Biochemical mechanisms in the Killmann experiment: critique of the deoxyuridine suppression test

Cobalamin-dependent metabolism in chronic myelogenous leukemia determined by deoxyuridine suppression test and the formiminoglutamic acid and methylmalonate excretion in urine

The cobalamin metabolism in chronic myelogenous leukemia (CML) was evaluated in 18 newly diagnosed and untreated patients by formiminoglutamic acid (FiGlu) and methyl malonic acid excretion (MMA) tests. A deoxyuridine (dU) suppression test of bone marrow cells was compared in patients with acute myelogenous leukemia (N = 5), myelodysplastic disease (N = 3), untreated pernicious anemia (N = 16), folate deficiency (N = 7), and a hospital reference group without signs of cobalamin or folate deficiency (N = 22). All had normal MMA excretion but 3 of 15 patients had increased FiGlu excretion. In vitro thymidine uptake in bone marrow cells of CML patients were lower (mean 40 fmol/106 cells) than pernicious anemia patients (115 fmol/106 cells). Methotrexate (MTX) increased the uptake in all cases. Addition of formyl-THF, methyltetrahydrofolate (methyl-THF), and pteroylglutamic acid (PGA) tended to normalize the effect of MTX. In pernicious anemia methyl-THF only decreased the uptake in combination with CN-Cbl. dU suppression values were significantly higher (6.3%) in CML than in the reference group (4.4%), but significantly lower than in pernicious anemia (41.6%) and folate deficiency (28.5%). The dU suppression values in bone marrow cells of CML patients correlated significantly with the transferrin saturation. In buffy coat cells dU suppression values were even higher (9.3%) than in bone marrow cells of the same CML patients. Addition of folate forms and CN-Cbl did not change the dU suppression values in CML, as it did in pernicious anemia. MTX increased dU suppression values significantly in all patients, but more in CML (64.5%) than in pernicious anemia (48.6%) and controls (49.8%). The MTX effect was to some extent neutralized by folate analogues with formyl-THF as the most effective followed by methyl-THF and lastly PGA. Methyl-THF also neutralized MTX in pernicious anemia, but its effect was certainly enhanced by addition of CN-Cbl. Thymidine uptake and dU suppression patterns were not significantly changed in CML after treatment with busulfan for 1 week or in accelerated phase. We concluded that signs of cobalamin or folate deficiency (apart from one patient) cannot be demonstrated in untreated CML. However, dU suppression was significantly increased and more so in circulating myeloid cells than in bone marrow. This indicates a deranged metabolism of deoxynucleotides which is independent of cobalamin and folates, and a difference between bone marrow cells and circulating cells. dU suppression is a valuable indicator of cobalamin deficiency.(ABSTRACT TRUNCATED AT 400 WORDS)

Metabolic evidence of cobalamin deficiency in bone marrow cells harvested for transplantation from donors given nitrous oxide

Nitrous oxide inactivates cobalamin, but clinically apparent sequelae ensue in nondeficient individuals only when exposure is prolonged. The gas is widely used in anesthesia, therefore, and is commonly given to donors during harvesting of their bone marrow cells for transplantation. The present study shows that nitrous oxide administered for only 75-120 minutes induced mild but unequivocal DNA synthetic abnormalities attributable to cobalamin deficiency in the harvested marrow cells of 4 out of 5 donors; the deoxyuridine suppression test in these 4 patients showed abnormal results more than 4 standard deviations above the reference mean. Metabolic evidence of cobalamin deficiency in cryopreserved cells diminished only slightly when they were thawed and retested 1 day later, but was no longer detectable in cells thawed and tested on the 3rd day. In contrast, cells harvested under nitrous oxide-free anesthesia in 4 subjects showed no evidence of cobalamin deficiency in the deoxyuridine suppression test. These results demonstrate that even relatively brief exposure to nitrous oxide induces cobalamin deficiency in harvested bone marrow cells, and that the cells remain metabolically impaired for more than 24 hours. Although clinical sequelae are not apparent at this time, the several potential implications of our findings indicate that the use of nitrous oxide in bone marrow transplantation needs to be evaluated further.

The effects of folate deficiency on thymidylate synthetase activity, deoxyuridine suppression, cell size and doubling time in a cultured human myeloid cell line

To help understand the pathogenesis of megaloblastic anaemia, we have studied folate-deprived HL60 cells. Cells grown with no added folic acid developed macrocytosis, a prolonged doubling time, a grossly increased deoxyuridine-suppressed value, and markedly reduced thymidylate synthetase activity. Cells in medium containing 50 nmol/l added folic acid became macrocytic with similar biochemical changes, but their doubling time was only marginally prolonged. In 100 nmol/l added folic acid, there was slight macrocytosis and a normal doubling time, but marked biochemical alterations were still present. The findings demonstrate that folate deficiency causes diminished thymidylate synthetase activity and macrocytosis in human myeloid cells, but that such cells may nevertheless demonstrate no prolongation of their doubling time, indicating either that their supply of thymidine triphosphate (TTP) is sufficient, or that misincorporation of deoxyuridine triphosphate (dUTP) is occurring. This suggests that the ineffectiveness of haemopoiesis in folate deficiency may result from damage to bone marrow cells in some way other than arrest in S-phase by a reduced delivery of TTP to the DNA replication fork.

In vitro DNA synthesis by megaloblastic bone marrow: effect of folates and cobalamins on thymidine incorporation and de novo thymidylate synthesis

The de novo pathway of thymidylate synthesis (i.e., methylation of dUMP to dTMP) is directly folate dependent and indirectly vitamin B12 (cobalamins) dependent. In deficiency of these vitamins, this pathway is impaired, and exogenous deoxyuridine (dU) fails to suppress adequately in vitro incorporation of [3H]thymidine (3H-TdR) into DNA via the salvage pathway (i.e., abnormal dU suppression). This abnormality is corrected by the addition of folate compounds (analogues) and/or vitamin B12 depending on the nature of the underlying deficiency. We studied the effects of addition of PteGlu, 5-methyl THF (5-CH3-FH4), 5-formyl-THF (5-CHO-FH4), and hydroxy-cobalamin (OH-cbl) on 3H-TdR incorporation into DNA and thymidine kinase activity (salvage pathway), and on [3H]deoxyuridine (3H-dU) incorporation and dU suppression values (de novo pathway) in cultures of normal and megaloblastic bone marrows. The results showed that 3H-TdR incorporation into DNA and the salvage enzyme, thymidine kinase, activity were greater and 3H-dU incorporation into DNA less in megaloblastic cells as compared with normal cells. The addition of folates significantly reduced 3H-TdR incorporation and thymidine kinase activity and enhanced 3H-dU incorporation in folate and vitamin B12-deficient cells except that 5-CH3-FH4 had no effect on vitamin B12-deficient cells. None of these additives had any significant effect on normal cells. This study also showed that the addition of the deficient vitamin(s) to the "control tubes" in the dU suppression test is inappropriate, as these vitamins may at least partially correct the defect in cellular DNA synthesis caused by the deficiencies of these vitamins and may mask these deficiencies in the results of the in vitro correction of the dU suppression abnormalities in mild cases of megaloblastic anemia.

Antiproliferative effects of methotrexate on peripheral blood mononuclear cells

Methotrexate was added to cultured mononuclear cells from the peripheral blood of normal individuals and patients with rheumatoid arthritis (RA) to study the drug's effects on mononuclear cell proliferation and antibody synthesis. In the presence of methotrexate, marked antiproliferative effects (to levels less than 15% of baseline) were seen with 3H-deoxyuridine, but not with 3H-thymidine, as the marker of cell division. This difference was not due to altered kinetics of proliferation or the presence of salvage nucleotides in the culture medium. The absence of suppression of antibody production preactivated by pokeweed mitogen in vitro and the low levels of suppression of spontaneous IgM rheumatoid factor production by blood mononuclear cells from RA patients suggested a relative resistance of activated cells to the effects of methotrexate. The effects of methotrexate on both cell proliferation and antibody synthesis were completely reversed by the addition of high concentrations of exogenous folinic acid. The results suggest that methotrexate has effects on immunocompetent cells that may contribute to the efficacy of this drug in the treatment of RA and other autoimmune diseases.

Thymidylate synthesis and utilization via the de novo pathway in normal and megaloblastic human bone marrow cells

We have measured the thymidylate synthetase activity of intact bone marrow cells using a 3H2O release assay. The mean thymidylate synthetase activity of vitamin B12- or folate-deficient megaloblastic marrow cells was reduced only in severely anaemic patients. There was a correlation between thymidylate synthetase activity and RBC in patients with megaloblastic haemopoiesis. The mean rate of incorporation into DNA of 6-3H deoxyuridine was similar in megaloblastic and normoblastic marrows. The rate of thymidylate synthesis exceeded its incorporation into DNA in all marrows, and the mean ratio between synthesis and incorporation was similar in normoblastic and megaloblastic patients, being independent of both thymidylate synthetase activity and RBC. Thus de novo thymine nucleotides were not utilized more efficiently in megaloblastic marrow cells. These data suggest that impaired thymidylate synthesis may not be the central defect in megaloblastic haemopoiesis, and that there is only a single pool of thymidine triphosphate in human bone marrow cells.

Deoxyuridine suppression: biochemical basis and diagnostic applications

The deoxyuridine (dU) suppression test evolved out of investigations into the biochemical basis of the megaloblastic changes seen in vitamin B12 and folate deficiency. Although the abnormality in dU suppression which occurs in vitamin B12- or folate-deficient states is assumed to reflect impaired methylation of deoxyuridylate, there is still no direct demonstration that this is so. Furthermore, there is evidence that reactions other than the methylation of deoxyuridylate are involved in the phenomenon of dU suppression. Nevertheless, in clinical practice abnormal dU suppression serves as a sensitive index of the presence of megaloblastosis due to vitamin B12 or folate deficiency. dU suppression is also abnormal in a number of conditions other than vitamin B12 or folate deficiency, but its overall specificity in detecting tissue dysfunction due to these two deficiency states is considerably higher than that of the serum vitamin B12 or red cell folate levels. Consequently, the test enables us simply and rapidly to define those patients in whom macrocytosis is unrelated to a deficiency of vitamin B12 or folate. For these reasons, the dU suppression test has been adopted by several laboratories across the world for investigating patients with (a) possible vitamin B12 or folate deficiency, (b) macrocytosis, and (c) megaloblastic erythropoiesis. Since the dU suppression test is abnormal in transcobalamin II deficiency and in some congenital disorders of vitamin B12 and folate metabolism, it is very useful in the investigation of obscure anaemias in infancy and childhood. In addition, it has contributed to our understanding of the mechanisms underlying the myelotoxicity of certain drugs, and particularly of nitrous oxide.

Effects of Deoxycytidine on Mycoplasma-Associated Inhibition of Thymidine Incorporation and Growth in Antifolate-Containing Media

Several mycoplasma species markedly inhibit lymphokine- and mitogen-induced3H-thymidine incorporation in cultured lymphoid cells, but have negligible short-term effects on cellular DNA synthesis as assessed by cytofluorography or by cell counts. The deoxyribonucleotide precursor deoxycytidine (dC) reverses this inhibition, but has little effect on isotope incorporation in uninfected cultures. Human lymphoblastoid leukemia cell lines contaminated with mycoplasma and hypoxanthine guanosine phosphoribosyl transferase (HGPRT)-deficient subclones do not grow in conventional HAT medium, but the unselected parent lines proliferate when dC is included in the culture medium. The beneficial effect of dC on the growth of contaminated cultures in selection medium is amplified by the addition of the cytidine deaminase inhibitor tetrahydrouridine (THU). These observations and corroborating nucleotide pool analysis suggest that dC may exert its beneficial effects on cellular proliferation and isotope utilization by inhibiting a mycoplasma-associated enzyme, thymidine phosphorylase. The data also suggest that the conversion of dC to dU by the cellular enzyme cytidine deaminase reduces the ability of dC to salvage contaminated cultures in the presence of an antifolate. The addition of dC to the culture medium in various3H-thymidine incorporation assays makes possible the detection of stimulatory lymphokines despite the presence of mycoplasma contamination of the indicator cells. The normalization of nucleotide pools and cellular growth of mycoplasma-infected HGPRT (+) human leukemic cell lines with the addition of dC to HAT selection medium has made possible the use of infected HGPRT-deficient subclones as fusion partners in the generation of T-T hybridomas. Our studies also suggest that the ability of cells to grow in HAT medium only when dC is included is presumptive evidence for mycoplasma infection.

Effect of methotrexate on the deoxyuridine suppression test: results with different cell preparations

Recently, the deoxyuridine suppression test was used to detect folate deficiency. Several cell preparations were used in this test, and the sensitivity of the test seems to vary with them. We used whole blood (micro-dU test) and bone marrow cells for the deoxyuridine suppression test, and the effects of methotrexate were compared. [3H]Thymidine incorporation into DNA was highest when the concentration of methotrexate was 1 microM in the whole blood culture and bone marrow culture. Methotrexate concentrations from 100 nM to 1 mM did not affect the results of the micro-dU test. However, the bone marrow deoxyuridine test became abnormal with methotrexate, and the abnormality in test values was corrected by the addition of N5-formyltetrahydrofolate. Differences in the results between the micro-dU test and the bone marrow deoxyuridine suppression test seem to represent specificity of each dU test.

Metabolism of pyrimidine bases and nucleosides by pyrimidine-nucleoside phosphorylases in cultured human lymphoid cells

The anabolism of pyrimidine ribo- and deoxyribonucleosides from uracil and thymine was investigated in phytohemagglutinin-stimulated human peripheral blood lymphocytes and in a Burkitt's lymphoma-derived cell line (Raji). We studied the ability of these cells to synthesize pyrimidine nucleosides by ribo- and deoxyribosyl transfer between pyrimidine bases or nucleosides and the purine nucleosides inosine and deoxyinosine as donors of ribose 1-phosphate and deoxyribose 1-phosphate, respectively: these reactions involve the activities of purine-nucleoside phosphorylase, and of the two pyrimidine-nucleoside phosphorylases (uridine phosphorylase and thymidine phosphorylase). The ability of the cells to synthesize uridine was estimated from their ability to grow on uridine precursors in the presence of an inhibitor of pyrimidine de novo synthesis (pyrazofurin). Their ability to synthesize thymidine and deoxyuridine was estimated from the inhibition of the incorporation of radiolabelled thymidine in cells cultured in the presence of unlabelled precursors. In addition to these studies on intact cells, we determined the activities of purine- and pyrimidine-nucleoside phosphorylases in cell extracts. Our results show that Raji cells efficiently metabolize preformed uridine, deoxyuridine and thymidine, are unable to salvage pyrimidine bases, and possess a low uridine phosphorylase activity and markedly decreased (about 1% of peripheral blood lymphocytes) thymidine phosphorylase activity. Lymphocytes have higher pyrimidine-nucleoside phosphorylases activities, they can synthesize deoxyuridine and thymidine from bases, but at high an non-physiological concentrations of precursors. Neither type of cell is able to salvage uracil into uridine. These results suggest that pyrimidine-nucleoside phosphorylases have a catabolic, rather than an anabolic, role in human lymphoid cells. The facts that, compared to peripheral blood lymphocytes, lymphoblasts possess decreased pyrimidine-nucleoside phosphorylases activities, and, on the other hand, more efficiently salvage pyrimidine nucleosides, are consistent with a greater need of these rapidly proliferating cells for pyrimidine nucleotides.

Acquired folate deficiency in phytohaemagglutinin-stimulated human lymphocytes

3H-thymidine (3H-TdR) incorporation, deoxyuridine (dU)-suppressed values, modal cell volume and the relative DNA content of individual cells have been determined in phytohaemagglutinin (PHA)-stimulated normal human lymphocytes cultured for varying periods in folate-free medium and media supplemented with various concentrations of folic acid. The results indicate that when the intracellular folate content falls below 400-600 pg/10(6) cells, lymphocytes exhibit increased 3H-TdR incorporation into DNA, raised dU-suppressed values, an increase in cell volume and abnormal DNA synthesis. This critical concentration of folate is just present in resting lymphocytes, but falls on stimulation by PHA, and the effects of folate deficiency become increasingly evident beyond a culture period of 24 h unless the folic acid concentration in the medium is at least 0.32 microgram/ml. Thus human lymphocytes cultured in folate-free medium provide a model for folate-deficient DNA synthesis, but their usefulness for the performance of dU suppression tests in the diagnosis of clinical folate deficiency is likely to be limited.

The role of vitamin B12 and folate in carcinogenesis

The roles of vitamin B12 and folate in carcinogenesis are largely extensions of and linked to their roles in normal metabolism, particularly 1-carbon unit metabolism. A possible key area may be hypomethylation to "switch on" genes and methylation to "switch them off." Some vitamin analogues may act as antivitamins in these reactions, as may some vitamin-binding proteins. Others may act as specific delivery proteins. Using appropriate radioactive substrates and suspensions of vitamin-dependent normal and malignant cells, it may be possible to work out their positive and negative control of DNA synthesis.

Rapid determination of thymidylate synthase activity and its inhibition in intact L1210 leukemia cells in vitro

A rapid and convenient tritium release assay for measuring thymidylate (dTMP) synthase activity and its inhibition within intact mammalian cells is described in detail. Short-term incubation of murine leukemia L1210 cells with an appropriately labeled substrate precursor, either deoxyuridine ([5-3H]dUrd) or deoxycytidine ([5-3H]dCyd), allowed for: (1) uptake and intracellular conversion to the substrate deoxyuridylate ([5-3H]dUMP); and (2) the obligatory displacement of tritium from [5-3H]-dUMP during the dTMP synthase catalyzed reaction. Tritium released into the aqueous environment was quantitated after a quick one-step separation of tritiated H2O from other radiolabeled materials and cell debris. The amount of tritium released was evaluated as a function of a number of variables, including the concentration of labeled substrate precursors, cell number, and incubation time. Tritium from [5-3H]dCyd was released significantly faster than from [5-3H]dUrd under a variety of conditions. Both 5-fluorodeoxyuridine (1 microM) and methotrexate (10 microM), which effectively block intracellular dTMP synthesis, completely inhibited the release of tritium from either [5-3H]dCyd or [5-3H]dUrd demonstrating that the release of tritium is mediated exclusively by the dTMP synthase catalyzed reaction. In addition, there was a good correlation between tritium release, cellular uptake, and incorporation of [2-14C]dUrd into DNA. The inhibitory effects of antifolates such as methotrexate were independent of the type of labeled precursor used. In contrast, preferential interference with the release of tritium from [5-3H]-dCyd by dCyd derivatives and from [5-3H]dUrd by dUrd derivatives was observed, suggesting that competition for uptake and/or phosphorylation may contribute to the overall effects of certain nucleoside analogues on cellular dTMP synthase activity measured using the tritium release assay.

Methylcobalamin corrects the deleterious in vitro effect of nitrous oxide on thymidylate synthetase

In this study, cobalamin deficiency was produced in vitro by the use of nitrous oxide, known to inactivate the vitamin. In 14 sets of experiments, normal human lymphocytes stimulated with phytohemagglutinin on day 0 were exposed to nitrous oxide and oxygen on day 2. MeCbl was delivered later to half of the cells. Untreated cells served as a control. On day 3, the cells were harvested, the lymphocytes were lysed, and the obtained extracts were assayed for thymidylate synthetase. In 16 other experiments the same procedure was performed, and the incorporation of radioactive thymidine or deoxyuridine by the intact cells was measured. In additional experiments, a deoxyuridine suppression test of treated and untreated stimulated lymphocytes was also performed. The results indicate that nitrous oxide significantly reduces the activity of thymidylate synthetase and that this reduction is significantly corrected by MeCbl, suggesting a causative relation between the vitamin and the enzyme. However, there was no statistically significant effect of nitrous oxide demonstrated on the nucleoside incorporation nor on the deoxyuridine suppression test.

Disorders of cobalamin metabolism

Recent developments in our knowledge of the biochemistry and metabolism of cobalamin have given us some insight into clinical disorders. N2O, which easily induces cobalamin deficiency, both in vivo and in vitro, has greatly contributed to the investigation of the cobalamin deficient state, especially in relation to folate and amino acid metabolism. Demonstration of the cobalamin analog in human serum and a new enzyme which requires cobalamin as a coenzyme has led to recent increased interest in this field. The disorders of cobalamin metabolism will be summarized briefly as well as those areas currently of particular interest.

Differences in coenzyme specificity of the N5-methyltetrahydrofolate-homocysteine methyltransferases of various species: implications for corrin binding loci

Investigations of the coenzyme specificity of N5-methyltetrahydrofolate-homocysteine methyltransferases of diverse biological origin revealed previously unrecognized differences between Escherichia coli methyltransferase and the corresponding enzymes of other species. Cyanocobalamin (CNCbl) actively supports methyltransferase in extracts of animal tissues and E. coli. Cobinamide is more active than CNCbl with rat liver methyltransferase; however, it is non-competitively inhibitory with E. coli enzyme. E. coli methyltransferase, but not rat liver enzyme, is competitively inhibited by alpha-ribazole 3'-phosphate and 5,6-dimethyl-benzimidazole, two moieties of the nucleotide loop. This suggests that animal enzyme binds its corrinoid coenzyme at a site on the corrin macro-ring, while E. coli enzyme binds to the nucleotide loop as well as the macro-ring.

The deoxyuridine suppression test

The deoxyuridine suppression (dU) test, first described in 1964, has gained an important place both in the diagnosis of megaloblastic anemias and in the study of vitamin B12 folate interrelationships in the pathogenesis of megaloblastic anemia. The test measures the integrity of the de novo synthetic pathway of DNA synthesis, in which vitamin B12 and folate play an essential role. The exact mechanism of the test is still largely unknown. However, it is probably the most sensitive and specific functional test for the establishment of vitamin B12 and/or folate deficiency. As such, it is an important diagnostic tool in the investigation of patients suspected of suffering from deficiency of either or both of these vitamins. The test may also have applications towards the study of other factors required for the de novo synthesis of DNA.

Regulation of cobalamin and folate metabolism by methionine in human bone marrow cultures

In cobalamin deficiency folate metabolism is disturbed. In the liver this deranged metabolism can be overcome by methionine, however, methionine failed to overcome this abnormality in bone marrow cultures from cobalamin deficient patients. In cobalamin deficient E. coli mutant bacteria, methionine under different conditions could either inhibit or potentiate the growth of the organism. This study was therefore initiated to test the effect of methionine, under different conditions, on bone marrow cultures. The defective DNA synthesis in megaloblastic bone marrow due to cobalamin deficiency could be corrected by the in vitro addition of low 0.27 mumol (40 micrograms) but not high 6.7 mumol (1 mg) amounts of methionine. This was measured by the ability of deoxyuridine to suppress the 3H-thymidine incorporation into DNA. The effect of methionine in facilitating de novo DNA synthesis is probably due to the catalytic action of SAM which activates cobalamin dependent methyltransferase enzyme thus potentiating the effect of cobalamin. In contrast high concentrations of methionine may inhibit this enzyme.

Comparison of flow cytometric analysis and [3H]thymidine incorporation for measurement of the effects of drug toxicity on lymphocyte stimulation

Human mononuclear cells were exposed to three antiviral agents, stimulated with phytohemagglutinin, and assayed for DNA synthesis with [3H]thymidine uptake and flow cytometric analysis. Cytosine-arabinoside demonstrated inhibition of blastogenic reactivity by both [3H]thymidine uptake and flow cytometric analysis, whereas acyclovir showed no significant suppression. In contrast, (E)-5-(2-bromovinyl)-2'-deoxyuridine, a thymidine analog, demonstrated a lack of correlation between the two methods. The competitive inhibition of some compounds with [3H]thymidine incorporation necessitates the use of other methods to measure DNA synthesis.

Cellular abnormalities of folate deficiency

To trace the development of folate-deficient abnormalities of morphology and DNA synthesis, Friend erythroleukaemia cells were grown in media containing 10(2), 10(3) and 10(4) ng of [3H]PteGlu1/ml and then transferred to folate-free media. Parameters examined were: intracellular folate levels; growth potential; morphology; dU suppression; and DNA content by flow microfluorimetry. The most sensitive indicators of folate-deficient cell growth were those related to DNA synthesis (dU and flow microfluorimetry). These became abnormal at intracellular folate levels of 0.2-0.5 ng/10(6) cells and markedly so below 0.1 ng/10(6) cells. Morphological criteria were less sensitive. Cells became megaloblastic at intracellular folate levels below 0.06 ng/10(6). The capacity of the cells to replicate in folate-free media was a function of the intracellular folate (ICF): duplications = 4.01 + ln(ICF)/0.67 (r = 0.993, P less than 0.001). These studies demonstrate that regardless of initial intracellular folate levels, cellular stigmata of folate deficiency appear when cellular folate falls below 3 X 10(5) molecules per cell (dU and flow microfluorimetry) and cells lose the capacity for further replication below 7-10 X 10(5) molecules. The intracellular folate level not only predicts early defects, but also determines the replicative capacity.

The effect of folate analogues on the thymidine utilization by human and rat marrow cells and the effect on the deoxyuridine suppression test

The deoxyuridine (dU) suppression test assesses the capacity of marrow cells or activated lymphocytes to convert exogenous dU into thymidine. In addition, the effect of the added cobalamin or folate on the result is used to determine the nature of the deficiency in megaloblastic marrows. This study shows that folates have a considerable effect on the uptake of labelled thymidine by marrows from patients with megaloblastic anaemia in the absence of added dU. Less thymidine was taken up by megaloblastic marrow cells if they were first incubated with 5-formyltetrahydrofolate, 10-formyltetrahydrofolate or tetrahydrofolate. 5-Methyltetrahydrofolate increased thymidine uptake in cobalamin-deficient marrows and reduced thymidine uptake in folate-deficient marrows. These results could be explained if added folates facilitated utilization of endogenous dU. However, the addition of folates or cobalamin did not affect the validity of a dU suppression test with human marrow. More marked changes were present on the addition of folates to rat marrow cells both from control and nitrous oxidetreated animals.

Thymidylate synthesis in a folate deprived cell line

Abnormalities of the de novo and salvage pathways of thymidylate synthesis have been investigated in a folate deprived lymphoblastoid cell line. Impaired DNA synthesis was observed, with an increased percentage of cells in S and G2 phase, whereas the mitotic index was decreased. Thymidylate synthesis along the salvage pathway was markedly increased, with a higher activity of thymidine kinase and higher uptake of 3H-thymidine (3H-TdR). The same abnormalities were observed when cells were treated with 5-fluorodeoxyuridine or methotrexate. The de novo pathway was slightly modified with a nearly normal incorporation of 3H-6 deoxyuridine (3H-UdR) and a moderate decrease of thymidylate synthetase activity; in contrast, the uptake of 3H-dU was markedly inhibited in drug-treated cells. Preincubation with cold deoxyuridine (10(-4) M) did not suppress the uptake of 3H-TdR as efficiently as in control cells; with increasing concentration of dU to 10(-2) M, this suppressive effect became almost complete. This high concentration of cold dU exerted a competitive inhibition on thymidine kinase. The deoxythymidine triphosphate (dTTP) pool was increased in deficient cells and it was only slightly increased by addition of cold dU (10(-4) M) in the culture medium whereas a substantial expansion of this pool was observed in control cells treated under the same conditions. These data do not necessarily exclude a defect of thymidylate synthesis along the de novo pathway in the folate deficient cells. the normal incorporation of 3H-dU could be explained by a decreased isotope dilution due to a reduced deoxyuridine monophosphate (dUMP) pool. This pool could be decreased by feedback inhibition by dTTP on some enzymatic activities, mainly deoxycytidylate deaminase. The enlarged dTTP pool which probably derives mainly from the salvage pathway could be poorly functional for DNA replication according to the model of compartmentation of DNA precursors.