Altered folate metabolism and disposition in mothers affected by a spina bifida pregnancy: influence of 677c --> t methylenetetrahydrofolate reductase and 2756a --> g methionine synthase genotypes.

Periconceptional folate prevents spina bifida although the mechanisms involved are unclear. We present the genotype frequency for the 677 ct methylenetetrahydrofolate reductase (MTHFR) and 2756ag methionine synthase (MetSyn) polymorphisms. Calculated odds ratios (OR) show that neither the homozygous recessive genotype, carriage of the mutant allele, nor frequency of the mutant allele represent significantly increased risk for neural tube defect (NTD). This is true for both polymorphisms. Simultaneous carriage of t and g alleles is also not a significantly increased risk for NTD. OR and 95% CI for carriage of (i) t allele, (ii) g allele, and (iii) simultaneous carriage of t and g alleles in NTD are 0.89 (0.28-2.82), 0.97 (0.28-3.30), and 0.61 (0.11-3.52), respectively. OR and 95% CI for frequency of t and g alleles are 0.94 (0.42-2.13) and 0.88 (0. 29-2.67), respectively. Unlike some previous studies, we could not detect a significantly increased risk for NTD conferred by the 677ct MTHFR tt genotype; OR 0.98 (0.19-6.49). Differences were found to exist in the circulating whole blood folate profile: total formyl-H(4)PteGlu was significantly higher than total 5-methyl-H(4)PteGlu in control (P = 0.036) but not NTD blood. When broken down into the various 677 ct MTHFR and 2756ag MetSyn genotypes, carriage of the 677ct MTHFR allele appears to affect formyl-H(4)PteGlu metabolism in non-NTD mothers. In addition, NTD mothers exhibited noticeably lower formyl-H(4)PteGlu levels compared to controls; these effects, however, were not significant. 2756ag MetSyn is similarly associated with an altered formyl-H(4)PteGlu disposition. The ag genotype had significantly more formyl-H(4)PteGlu relative to 5-methyl-H(4)PteGlu than wildtype 2756ag MetSyn (P = 0.024). This heterozygous increase in the relative formyl-H(4)PteGlu level holds true for controls only; no such relationship occurred in NTD samples. Folyl hexaglutamates are the active cellular coenzyme forms. We showed that where 5-methyl-H(4)PteGlu(6) predominates, Hcy levels are highest. As the relative abundance of formyl-H(4)PteGlu(6) increased, so Hcy decreased, presumably due to increased Hcy remethylation, a process in which 5-methyl-H(4)PteGlu(6) is demethylated and downstream folates like formyl-H(4)PteGlu(6) are produced. The negative linear association between the hexaglutamate ratio (formyl-H(4)PteGlu(6)/5-methyl-H(4)PteGlu(6)) and Hcy is significant for control (r = -0.64, P = 0.003) but not NTD samples. This effect, centering on Hcy remethylation, is supported by a statistically elevated formyl-H(4)PteGlu(6) to 5-methyl-H(4)PteGlu(6) level in controls relative to NTDs (P = 0.047). The overall (polymorphism independent) effect of exogenous 5,10-methenyl-H(4)PteGlu(1) substrate on the cellular folate profile was to preferentially increase formyl-H(4)PteGlu, while exogenous 5-methyl-H(4)PteGlu(1) substrate dramatically increased metabolic production of 5, 10-methylene-H(4)PteGlu. The following differences were observed between NTD and control samples: (i) a reduced expansion of the formyl-H(4)PteGlu(6) pool in NTD with exogenous 5, 10-methenyl-H(4)PteGlu(1) (P = 0.0005 for control expansion, NS for NTD increase); (ii) a reduced initial expansion of the 5, 10-methylene-H(4)PteGlu pool in NTD following treatment with exogenous 5-methyl-H(4)PteGlu(1) substrate (difference between subject groups; P = 0.031). In addition, taking polymorphisms into account, lysate from NTD-MTHFR wildtypes utilized less exogenous 5-methyl-H(4)PteGlu(1) substrate than control-MTHFR wildtypes in the short (P = 0.011) and long term (P = 0.036). Commensurate with this latter effect, the initial production of 5,10-methylene-H(4)PteGlu due to exogenous 5-methyl-H(4)PteGlu(1) substrate was significantly reduced in the NTD-MTHFR wildtype (P = 0.037). These two MTHFR wildtype effects imply that the 677 ct polymorphism is not the only mutation affecting folate metabolism in NTD mothers. (ABSTRACT TRUNCATED)