FOLATE CYCLE METABOLIC PATHWAY (PW:0001207)
Description
Tetrahydrofolates (THF) are soluble forms of vitamin B9 that play essential roles in a number of metabolic pathways by mediating the transfer of 1-carbon (1C) units for the de novo synthesis of purines and thymidylates and for the re-methylation of homocysteine (Hcy) to methionine (Met). Humans cannot synthesize folate and must derive it from diet or as a supplement in the form of folic acid (FA). The folate/FA consist of three moieties: a pterin (pteridine) ring, a para aminobenzoyl group (PABA) and the amino acid glutamate. The biologically active derivatives are 5,6,7,8-tetrahydrofolates (THF) with 1C units at the N5, N10 positions or both. Their interconversion(s) assures the continuous provision of these important derivatives. The various aspects of folate uptake, processing and interconversion constitute the metabolic pathway of the folate cycle and are presented here. The important folate mediated 1C transfer reactions and the pathways and processes they support constitute the folate mediated one-carbon metabolic pathway and are presented in a separate diagram. Together they are part of the folate metabolic pathway. Dietary folates circulate as polyglutamates, also the forms that are better retained in the cell and are better substrates for the folate dependent enzymes. The uptake and transport of folates however, require the monoglutamic form. Hydrolysis of polyglutamates outside and inside the cell and addition of glutamates to the monoglutamate form are important for maintaining an adequate pool of biological active THFs and the balance between their influx and efflux. The intestinal apical brush border membrane anchored Folh1 hydrolyzes the polyGluTHFs which are then absorbed in the duodenum and jejunum by the Slc46a1 proton-coupled transporter. Circulating folates are transported into the cell by the folate receptors 1 and 2 and by Slc19a1 reduced folate carrier. MonoGluTHFs are taken up in the mitochondria by the Slc25a32 transporter. If FA is the folate source, it must first be reduced to dyhdrofolate (DHF) and then to THF by Dhfr. In the cell, addition of up to nine glutamate residues is mediated by Fpgs while their removal is mediated by the lysosomal enzyme Ggh. Segregation of the two processes allows cells to control the occurrence of the two reactions. The ratio of the two enzymatic activities is also important for the processing and availability of various antifolate drugs such as methotrexate (MTX). 1C units are derived primarily from serine, but also from glycine, dimethylglycine (DMG) and sarcosine. Mitochondria and the cytoplasm represent the major pools of folates and in the two compartments the interconversion of THF derivatives is largely carried out by separate enzymes. Serine is a major source of 1C; its transfer to THF generates 5,10-methyleneTHF and glycine in the reversible reaction catalyzed by the pyridoxal-5'-phosphate (PLP/vitamin B6) dependent Shmt1 and Shmt2 enzymes in the cytoplasm and mitochondria, respectively. 5,10-methyleneTHF can be oxidized to 10-formylTHF (FTHF) and formate or reduced to 5-methylTHF. 5,10-methyleneTHF, FTFH and 5-methylTHF are the 1C donors for the three important 1C transfer reactions and are highlighted along with the THF-co-factor with a different color. Mitochondria generate formate from THF. Shmt2 converts THF and serine (mSer) to 5,10-methyleneTHF. The glycine cleavage system (GCS) - a multienzyme complex of four subunits, uses glycine (mGly) to generate 5,10-methyleneTHF. Of the four GCS subunits, three are unique and one is shared with other mitochondrial complexes. Dimethylglycine (DMG) and sarcosine, derived from choline oxidation, are the other sources of 5,10-methyleneTHF generation in reactions catalyzed by Dmgdh and Sardh, respectively. The four enzymes/complex are associated with the inner mitochondrial membrane. 5,10-methyleneTHF is then sequentially processed to 5,10-methenylTHF and to FTFH by two bifunctional enzymes Mthfd and Mthfd2l; FTFH is then used to generate formate in the reaction catalyzed by Mthfd1l. Formate is transported to the cytoplasm where is condensed with THF to yield FTHF in the ATP-dependent reaction catalyzed by the trifunctional Mthfd1 enzyme. In the cytoplasm, 5,10-methyleneTHF generated by Shmt1 is the substrate for Mthfr, the FAD (flavin adenine dinucleotide), NADPH dependent enzyme which irreversibly converts it to 5-methylTHF. 5-methylTHF is the 1C donor for the cobalamin dependent Mtr mediated re-methylation of Hcy to Met in the homocysteine and methionine cycle metabolic pathways. Interconversion of 5,10-methyleneTHF and 5,10 methenylTHF (dehydrogenase reaction) and of 5,10-methenyl and FTFH (cyclohydrolase reaction) and the reaction of formate with THF generating FTFH (synthetase reaction are carried out by the trifunctional enzyme Mthfd1. The mammalian enzyme contains the synthetase activity on the C-terminal domain; the dehydrogenase and cyclohydrolase activities are on the N-terminal domain. FTFH can also be irreversibly converted to THF and CO2 in the NADP-dependent reaction catalyzed by Aldh1l1, an abundant enzyme in the liver. The Aldh1l1 mediated reaction regulates cellular concentration of FTHF. The pathways of methionine, homocysteine and folate metabolism are intimately interconnected. Defects in enzymes within these pathways have been associated with several disorders and conditions.
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Pathway Diagram:
Genes in Pathway:
G
Aldh1l1
aldehyde dehydrogenase 1 family, member L1
ISO
RGD
PMID:22353665
RGD:7242562
NCBI chr 4:123,059,989...123,106,471
Ensembl chr 4:123,060,008...123,106,465
G
Amt
aminomethyltransferase
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr 8:108,981,620...108,988,127
Ensembl chr 8:108,976,472...108,988,126
G
Dhfr
dihydrofolate reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 2:23,585,876...23,611,199
Ensembl chr 2:23,586,031...23,613,713
G
Dld
dihydrolipoamide dehydrogenase
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr 6:47,904,153...47,924,814
Ensembl chr 6:47,903,914...47,924,795
G
Dmgdh
dimethylglycine dehydrogenase
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr 2:24,912,600...24,987,533
Ensembl chr 2:24,912,578...24,987,528
G
Folh1
folate hydrolase 1
ISO
RGD
PMID:20814827 PMID:16859665
RGD:7242426 , RGD:7242559
NCBI chr 1:140,428,101...140,501,563
Ensembl chr 1:140,428,101...140,501,379
G
Folr1
folate receptor alpha
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:156,219,460...156,238,436
Ensembl chr 1:156,219,460...156,230,667
G
Folr2
folate receptor beta
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:156,200,044...156,218,380
Ensembl chr 1:156,200,060...156,205,724
G
Fpgs
folylpolyglutamate synthase
ISO
RGD
PMID:16859665
RGD:7242559
NCBI chr 3:15,972,800...15,993,592
Ensembl chr 3:15,972,800...15,993,563
G
Gcsh
glycine cleavage system protein H
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr19:45,036,013...45,046,770
Ensembl chr19:45,036,011...45,046,792
G
Ggh
gamma-glutamyl hydrolase
TAS
RGD
PMID:16859665
RGD:7242559
NCBI chr 5:33,529,880...33,552,790
Ensembl chr 5:33,529,880...33,552,787
G
Gldc
glycine decarboxylase
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr 1:227,883,249...227,962,119
Ensembl chr 1:227,883,249...227,962,097
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 6:94,977,862...95,045,375
Ensembl chr 6:94,977,862...95,045,372
G
Mthfd1l
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 1-like
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:40,443,926...40,632,911
Ensembl chr 1:40,444,008...40,632,905
G
Mthfd2
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 2, methenyltetrahydrofolate cyclohydrolase
ISO
RGD
PMID:20645850 PMID:22108709
RGD:7242560 , RGD:7242557
NCBI chr 4:115,811,135...115,822,663
Ensembl chr 4:115,811,139...115,822,608
G
Mthfd2l
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 2-like
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr14:17,089,947...17,170,036
Ensembl chr14:17,089,952...17,170,112
G
Mthfr
methylenetetrahydrofolate reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 5:158,465,248...158,484,999
Ensembl chr 5:158,465,296...158,483,797
G
Mtr
5-methyltetrahydrofolate-homocysteine methyltransferase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr17:58,219,998...58,308,560
Ensembl chr17:58,220,071...58,304,822
G
Mtrr
5-methyltetrahydrofolate-homocysteine methyltransferase reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:34,866,991...34,899,425
Ensembl chr 1:34,867,089...34,899,425
G
Sardh
sarcosine dehydrogenase
ISO
RGD
PMID:20645850
RGD:7242560
NCBI chr 3:10,510,553...10,575,342
Ensembl chr 3:10,510,553...10,573,874
G
Shmt1
serine hydroxymethyltransferase 1
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr10:45,468,698...45,490,833
Ensembl chr10:45,468,700...45,497,820
G
Shmt2
serine hydroxymethyltransferase 2
ISO
RGD
PMID:20645850 PMID:22108709
RGD:7242560 , RGD:7242557
NCBI chr 7:63,358,961...63,364,293
Ensembl chr 7:63,358,961...63,364,236
G
Slc19a1
solute carrier family 19 member 1
ISO
RGD
PMID:22108709 PMID:20814827
RGD:7242557 , RGD:7242426
NCBI chr20:11,584,410...11,602,429
Ensembl chr20:11,584,411...11,601,972
G
Slc25a32
solute carrier family 25 member 32
ISO
RGD
PMID:22332074
RGD:7242561
NCBI chr 7:70,142,958...70,160,726
Ensembl chr 7:70,142,964...70,160,770
G
Slc46a1
solute carrier family 46 member 1
ISO
RGD
PMID:22108709 PMID:20814827
RGD:7242557 , RGD:7242426
NCBI chr10:63,361,504...63,367,940
Ensembl chr10:63,361,486...63,368,848
G
Aldh1l1
aldehyde dehydrogenase 1 family, member L1
ISO
RGD
PMID:22353665
RGD:7242562
NCBI chr 4:123,059,989...123,106,471
Ensembl chr 4:123,060,008...123,106,465
G
Dhfr
dihydrofolate reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 2:23,585,876...23,611,199
Ensembl chr 2:23,586,031...23,613,713
G
Folr1
folate receptor alpha
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:156,219,460...156,238,436
Ensembl chr 1:156,219,460...156,230,667
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 6:94,977,862...95,045,375
Ensembl chr 6:94,977,862...95,045,372
G
Mthfr
methylenetetrahydrofolate reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 5:158,465,248...158,484,999
Ensembl chr 5:158,465,296...158,483,797
G
Mtr
5-methyltetrahydrofolate-homocysteine methyltransferase
ISO
RGD
PMID:22108709 PMID:22108709
RGD:7242557 , RGD:7242557
NCBI chr17:58,219,998...58,308,560
Ensembl chr17:58,220,071...58,304,822
G
Mtrr
5-methyltetrahydrofolate-homocysteine methyltransferase reductase
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr 1:34,866,991...34,899,425
Ensembl chr 1:34,867,089...34,899,425
G
Slc46a1
solute carrier family 46 member 1
ISO
RGD
PMID:22108709
RGD:7242557
NCBI chr10:63,361,504...63,367,940
Ensembl chr10:63,361,486...63,368,848
Pathway Gene Annotations
Disease Annotations Associated with Genes in the folate cycle metabolic pathway
Aldh1l1 alkaptonuria , autism spectrum disorder , cholestasis , Experimental Liver Cirrhosis , High Myopia , Hypoxia , obesity , Primary Lymphedema with Myelodysplasia Amt Acidoses , Aicardi-Goutieres Syndrome 1 , epilepsy , genetic disease , glycine encephalopathy , Glycine Encephalopathy 2 , Pierson syndrome Dhfr acute lymphoblastic leukemia , autistic disorder , Breast Neoplasms , cavernous sinus meningioma , Chemical and Drug Induced Liver Injury , Colorectal Neoplasms , Drug-Related Side Effects and Adverse Reactions , endometrial cancer , endometrial carcinoma , familial adenomatous polyposis 4 , Female Infertility , folic acid deficiency anemia , gastrointestinal stromal tumor , genetic disease , hepatocellular carcinoma , Hereditary Neoplastic Syndromes , inherited metabolic disorder , Kidney Reperfusion Injury , lung cancer , megaloblastic anemia , Megaloblastic Anemia due to Dihydrofolate Reductase Deficiency , myeloid leukemia , Neoplasm Metastasis , nervous system disease , Neurodevelopmental Disorders , osteosarcoma , pancytopenia , rheumatoid arthritis , Spontaneous Abortions Dld Congenital Infantile Lactic Acidosis due to LAD Deficiency , genetic disease , Leigh disease , lissencephaly 5 , maple syrup urine disease , pleomorphic xanthoastrocytoma , pyruvate decarboxylase deficiency , Subacute Necrotizing Encephalopathy of Leigh, Infantile Dmgdh dimethylglycine dehydrogenase deficiency , hepatocellular carcinoma , Neurodevelopmental Disorders Folh1 abdominal aortic aneurysm , amyotrophic lateral sclerosis type 1 , cerebral infarction , intellectual disability , Prostatic Neoplasms Folr1 3-methylglutaconic aciduria type 7b , cerebral folate receptor alpha deficiency , Colonic Neoplasms , Congenital Abnormalities , congenital heart disease , Craniofacial Abnormalities , epilepsy , gastrointestinal stromal tumor , Generalized Epilepsy , genetic disease , intellectual disability , Metabolic Brain Diseases, Inborn , movement disease , neural tube defect , osteosarcoma , Ovarian Neoplasms , Psychomotor Disorders Folr2 3-methylglutaconic aciduria type 7b , autism spectrum disorder , cerebral folate receptor alpha deficiency , Experimental Liver Cirrhosis , intellectual disability , metabolic dysfunction-associated steatotic liver disease , neural tube defect Fpgs acute lymphoblastic leukemia , Colorectal Neoplasms , congenital disorder of glycosylation Iu , developmental and epileptic encephalopathy , developmental and epileptic encephalopathy 31A , early infantile epileptic encephalopathy , non-Hodgkin lymphoma , primary coenzyme Q10 deficiency 7 , rheumatoid arthritis Gcsh amino acid metabolic disorder , genetic disease , giant axonal neuropathy 1 , glycine encephalopathy , Multiple Mitochondrial Dysfunctions Syndrome 7 Ggh Chemical and Drug Induced Liver Injury , Colorectal Neoplasms , COVID-19 , Experimental Liver Cirrhosis , rheumatoid arthritis , transitional cell carcinoma , urinary bladder cancer Gldc chromosome 9p deletion syndrome , COVID-19 , Developmental Disabilities , Generalized Epilepsy , genetic disease , glycine encephalopathy , Glycine Encephalopathy 1 , hydrocephalus , neural tube defect , Neurodevelopmental Disorders , obesity , Smith-Magenis syndrome , stomach cancer Mthfd1 abdominal aortic aneurysm , cleft lip , cleft palate , Combined Immunodeficiency and Megaloblastic Anemia with or without Hyperhomocysteinemia , developmental cardiac valvular defect , Down syndrome , Fetal Growth Retardation , Folate-Sensitive Neural Tube Defects , genetic disease , neural tube defect , placental abruption , severe combined immunodeficiency , spina bifida , tetralogy of Fallot Mthfd1l chromosome 6q24-q25 deletion syndrome , Craniofacial Abnormalities , neural tube defect Mthfd2 congenital disorder of glycosylation type IIb , congestive heart failure , COVID-19 , dystonia , hepatocellular carcinoma , Hodgkin's lymphoma , Methylmalonyl-CoA Epimerase Deficiency Mthfr abdominal aortic aneurysm , acute kidney failure , acute lymphoblastic leukemia , acute myeloid leukemia , Albuminuria , alcoholic liver cirrhosis , allergic disease , alopecia , Alzheimer's disease , amyotrophic lateral sclerosis , anemia , angle-closure glaucoma , ankylosing spondylitis , Aortic Coarctation , aphthous stomatitis , Arsenic Poisoning , Arterial Occlusive Diseases , asthma , atherosclerosis , attention deficit hyperactivity disorder , autism spectrum disorder , autistic disorder , B-Cell Chronic Lymphocytic Leukemia , Banti's Syndrome , bipolar disorder , brain ischemia , Breast Neoplasms , Budd-Chiari syndrome , cardia cancer , cardiovascular system disease , carotid stenosis , cataract , cerebral infarction , cervical cancer , cervix uteri carcinoma in situ , Charcot-Marie-Tooth disease type 2 , Chemical and Drug Induced Liver Injury , cholangiocarcinoma , chromosome 1p36 deletion syndrome , chronic kidney disease , chronic myeloid leukemia , clear cell renal cell carcinoma , cleft lip , clubfoot , Cognitive Dysfunction , Colonic Neoplasms , Colorectal Neoplasms , congenital heart disease , Conotruncal Cardiac Defects , coronary artery disease , Coronary Disease , coronary restenosis , Crohn's disease , Cytomegalovirus Infections , depressive disorder , Developmental Disabilities , dextro-looped transposition of the great arteries , diabetes mellitus , diabetic angiopathy , Diabetic Nephropathies , diabetic retinopathy , diffuse large B-cell lymphoma , Down syndrome , Drug Eruptions , Drug-Related Side Effects and Adverse Reactions , Ehlers-Danlos syndrome kyphoscoliotic type 1 , end stage renal disease , Endometrial Neoplasms , epilepsy with generalized tonic-clonic seizures , Experimental Diabetes Mellitus , eye disease , factor VIII deficiency , Familial Atrial Fibrillation 6 , familial Mediterranean fever , Female Infertility , Folate-Sensitive Neural Tube Defects , follicular lymphoma , gastrointestinal stromal tumor , gastrointestinal system disease , genetic disease , glomerulonephritis , graft-versus-host disease , Graves' disease , Habitual Abortions , Hearing Loss , Helicobacter Infections , Hematologic Neoplasms , hematopoietic system disease , hepatic veno-occlusive disease , hepatitis B , hepatocellular carcinoma , hyperhomocysteinemia , hyperthyroidism , hypopituitarism , hypothyroidism , inflammatory bowel disease , Inherited Blood Coagulation Disease , intellectual disability , intracranial sinus thrombosis , ischemia , kidney disease , kidney failure , Kuhnt-Junius degeneration , Left Ventricular Hypertrophy , Leukoencephalopathies , leukopenia , liver benign neoplasm , liver cirrhosis , liver disease , Lung Neoplasms , lung small cell carcinoma , lymphoma , male infertility , Malnutrition , Maxillofacial Abnormalities , Meniere's disease , metabolic dysfunction-associated steatotic liver disease , Methylenetetrahydrofolate Reductase Deficiency , Microsatellite Instability , Microvascular Angina , migraine , migraine with aura , mitral valve disease , Mthfr Deficiency, Thermolabile Type , mucositis , multiple myeloma , myeloid neoplasm , myelomeningocele , myocardial infarction , Necrosis , Neoplasm Metastasis , nephroblastoma , nephrosclerosis , nervous system disease , neural tube defect , neutropenia , non-arteritic anterior ischemic optic neuropathy , non-Hodgkin lymphoma , open-angle glaucoma , oral squamous cell carcinoma , osteonecrosis , osteosarcoma , pancreatic cancer , papillomavirus infectious disease , Parkinson's disease , peripheral artery disease , portal vein thrombosis , Prenatal Exposure Delayed Effects , prostate cancer , Prostatic Neoplasms , pulmonary embolism , rectal benign neoplasm , renal artery disease , renal cell carcinoma , retinal disease , retinal vein occlusion , rheumatoid arthritis , schizophrenia , sickle cell anemia , skin disease , smallpox , spina bifida , spinal cord disease , sporadic breast cancer , squamous cell carcinoma , steatotic liver disease , stomach cancer , Stomach Neoplasms , Stroke , Sudden Hearing Loss , tetralogy of Fallot , thrombocytopenia , thrombophilia , thrombophilia due to thrombin defect , thrombosis , Thrombotic Microangiopathies , thyrotoxicosis , transitional cell carcinoma , type 1 diabetes mellitus , type 2 diabetes mellitus , urinary bladder cancer , Uterine Cervical Neoplasms , Vascular Calcification , vascular dementia , vascular disease , Venous Thromboembolism , Venous Thrombosis Mtr abdominal aortic aneurysm , acute lymphoblastic leukemia , autism spectrum disorder , autistic disorder , Breast Neoplasms , catecholaminergic polymorphic ventricular tachycardia , catecholaminergic polymorphic ventricular tachycardia 1 , cerebral infarction , cleft lip , cleft palate , dilated cardiomyopathy 1AA , Drug-Related Side Effects and Adverse Reactions , epilepsy , Experimental Diabetes Mellitus , fetal alcohol spectrum disorder , Folate-Sensitive Neural Tube Defects , follicular lymphoma , gastrointestinal stromal tumor , gastrointestinal system disease , genetic disease , Hearing Loss , heart disease , hematopoietic system disease , homocystinuria , homocystinuria-megaloblastic anemia cblG type , hyperhomocysteinemia , hypertension , IgA glomerulonephritis , inherited metabolic disorder , intellectual disability , Leukoencephalopathies , lymphoma , male infertility , Malnutrition , methylmalonic aciduria and homocystinuria type cblG , multiple myeloma , pancreatic cancer , parathyroid carcinoma , Prenatal Exposure Delayed Effects , retinoblastoma , spina bifida , Sudden Hearing Loss , type 2 diabetes mellitus , urinary bladder cancer , vitamin B12 deficiency Mtrr abdominal aortic aneurysm , acute lymphoblastic leukemia , acute myeloid leukemia , adenoma , anencephaly , Colorectal Neoplasms , Diabetic Nephropathies , Down syndrome , Drug-Related Side Effects and Adverse Reactions , Folate-Sensitive Neural Tube Defects , gastrointestinal stromal tumor , genetic disease , heart disease , heart septal defect , hepatocellular carcinoma , homocystinuria , homocystinuria-megaloblastic anemia cblE type , hyperhomocysteinemia , inherited metabolic disorder , male infertility , meningioma , multiple myeloma , myelodysplastic syndrome , nervous system disease , non-Hodgkin lymphoma , pancreatic cancer , Parkinson's disease , spina bifida , Temporomandibular Joint Disorders , ulcerative colitis Sardh developmental and epileptic encephalopathy 14 , Ehlers-Danlos syndrome classic type 1 , hepatocellular carcinoma , Hypoxia , Kleefstra syndrome 1 , Leigh disease , primary coenzyme Q10 deficiency 7 , Rafiq syndrome , sarcosinemia , tuberous sclerosis 1 Shmt1 Animal Disease Models , autistic disorder , breast cancer , Breast Neoplasms , common variable immunodeficiency 2 , COVID-19 , Drug-Related Side Effects and Adverse Reactions , gastrointestinal stromal tumor , Joubert syndrome 1 , lung adenocarcinoma , nervous system disease , non-Hodgkin lymphoma , ovarian cancer , Potocki-Lupski syndrome Shmt2 familial melanoma , genetic disease , lung non-small cell carcinoma , NEURODEVELOPMENTAL DISORDER WITH CARDIOMYOPATHY, SPASTICITY, AND BRAIN ABNORMALITIES , Neurodevelopmental Disorders Slc19a1 abdominal aortic aneurysm , acute lymphoblastic leukemia , adenoma , angle-closure glaucoma , Animal Disease Models , autism spectrum disorder , autistic disorder , Axenfeld-Rieger syndrome type 3 , cataract , cataract 9 multiple types , chronic kidney disease , cleft lip , cleft palate , Colonic Neoplasms , Colorectal Neoplasms , developmental and epileptic encephalopathy 30 , dextro-looped transposition of the great arteries , Down syndrome , Drug-Related Side Effects and Adverse Reactions , epilepsy , Folate-Responsive Megaloblastic Anemia , fundus dystrophy , gastrointestinal stromal tumor , genetic disease , hematologic cancer , homocystinuria , Immunodeficiency 114 , Knobloch Syndrome , Knobloch Syndrome Type I , lung adenocarcinoma , macular degeneration , malaria , nervous system disease , neurodegenerative disease , primary ciliary dyskinesia , progressive myoclonus epilepsy , Recurrence , retinitis pigmentosa , urinary bladder cancer Slc25a32 Cohen syndrome , Exercise Intolerance , prostate cancer Slc46a1 anemia , chronic kidney disease , Experimental Liver Cirrhosis , genetic disease , hereditary folate malabsorption , hyperhomocysteinemia , intellectual disability , Malabsorption Syndromes , pancytopenia
3-methylglutaconic aciduria type 7b Folr1 , Folr2 abdominal aortic aneurysm Folh1 , Mthfd1 , Mthfr , Mtr , Mtrr , Slc19a1 Acidoses Amt acute kidney failure Mthfr acute lymphoblastic leukemia Dhfr , Fpgs , Mthfr , Mtr , Mtrr , Slc19a1 acute myeloid leukemia Mthfr , Mtrr adenoma Mtrr , Slc19a1 Aicardi-Goutieres Syndrome 1 Amt Albuminuria Mthfr alcoholic liver cirrhosis Mthfr alkaptonuria Aldh1l1 allergic disease Mthfr alopecia Mthfr Alzheimer's disease Mthfr amino acid metabolic disorder Gcsh amyotrophic lateral sclerosis Mthfr amyotrophic lateral sclerosis type 1 Folh1 anemia Mthfr , Slc46a1 anencephaly Mtrr angle-closure glaucoma Mthfr , Slc19a1 Animal Disease Models Shmt1 , Slc19a1 ankylosing spondylitis Mthfr Aortic Coarctation Mthfr aphthous stomatitis Mthfr Arsenic Poisoning Mthfr Arterial Occlusive Diseases Mthfr asthma Mthfr atherosclerosis Mthfr attention deficit hyperactivity disorder Mthfr autism spectrum disorder Aldh1l1 , Folr2 , Mthfr , Mtr , Slc19a1 autistic disorder Dhfr , Mthfr , Mtr , Shmt1 , Slc19a1 Axenfeld-Rieger syndrome type 3 Slc19a1 B-Cell Chronic Lymphocytic Leukemia Mthfr Banti's Syndrome Mthfr bipolar disorder Mthfr brain ischemia Mthfr breast cancer Shmt1 Breast Neoplasms Dhfr , Mthfr , Mtr , Shmt1 Budd-Chiari syndrome Mthfr cardia cancer Mthfr cardiovascular system disease Mthfr carotid stenosis Mthfr cataract Mthfr , Slc19a1 cataract 9 multiple types Slc19a1 catecholaminergic polymorphic ventricular tachycardia Mtr catecholaminergic polymorphic ventricular tachycardia 1 Mtr cavernous sinus meningioma Dhfr cerebral folate receptor alpha deficiency Folr1 , Folr2 cerebral infarction Folh1 , Mthfr , Mtr cervical cancer Mthfr cervix uteri carcinoma in situ Mthfr Charcot-Marie-Tooth disease type 2 Mthfr Chemical and Drug Induced Liver Injury Dhfr , Ggh , Mthfr cholangiocarcinoma Mthfr cholestasis Aldh1l1 chromosome 1p36 deletion syndrome Mthfr chromosome 6q24-q25 deletion syndrome Mthfd1l chromosome 9p deletion syndrome Gldc chronic kidney disease Mthfr , Slc19a1 , Slc46a1 chronic myeloid leukemia Mthfr clear cell renal cell carcinoma Mthfr cleft lip Mthfd1 , Mthfr , Mtr , Slc19a1 cleft palate Mthfd1 , Mtr , Slc19a1 clubfoot Mthfr Cognitive Dysfunction Mthfr Cohen syndrome Slc25a32 Colonic Neoplasms Folr1 , Mthfr , Slc19a1 Colorectal Neoplasms Dhfr , Fpgs , Ggh , Mthfr , Mtrr , Slc19a1 Combined Immunodeficiency and Megaloblastic Anemia with or without Hyperhomocysteinemia Mthfd1 common variable immunodeficiency 2 Shmt1 Congenital Abnormalities Folr1 congenital disorder of glycosylation Iu Fpgs congenital disorder of glycosylation type IIb Mthfd2 congenital heart disease Folr1 , Mthfr Congenital Infantile Lactic Acidosis due to LAD Deficiency Dld congestive heart failure Mthfd2 Conotruncal Cardiac Defects Mthfr coronary artery disease Mthfr Coronary Disease Mthfr coronary restenosis Mthfr COVID-19 Ggh , Gldc , Mthfd2 , Shmt1 Craniofacial Abnormalities Folr1 , Mthfd1l Crohn's disease Mthfr Cytomegalovirus Infections Mthfr depressive disorder Mthfr developmental and epileptic encephalopathy Fpgs developmental and epileptic encephalopathy 14 Sardh developmental and epileptic encephalopathy 30 Slc19a1 developmental and epileptic encephalopathy 31A Fpgs developmental cardiac valvular defect Mthfd1 Developmental Disabilities Gldc , Mthfr dextro-looped transposition of the great arteries Mthfr , Slc19a1 diabetes mellitus Mthfr diabetic angiopathy Mthfr Diabetic Nephropathies Mthfr , Mtrr diabetic retinopathy Mthfr diffuse large B-cell lymphoma Mthfr dilated cardiomyopathy 1AA Mtr dimethylglycine dehydrogenase deficiency Dmgdh Down syndrome Mthfd1 , Mthfr , Mtrr , Slc19a1 Drug Eruptions Mthfr Drug-Related Side Effects and Adverse Reactions Dhfr , Mthfr , Mtr , Mtrr , Shmt1 , Slc19a1 dystonia Mthfd2 early infantile epileptic encephalopathy Fpgs Ehlers-Danlos syndrome classic type 1 Sardh Ehlers-Danlos syndrome kyphoscoliotic type 1 Mthfr end stage renal disease Mthfr endometrial cancer Dhfr endometrial carcinoma Dhfr Endometrial Neoplasms Mthfr epilepsy Amt , Folr1 , Mtr , Slc19a1 epilepsy with generalized tonic-clonic seizures Mthfr Exercise Intolerance Slc25a32 Experimental Diabetes Mellitus Mthfr , Mtr Experimental Liver Cirrhosis Aldh1l1 , Folr2 , Ggh , Slc46a1 eye disease Mthfr factor VIII deficiency Mthfr familial adenomatous polyposis 4 Dhfr Familial Atrial Fibrillation 6 Mthfr familial Mediterranean fever Mthfr familial melanoma Shmt2 Female Infertility Dhfr , Mthfr fetal alcohol spectrum disorder Mtr Fetal Growth Retardation Mthfd1 Folate-Responsive Megaloblastic Anemia Slc19a1 Folate-Sensitive Neural Tube Defects Mthfd1 , Mthfr , Mtr , Mtrr folic acid deficiency anemia Dhfr follicular lymphoma Mthfr , Mtr fundus dystrophy Slc19a1 gastrointestinal stromal tumor Dhfr , Folr1 , Mthfr , Mtr , Mtrr , Shmt1 , Slc19a1 gastrointestinal system disease Mthfr , Mtr Generalized Epilepsy Folr1 , Gldc genetic disease Amt , Dhfr , Dld , Folr1 , Gcsh , Gldc , Mthfd1 , Mthfr , Mtr , Mtrr , Shmt2 , Slc19a1 , Slc46a1 giant axonal neuropathy 1 Gcsh glomerulonephritis Mthfr glycine encephalopathy Amt , Gcsh , Gldc Glycine Encephalopathy 1 Gldc Glycine Encephalopathy 2 Amt graft-versus-host disease Mthfr Graves' disease Mthfr Habitual Abortions Mthfr Hearing Loss Mthfr , Mtr heart disease Mtr , Mtrr heart septal defect Mtrr Helicobacter Infections Mthfr hematologic cancer Slc19a1 Hematologic Neoplasms Mthfr hematopoietic system disease Mthfr , Mtr hepatic veno-occlusive disease Mthfr hepatitis B Mthfr hepatocellular carcinoma Dhfr , Dmgdh , Mthfd2 , Mthfr , Mtrr , Sardh hereditary folate malabsorption Slc46a1 Hereditary Neoplastic Syndromes Dhfr High Myopia Aldh1l1 Hodgkin's lymphoma Mthfd2 homocystinuria Mtr , Mtrr , Slc19a1 homocystinuria-megaloblastic anemia cblE type Mtrr homocystinuria-megaloblastic anemia cblG type Mtr hydrocephalus Gldc hyperhomocysteinemia Mthfr , Mtr , Mtrr , Slc46a1 hypertension Mtr hyperthyroidism Mthfr hypopituitarism Mthfr hypothyroidism Mthfr Hypoxia Aldh1l1 , Sardh IgA glomerulonephritis Mtr Immunodeficiency 114 Slc19a1 inflammatory bowel disease Mthfr Inherited Blood Coagulation Disease Mthfr inherited metabolic disorder Dhfr , Mtr , Mtrr intellectual disability Folh1 , Folr1 , Folr2 , Mthfr , Mtr , Slc46a1 intracranial sinus thrombosis Mthfr ischemia Mthfr Joubert syndrome 1 Shmt1 kidney disease Mthfr kidney failure Mthfr Kidney Reperfusion Injury Dhfr Kleefstra syndrome 1 Sardh Knobloch Syndrome Slc19a1 Knobloch Syndrome Type I Slc19a1 Kuhnt-Junius degeneration Mthfr Left Ventricular Hypertrophy Mthfr Leigh disease Dld , Sardh Leukoencephalopathies Mthfr , Mtr leukopenia Mthfr lissencephaly 5 Dld liver benign neoplasm Mthfr liver cirrhosis Mthfr liver disease Mthfr lung adenocarcinoma Shmt1 , Slc19a1 lung cancer Dhfr Lung Neoplasms Mthfr lung non-small cell carcinoma Shmt2 lung small cell carcinoma Mthfr lymphoma Mthfr , Mtr macular degeneration Slc19a1 Malabsorption Syndromes Slc46a1 malaria Slc19a1 male infertility Mthfr , Mtr , Mtrr Malnutrition Mthfr , Mtr maple syrup urine disease Dld Maxillofacial Abnormalities Mthfr megaloblastic anemia Dhfr Megaloblastic Anemia due to Dihydrofolate Reductase Deficiency Dhfr Meniere's disease Mthfr meningioma Mtrr Metabolic Brain Diseases, Inborn Folr1 metabolic dysfunction-associated steatotic liver disease Folr2 , Mthfr Methylenetetrahydrofolate Reductase Deficiency Mthfr methylmalonic aciduria and homocystinuria type cblG Mtr Methylmalonyl-CoA Epimerase Deficiency Mthfd2 Microsatellite Instability Mthfr Microvascular Angina Mthfr migraine Mthfr migraine with aura Mthfr mitral valve disease Mthfr movement disease Folr1 Mthfr Deficiency, Thermolabile Type Mthfr mucositis Mthfr Multiple Mitochondrial Dysfunctions Syndrome 7 Gcsh multiple myeloma Mthfr , Mtr , Mtrr myelodysplastic syndrome Mtrr myeloid leukemia Dhfr myeloid neoplasm Mthfr myelomeningocele Mthfr myocardial infarction Mthfr Necrosis Mthfr Neoplasm Metastasis Dhfr , Mthfr nephroblastoma Mthfr nephrosclerosis Mthfr nervous system disease Dhfr , Mthfr , Mtrr , Shmt1 , Slc19a1 neural tube defect Folr1 , Folr2 , Gldc , Mthfd1 , Mthfd1l , Mthfr neurodegenerative disease Slc19a1 NEURODEVELOPMENTAL DISORDER WITH CARDIOMYOPATHY, SPASTICITY, AND BRAIN ABNORMALITIES Shmt2 Neurodevelopmental Disorders Dhfr , Dmgdh , Gldc , Shmt2 neutropenia Mthfr non-arteritic anterior ischemic optic neuropathy Mthfr non-Hodgkin lymphoma Fpgs , Mthfr , Mtrr , Shmt1 obesity Aldh1l1 , Gldc open-angle glaucoma Mthfr oral squamous cell carcinoma Mthfr osteonecrosis Mthfr osteosarcoma Dhfr , Folr1 , Mthfr ovarian cancer Shmt1 Ovarian Neoplasms Folr1 pancreatic cancer Mthfr , Mtr , Mtrr pancytopenia Dhfr , Slc46a1 papillomavirus infectious disease Mthfr parathyroid carcinoma Mtr Parkinson's disease Mthfr , Mtrr peripheral artery disease Mthfr Pierson syndrome Amt placental abruption Mthfd1 pleomorphic xanthoastrocytoma Dld portal vein thrombosis Mthfr Potocki-Lupski syndrome Shmt1 Prenatal Exposure Delayed Effects Mthfr , Mtr primary ciliary dyskinesia Slc19a1 primary coenzyme Q10 deficiency 7 Fpgs , Sardh Primary Lymphedema with Myelodysplasia Aldh1l1 progressive myoclonus epilepsy Slc19a1 prostate cancer Mthfr , Slc25a32 Prostatic Neoplasms Folh1 , Mthfr Psychomotor Disorders Folr1 pulmonary embolism Mthfr pyruvate decarboxylase deficiency Dld Rafiq syndrome Sardh rectal benign neoplasm Mthfr Recurrence Slc19a1 renal artery disease Mthfr renal cell carcinoma Mthfr retinal disease Mthfr retinal vein occlusion Mthfr retinitis pigmentosa Slc19a1 retinoblastoma Mtr rheumatoid arthritis Dhfr , Fpgs , Ggh , Mthfr sarcosinemia Sardh schizophrenia Mthfr severe combined immunodeficiency Mthfd1 sickle cell anemia Mthfr skin disease Mthfr smallpox Mthfr Smith-Magenis syndrome Gldc spina bifida Mthfd1 , Mthfr , Mtr , Mtrr spinal cord disease Mthfr Spontaneous Abortions Dhfr sporadic breast cancer Mthfr squamous cell carcinoma Mthfr steatotic liver disease Mthfr stomach cancer Gldc , Mthfr Stomach Neoplasms Mthfr Stroke Mthfr Subacute Necrotizing Encephalopathy of Leigh, Infantile Dld Sudden Hearing Loss Mthfr , Mtr Temporomandibular Joint Disorders Mtrr tetralogy of Fallot Mthfd1 , Mthfr thrombocytopenia Mthfr thrombophilia Mthfr thrombophilia due to thrombin defect Mthfr thrombosis Mthfr Thrombotic Microangiopathies Mthfr thyrotoxicosis Mthfr transitional cell carcinoma Ggh , Mthfr tuberous sclerosis 1 Sardh type 1 diabetes mellitus Mthfr type 2 diabetes mellitus Mthfr , Mtr ulcerative colitis Mtrr urinary bladder cancer Ggh , Mthfr , Mtr , Slc19a1 Uterine Cervical Neoplasms Mthfr Vascular Calcification Mthfr vascular dementia Mthfr vascular disease Mthfr Venous Thromboembolism Mthfr Venous Thrombosis Mthfr vitamin B12 deficiency Mtr