Fatal Folic Acid Toxicity in Humans

Impact of folic acid supplementation on ischemia‒reperfusion-induced kidney injury in rats: folic acid prophylactic role revisited

Folic acid (FA), with its anti-inflammatory and antioxidant properties, may offer protection against ischemia-reperfusion (IR) injury. This study investigated whether FA safeguards rat kidneys from IR by targeting high mobility group box-1 (HMGB1), a key inflammatory mediator. Fifty adult male Wistar rats were randomly allocated into four groups: control, IR, IR + FA pretreatment, and FA alone. Compared to controls, IR significantly impaired renal function and elevated levels of malondialdehyde, HMGB1, NF-κB, and caspase 3. FA pretreatment effectively reversed these detrimental changes, protecting renal function and minimizing tissue damage. The FA-alone group showed no significant differences compared to the control group, indicating no adverse effects of FA treatment. Mechanistically, FA inhibited HMGB1 expression and its downstream activation of NF-κB and caspase 3, thereby quelling inflammation and cell death. FA shields rat kidneys from IR-induced injury by suppressing HMGB1-mediated inflammation and apoptosis, suggesting a potential therapeutic avenue for IR-associated kidney damage.

Rationally Designed Naringenin-Conjugated Polyester Nanoparticles Enable Folate Receptor-Mediated Peroral Delivery of Insulin

Receptor-mediated transcytosis of nanoparticles is paramount for the effective delivery of various drugs. Here, we report the design and synthesis of highly functional nanoparticles with specific targeting toward the folate receptor (FR) for the peroral delivery of insulin. In doing so, we demonstrate naringenin (NAR), a citrous flavonoid, as a targeting ligand to FR, with a similar affinity as folic acid. The NAR-decorated nanoparticles indicated a 4-fold increase in FR colocalization compared to unfunctionalized nanoparticles. The NAR-conjugated precision polyester allows for high insulin loading and entrapment efficiencies. As a result, insulin-laden NAR-functional nanoparticles offered a 3-fold higher bioavailability in comparison to unfunctionalized nanoparticles. This work generated a promising contribution to folate-receptor-mediated peroral delivery of insulin, utilizing polymeric nanoparticles decorated with a natural ligand, NAR.

Characteristics of suicidal attacks in pregnancy; a multicenter study

BACKGROUND

Maternal death, fetal death and suicidal attack (SA), each one of these topics are an important public health problem. A suicide attack attempt during pregnancy includes all these important issues together and requires additional attention. Some factors may show regional differences such as suicidal method, distribution of attempts according to the gestational week and the most common preferred drugs. The predetermination of these variables may allow taking preventive measures and advantages can be gains on maternal-fetal health.

METHODS

The data of pregnant women who were admitted to 3 different university hospital emergency departments in same city between 2015 and 2020 after a SA was investigated. SAs features and distribution of attacks based on variables such as age, gravidity and gestational week etc. was recorded. In addition, obstetric/non-obstetric injuries and pregnancy outcomes was also analyzed.

RESULTS

The mean age of 78 cases was 26.9 ± 6.4 (17-44) years. SAs were detected most frequently in the 1st trimester (42.3%) and at least in the 3rd trimester (20.5%). The most preferred SA method (89.7%) was high-dose drug intake. The most commonly preferred drugs were paracetamol, iron/folic acid replacement therapy drugs and antidepressants.

CONCLUSIONS

Pregnant women are at risk of SA, especially in the first trimester. Contrary to popular belief, 75% of pregnant women who have SA do not have a known psychiatric disease diagnosis before. Therefore, psychiatric evaluation should be a part of routine pregnancy follow-up examination, especially in the first trimester. In this way, pregnant women which have increased risk factors for SA such as alcohol addiction, unwanted pregnancy, and depressive mood can be detected early. In this special patient group, the most commonly SA method is high-dose drug intake. Knowing the high dose treatments for frequently used drugs such as paracetamol by emergency physicians and obstetricians, educating medical staff about treatments can save additional time for mother and fetus and can be a life saver approach.

Dietary Intake and Genetic Background Influence Vitamin Needs during Pregnancy

Numerous approaches demonstrate how nutritional intake can be sufficient to ensure the necessary supply of vitamins. However, it is evident that not all vitamins are contained in all foods, so it is necessary either to combine different food groups or to use a vitamin supplement to be well-fed. During pregnancy, deficiencies are often exacerbated due to increased energy and nutritional demands, causing adverse outcomes in mother and child. Micronutrient supplementation could lead to optimal pregnancy outcomes being essential for proper metabolic activities that are involved in tissue growth and functioning in the developing fetus. In order to establish adequate vitamin supplementation, various conditions should be considered, such as metabolism, nutrition and genetic elements. This review accurately evaluated vitamin requirements and possible toxic effects during pregnancy. Much attention was given to investigate the mechanisms of cell response and risk assessment of practical applications to improve quality of life. Importantly, genetic studies suggest that common allelic variants and polymorphisms may play an important role in vitamin metabolism during pregnancy. Changes in gene expression of different proteins involved in micronutrients’ metabolism may influence the physiological needs of the pregnant woman.

Improved Stability of a Stable Crystal Form C of 6S-5-Methyltetrahydrofolate Calcium Salt, Method Development and Validation of an LC-MS/MS Method for Rat Pharmacokinetic Comparison

Folate is a vitamin beneficial for humans that plays an important role in metabolism, but it cannot be well supplemented by food; it is necessary to supplement it in other ways. Based on this consideration, a novel crystal form C of 6S-5-methyltetrahydrofolate calcium salt (MTHF CAC) was obtained. To explore the difference between MTHF CAC and the crystal form Ⅰ of 6S-5-methyltetrahydrofolate calcium salt (MTHF CA) as well as an amorphous product of 6S-5-methyltetrahydrofolate glucosamine salt (MTHF GA), their stability and pharmacokinetic behaviours were compared. The results of high-performance liquid chromatography coupled with ultraviolet detection analysis indicated that MTHF CAC showed a better stability than MTHF CA and MTHF GA. After oral administration of MTHF CAC, MTHF CA, and MTHF GA to male rats, the MTHF concentrations were analysed using a validated liquid chromatography-tandem mass spectrometry, and the pharmacokinetic parameters were compared. The mean residence times (0-t) of MTHF CAC, MTHF CA, and MTHF GA were 3.7 ± 1.9 h, 1.0 ± 0.2 h (p < 0.01), and 1.5 ± 0.3 h (p < 0.05), respectively. The relative bioavailability of MTHF CAC was calculated to be 351% and 218% compared with MTHF CA and MTHF GA, respectively, which suggests that MTHF CAC can be better absorbed and utilized for a longer period of time.

Amino group decorated coordination polymers for enhanced detection of folic acid

A series of fluorescent coordination polymers (CPs) {[Cd₂(CH₃-bpeb)₂(BDC)₂] CP1, (BDC)_0.5/(NH₂-BDC)_0.5-CP1, (BDC)_0.34/(NH₂-BDC)_0.66-CP1, (BDC)_0.25/(NH₂-BDC)_0.75-CP1, (BDC)_0.2/(NH₂-BDC)_0.8-CP1, (NH₂-BDC)-CP1} were prepared from conjugated ligand 4,4'-((2-methyl-1,4-phenylene)bis(ethene-2,1-diyl))bipyridine (CH₃-bpeb), terephthalic acid (BDC), aminoterephthalic acid (NH₂-BDC) and CdSO₄ under solvothermal conditions. The fluorescence of aqueous suspensions of these CPs was quenched by folic acid (FA) in a concentration dependent manner. The efficiency of quenching increasing with an increased proportion of NH₂-BDC ligand in the CP with (NH₂-BDC)-CP1 exhibiting a low detection limit of 1.7 × 10^-7 M.

Nutritional and medical food therapies for diabetic retinopathy

Diabetic retinopathy (DR) is a form of microangiopathy. Reducing oxidative stress in the mitochondria and cell membranes decreases ischemic injury and end-organ damage to the retina. New approaches are needed, which reduce the risk and improve the outcomes of DR while complementing current therapeutic approaches. Homocysteine (Hcy) elevation and oxidative stress are potential therapeutic targets in DR. Common genetic polymorphisms such as those of methylenetetrahydrofolate reductase (MTHFR), increase Hcy and DR risk and severity. Patients with DR have high incidences of deficiencies of crucial vitamins, minerals, and related compounds, which also lead to elevation of Hcy and oxidative stress. Addressing the effects of the MTHFR polymorphism and addressing comorbid deficiencies and insufficiencies reduce the impact and severity of the disease. This approach provides safe and simple strategies that support conventional care and improve outcomes. Suboptimal vitamin co-factor availability also impairs the release of neurotrophic and neuroprotective growth factors. Collectively, this accounts for variability in presentation and response of DR to conventional therapy. Fortunately, there are straightforward recommendations for addressing these issues and supporting traditional treatment plans. We have reviewed the literature for nutritional interventions that support conventional therapies to reduce disease risk and severity. Optimal combinations of vitamins B1, B2, B6, L-methylfolate, methylcobalamin (B12), C, D, natural vitamin E complex, lutein, zeaxanthin, alpha-lipoic acid, and n-acetylcysteine are identified for protecting the retina and choroid. Certain medical foods have been successfully used as therapy for retinopathy. Recommendations based on this review and our clinical experience are developed for clinicians to use to support conventional therapy for DR. DR from both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) have similar retinal findings and responses to nutritional therapies.

Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES)

BACKGROUND/OBJECTIVES

Studies based on food frequency questionnaires suggest that folate and vitamin B12 intake could protect against hearing loss. We investigated whether erythrocyte folate and serum vitamin B12 levels are independently associated with hearing loss in humans.

SUBJECTS/METHODS

Participants in the 2003-2004 US National Health and Nutrition Examination Survey who had data on hearing, folate, and vitamin B12 levels were included. Pure-tone average (PTA) at 0.5, 1.0, 2.0, and 4.0 kHz was computed for each ear. We used weighted logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation between quartiles of folate and vitamin B12, and hearing loss (present if PTA > 25 dB in either ear and absent if PTA ≤ 25 dB in both ears).

RESULTS

Participants (n = 1149) were 20-69 (mean 42) years old and 16.4% had hearing loss in at least one ear. Our data suggest a U-shaped relationship between folate and hearing loss. Compared to the 1st quartile, the ORs (95% CIs) for hearing loss were 0.87 (0.49-1.53), 0.70 (0.49-1.00), and 1.08 (0.61-1.94) for the 2nd, 3rd, and 4th quartile of erythrocyte folate in analyses adjusted for age, sex, vitamin B12, smoking, alcohol use, body mass index, race/ethnicity, exposure to noise, income, and education. Although we observed inverse associations between vitamin B12 and hearing loss, the associations were not statistically significant (P > 0.05).

CONCLUSIONS

Our data show a U-shaped relationship between erythrocyte folate levels and hearing loss, suggesting a need to evaluate whether optimizing blood folate levels could prevent hearing loss.