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[Acute pancytopenia induced by pyrimethamine during treatment of cerebral toxoplasmosis associated with AIDS. Role of dihydrofolate reductase inhibitors].

An AIDS patient with cerebral toxoplasmosis had a folate deficiency-induced acute pancytopenia, which was rapidly reversed by the administration of folic acid. This observation is particularly important as a possible preventive therapy to be given to all HIV-infected patients because of the anti-folic activity of the majority of anti-infectious agents used during the course of this disease and the many potential sites of hematopoietic involvement. The patient's condition is stressed because the undernourished subject is at greater risk for this type of manifestation.

Acquired Immunodeficiency Syndrome↗

Celiac sprue in an asymptomatic elderly man.

The authors discuss the case of an asymptomatic patient with celiac sprue presenting with hematologic abnormalities on screening laboratory examination. The patient was initially treated for vitamin B-12 and folate deficiency, and subsequently for iron deficiency with limited success until the diagnosis was established. The absence of such classic features of celiac disease as steatorrhea and diarrhea is not an uncommon presentation. Unexplained iron deficiency should alert the clinician to the possibility of celiac sprue.

Aged↗

Purine synthesis and reutilization in folate-deficient rat hepatocytes.

Although folic acid is known to be involved in the pathways of purine metabolism, the precise changes brought about in purine synthesis, reutilization, pool sizes, and ratios by experimental folate deficiency are not clear. Consequently, these aspects of purine metabolism were measured in hepatocytes from control and folate-deficient rats fed an amino acid diet with and without folic acid, respectively. Purine synthesis and reutilization were measured as the rates of incorporation of [U-14C]glycine and [G-3H]hypoxanthine, respectively, into the adenine and guanine pools of freshly isolated hepatocytes after a 3-hour incubation in folate-free, as well as folate- and/or thymidine-supplemented culture media. Hepatocytes from folate-deficient rats had the same rates of purine synthesis as those from control rats. Purine reutilization, purine pool sizes, and the adenine:guanine ratios were lower in hepatocytes from deficient compared with control rats. Purine synthesis was increased when folic acid or thymidine was added to the culture medium. Although hepatocytes from folate-deficient rats had a lower rate of purine reutilization compared with those from control rats, the reutilization rates did not respond to the addition of folic acid or thymidine to the culture medium. The data suggest that purine synthesis was not impaired but purine reutilization was diminished in folate deficiency. Thymidine was as effective as folic acid in stimulating purine synthesis in both control and folate-deficient hepatocytes.

Animals↗

Diagnosis of megaloblastic anaemias.

There are a large number of causes of megaloblastic anaemia. The most frequent are disorders resulting in vitamin B(12) or folate deficiency. The diagnostic process often consists first of establishing the presence of B(12) or folate deficiency and then of determining the cause of deficiency. The blood count, blood film, serum B(12) assay, and red cell and serum folate assays are the primary investigations. Other useful investigations include serum/plasma methylmalonic acid (MMA), plasma total homocysteine (tHCYS) and serum holo-transcobalamin II assays. All currently used tests have limitations regarding specificity or sensitivity or both and the metabolite assays are not widely available. An understanding of these limitations is essential in formulating any diagnostic strategy. The wide use of serum B(12) and metabolite assays has resulted in the increasingly early diagnosis of B(12) deficiency, often in patients without B(12)-related symptoms (subclinical deficiency). Food cobalamin malabsorption is the most frequent cause of a low serum B(12). At least 25% of low serum B(12) levels are not associated with elevated metabolite levels and may not indicate B(12) deficiency. Some of these are caused by partial deficiency of transcobalamine I.

Anemia, Megaloblastic↗

Acute folate deficiency in surgical patients on aminoacid/ethanol intravenous nutrition.

Acute folate deficiency with pancytopenia and megaloblastic haemopoiesis developed in four patients after abdominal operations; all four responded to folic acid over 3-9 days. Three of them had been given intravenous nutrition with amino-acid/ethanol before the blood changes developed. A prospective study of twenty-five surgical patients with gastrointestinal diseases revealed a high frequency of acutely developing negative folate balance. Megaloblastic haemopoiesis and consequent blood changes were found in five patients. Treatment with intravenous nutrition correlated strongly with a fall in serum-folate and megaloblastic haemopoiesis. Some surgical patients develop acute folate deficiency which may proceed to megaloblastic arrest of haemopoiesis. Patients receiving intravenous nutrition containing ethanol are especially prone to this complication, which may be life-threatening if untreated. It is not yet known whether other forms of intravenous nutrition carry a similar risk.

Acute Disease↗

Downregulation of miR-122 in the rodent and human hepatocellular carcinomas.

MicroRNAs (miRs) are conserved small non-coding RNAs that negatively regulate gene expression. The miR profiles are markedly altered in cancers and some of them have a causal role in tumorigenesis. Here, we report changes in miR expression profile in hepatocellular carcinomas (HCCs) developed in male Fisher rats-fed folic acid, methionine, and choline-deficient (FMD) diet. Comparison of the miR profile by microarray analysis showed altered expression of some miRs in hepatomas compared to the livers from age-matched rats on the normal diet. While let-7a, miR-21, miR-23, miR-130, miR-190, and miR-17-92 family of genes was upregulated, miR-122, an abundant liver-specific miR, was downregulated in the tumors. The decrease in hepatic miR-122 was a tumor-specific event because it did not occur in the rats switched to the folate and methyl-adequate diet after 36 weeks on deficient diet, which did not lead to hepatocarcinogenesis. miR-122 was also silent in a transplanted rat hepatoma. Extrapolation of this study to human primary HCCs revealed that miR-122 expression was significantly (P = 0.013) reduced in 10 out of 20 tumors compared to the pair-matched control tissues. These findings suggest that the downregulation of miR-122 is associated with hepatocarcinogenesis and could be a potential biomarker for liver cancers.

Animals↗

Tribromomethane exposure and dietary folate deficiency in the formation of aberrant crypt foci in the colons of F344/N rats.

Folate and folic acid are forms of the B vitamin that are involved in the synthesis, repair, and functioning of DNA and are required for the production and maintenance of cells. Low levels of folate have been associated with several forms of cancer, including colon cancer. Aberrant crypt foci (ACF), identified as putative precursor lesions in the development of colon cancer, have been induced by the drinking water disinfection by-product, tribromomethane (TBM). To investigate whether ACF induced by TBM could be promoted by a diet devoid of dietary folate, male F344/N rats were exposed to 500 mg/l of TBM in drinking water and fed either a normal or no folate diet (NFD) for 26 weeks. At the conclusion of the study, colons were excised and examined for ACF. Rats exposed to TBM and fed a NFD, evident by significantly reduced serum folate concentrations and elevated serum homocysteine levels, had significant increases of ACF when compared to rats exposed to TBM and fed a normal diet. This study highlights the important role that diet, especially folate intake, represents in protecting the colon against TBM-induced ACF.

Animals↗

Effects of acute ethanol on urinary excretion of 5-methyltetrahydrofolic acid and folate derivatives in the rat.

Acute ethanol treatment enhances the urinary excretion of endogenous folate. This effect has been implicated in the development of folate deficiency associated with chronic alcoholism. Previous studies have shown that urinary excretion of total [3H]-label after administration of [3H]folic acid is slightly higher in ethanol-treated rats because of conversion of the tracer to forms whose excretion is not affected by ethanol. Since [3H]folic acid is not the physiological substrate for the kidney, studies were performed using a high specific activity 5-methyltetrahydrofolic acid ([3H]5-CH3-H4 folic acid). Male Sprague-Dawley rats were given four consecutive hourly doses of ethanol at 1 g/kg, followed by infusion of [3H]5-CH3-H4 folic acid at 5 h. Urine samples were collected to 6 h, when rats were killed, and plasma, liver and kidney samples were collected. Endogenous urinary folate excretion and the fractional urinary excretion of both endogenous and [3H]5-CH3-H4 folic acid at the 5-6 h time period were significantly higher in ethanol-treated rats. The kidney had a tenfold greater specific incorporation of [3H]-label than did the liver. High performance liquid chromatography (HPLC) analysis of the plasma obtained at 6 h showed that 68% of the label was [3H]5-CH3-H4 folic acid, and HPLC analysis of the urine obtained from 5-6 h showed that only 10% of the label was [3H]5-CH3-H4 folic acid. The data indicate that [3H]5-CH3-H4 folic acid was rapidly taken up by the kidney and metabolized to other folate and nonfolate forms, which were then secreted into the renal tubule for excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗

The aetiology of severe anaemia in pregnancy in Ndola, Zambia.

The aetiology of severe anaemia (haemoglobin less than 7.0 g dl-1) has been studied in 37 pregnant Zambians. Aetiology was usually multiple; 31 (84%) had Plasmodium falciparum malaria, 23 (62%) were folate deficient, 13 (35%) were iron deficient, one had sickle-cell anaemia and one had the acquired immunodeficiency syndrome (AIDS). Folate deficiency was most often secondary to malarial haemolysis: iron deficiency was nutritional, but hookworm was contributory in about one-third of patients. The anaemia of malaria and folate deficiency was both more common and more severe than anaemia due to iron deficiency; it was seen in younger women although primigravidae were not over-represented, it occurred earlier in pregnancy, and was associated with low birthweight. AIDS must now be included in the differential diagnosis of anaemia in pregnancy. Vigorous antimalarial treatment and prophylaxis are essential in the management and prevention of anaemia in pregnancy. Total dose iron infusion is indicated only when severe iron deficiency anaemia has been proven, and must be accompanied by antimalarial therapy and folic acid supplements. Because of the risk of transmission of human immunodeficiency virus, it is more important than ever to prevent anaemia and malaria in pregnancy, and to give blood transfusion only as a life-saving treatment.

Acquired Immunodeficiency Syndrome↗

Malabsorption of dietary folate (Pteroylpolyglutamates) in adult coeliac disease and dermatitis herpetiformis.

Tests of absorption of folic acid (pteroylglutamic acid) and of dietary folates (pteroylpolyglutamates) were performed in 10 patients with untreated adult coeliac disease, five with dermatitis herpetiformis, and three with nutritional folate deficiency. Absorption of pteroylglutamic acid was impaired in eight patients with coeliac disease and in two with dermatitis herpetiformis. Absorption of pteroylpolyglutamates was impaired in all 10 coeliac patients and in four of the five patients with dermatitis herpetiformis. Absorption of both forms of folate was normal in all three patients with nutritional folate deficiency.

Adult↗