnancy 600 mcg DFE/DAY

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• What type of anemia would a woman have during
  menstruation?

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B

• Normocytic because it can be a deficiency of
  iron, hemorrhage.

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• Dr. Block has an iron deficiency what type of
  anemia would it be?

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• Microcytic
• Inability to make adequate amount of hemoglobin
  leading to small sized erythrocytes
• Iron deficiency (He said he has problems with
  iron absorption)

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• This anemia is caused by toxins.

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• Aplastic anemia

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• What form of folic acid stored in the body? 3-6
  month supply?

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• Polyglutamate form

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B12

• What is the other name for B12?

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• Cyanocobalamin

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• What happens in the stomach of cobalamin uptake?

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• The cobalamins combine with a stomach protein
  called R -Factor
• R B12 --gt R---B12

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• True or False
• Deficiency of B12 is a direct result of poor diet.

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• False
• Why
• BC The problem is due to malabsorption due to
  lack intrinsic factor.

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• True or False
• Your liver stores only 2 month supply of B12.

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• False
• Due to enterohepatic cycling you could
  potentially get 20 years.

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• What are the two biochemical functions of B12.

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• Regenerate methionine by transfering the methyl
  group from 5-CH3-THF to homocysteine.
• The final reaction in the conversion of propionyl
  CoA to succinyl CoA.
• (Key RXN causes damage to mylen sheath.

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• What are symptoms of a cobalamin deficiency?

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• A characteristic megaloblastic anemia which may
  be masked by a megaloblastic anemia by folic acid
  deficiency.
• Degeneration of the myelin sheath in the spinal
  chord
• Degeneration of the peripheral nerves affecting
  the reflexes and walking
• Deterioration of the patients mental state.

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• If you were deficient in both cyanocobalamin and
  folic acid would you still have megablastic
  anemia?

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• Because you wouldnt be able to get out of the
  5-methyl THF trap

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• What was that again?

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• Megablastic anemia
• Degeneration spinal chord
• Degeneration of peripheral nerves
• Trouble walking
• ?Mental state

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• Loss of intrinsic factor may be a result of what
  process?

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• Achlorohydria
• ??gastric acid production
• W/O HCl

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• If a deficiency of B12 is apparent what would be
  high in the blood?

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• Homocysteine
• 5-CH3-THF (5 Methyl THF) (from the methyl trap
  hypothesis.)
• Methylmalonyl CoA

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• For some reason I have lost the ability to
  produce intrinsic factor how long do I have in
  liver supplies?

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• 3 - 6 year supply of the vitamin in the liver.
• Some sources say that if the liver stores are
  excellent, the patient may get along for the next
  twenty years due to efficient enterohepatic
  cycling.

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• Cobalamin is a cofactor for what conversion step
  in the Kreb Cycle?

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• Methylmalonyl CoA to succinyl CoA

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• How do we make B12?

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• This is the one, true natural vitamin.
• It is obtained from anaerobic bacteria.
  (Fermentation- not in the body)

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• What is the RDA for B12?

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• 2.4 µg/day

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• What is the UL of B12

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• None Reported.

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• What are food sources of B12?

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• Liver
• Kidney
• Red Meat
• Dairy products
• Clams and mussels high concentrations.

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• What drugs do you not want to take with B12?

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• H2RAs
• PPI

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• What drug decreases absorption of folic acid?

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• Phenytoin Dilantin

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• What are the dietary and natural forms of
  cobalamin

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• Commercial Form R CN
• Dietary forms R CH3 adenosyl