FOLATE MEDIATED ONE-CARBON METABOLIC PATHWAY (PW:0000189)
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. The important folate mediated 1C transfer reactions and the pathways and processes they support are presented here. The various aspects of folate uptake, processing and interconversion constitute the metabolic pathway of folate cycle and are presented in a separate diagram. Together they are part of the folate metabolic pathway. The 1C transfer reactions take place in the cytoplasm, nucleus and mitochondria. Serine, a major 1C donor is reversibly converted to glycine and 5,10-methyleneTHF 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-methyl THF. 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. 5,10-methyleneTHF is the 1C donor for the de novo thymidylate synthesis in the reaction catalyzed by thymidylate synthase enzyme Tyms. The reversible reaction generates thymidine monophosphates (dTMP) and DHF using deoxyuridine monophosphate (dUMP) and the folate cofactor. The dTMPs are then phosphorylated by thymidine triphosphate for use in DNA synthesis and repair. DHF is reduced to THF by Dhfr. FTFH is required for de novo biosynthesis of purines where it is used in two separate steps that contribute the carbon 2 and 8 of the purine ring in the reactions catalyzed by Atic and Gart. Interconversion reactions involving FTHF and 5,10-methyleneTHF are carried out by separate enzymes in the mitochondria and the cytoplasm. In the cytoplasm, mitochondrially derived formate is condensed with THF to yield FTFH in the ATP-dependent reaction catalyzed by the trifunctional enzyme Mthfd1. 5-methylTHF is the 1C donor for the cobalamin dependent remethylation of Hcy and is generated by the irreversible reduction of 5,10-methyleneTHF by (Mthfr), an FAD (flavin adenine dinucleotide)/vitamin B2, NADPH dependent enzyme. Mtr carries out the cobalamin dependent remethylation of Hcy in a reaction that also generates THF which then re-enters the cycle. Oxidation of cobalamin co-factor renders the enzyme inactive; reductive methylation carried out by Mtrr restores the functional enzyme. The Mtr dependent route, one of the two homocysteine remethylation pathways, links folate with homocysteine and methionine metabolism. The other route uses the methyl group of betaine as 1C donor and is not folate mediated; it is however, the major Hcy remethylation pathway in the liver. Once reformed, Met can go through another metabolic cycle whose first step produces S-adenosylmethionine (AdoMet or Sam), the primary methyl donor for nucleic acids, protein, lipids and small molecules. Folate, methionine and homocysteine metabolic pathways are intimately interconnected. Mutations in the genes involved in folate metabolism have been associated with several deficiencies and conditions.
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Pathway Diagram:
Genes in Pathway:
G
Aldh1l1
aldehyde dehydrogenase 1 family, member L1
IEA TAS
KEGG RGD
PMID:14729668
rno:00670, RGD:1547843
NCBI chr 4:124,617,182...124,663,674
Ensembl chr 4:124,617,217...124,664,704
G
Aldh1l2
aldehyde dehydrogenase 1 family, member L2
IEA
KEGG
rno:00670
NCBI chr 7:22,141,872...22,193,403
Ensembl chr 7:22,141,842...22,193,398
G
Amt
aminomethyltransferase
IEA
KEGG
rno:00670
NCBI chr 8:117,859,700...117,866,692
Ensembl chr 8:117,860,345...117,866,803
G
Atic
5-aminoimidazole-4-carboxamide ribonucleotide formyltransferase/IMP cyclohydrolase
IEA IDA ISO
KEGG RGD
PMID:9332377 PMID:22332074
rno:00670, RGD:70804 , RGD:7242561
NCBI chr 9:80,614,311...80,634,360
Ensembl chr 9:80,614,283...80,635,756
G
Dhfr
dihydrofolate reductase
IDA IEA ISO
KEGG RGD
PMID:11502523 PMID:22332074
rno:00670, RGD:1298877 , RGD:7242561
NCBI chr 2:25,320,895...25,346,004
G
Dmgdh
dimethylglycine dehydrogenase
TAS
RGD
PMID:15358367
RGD:1547831
NCBI chr 2:26,647,540...26,722,496
Ensembl chr 2:26,647,565...26,723,071
G
Folh1
folate hydrolase 1
TAS
RGD
PMID:9501243
RGD:728645
NCBI chr 1:149,828,286...149,914,313
Ensembl chr 1:149,840,760...149,914,035
G
Ftcd
formimidoyltransferase cyclodeaminase
IEA
KEGG
rno:00670
NCBI chr20:12,054,710...12,068,219
Ensembl chr20:12,054,711...12,068,237
G
Gart
phosphoribosylglycinamide formyltransferase, phosphoribosylglycinamide synthetase, phosphoribosylaminoimidazole synthetase
ISO IEA
KEGG RGD
PMID:12450384 PMID:22332074
rno:00670, RGD:1547842 , RGD:7242561
NCBI chr11:44,351,841...44,377,086
Ensembl chr11:44,351,851...44,377,086
G
Gnmt
glycine N-methyltransferase
TAS
RGD
PMID:8278367
RGD:1545057
NCBI chr 9:21,752,235...21,756,368
Ensembl chr 9:21,752,266...21,755,692
G
Mtfmt
mitochondrial methionyl-tRNA formyltransferase
IEA
KEGG
rno:00670
NCBI chr 8:74,848,936...74,866,987
Ensembl chr 8:74,848,729...74,867,039
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
IEA ISO
KEGG RGD
PMID:22332074
rno:00670, RGD:7242561
NCBI chr 6:100,713,510...100,781,013
Ensembl chr 6:100,713,681...100,781,957
G
Mthfd1l
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 1-like
IEA
KEGG
rno:00670
NCBI chr 1:42,849,424...43,038,313
Ensembl chr 1:42,849,374...43,038,309
G
Mthfd2
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 2, methenyltetrahydrofolate cyclohydrolase
ISO IEA
KEGG RGD
PMID:9454603
rno:00670, RGD:1540378
NCBI chr 4:117,368,833...117,380,350
Ensembl chr 4:117,368,835...117,380,350
G
Mthfd2l
methylenetetrahydrofolate dehydrogenase (NADP+ dependent) 2-like
IEA
KEGG
rno:00670
NCBI chr14:17,374,139...17,455,508
Ensembl chr14:17,374,144...17,454,322
G
Mthfr
methylenetetrahydrofolate reductase
ISO IEA
KEGG RGD
PMID:11933257 PMID:22332074
rno:00670, RGD:1535021 , RGD:7242561
NCBI chr 5:163,748,346...163,768,141
Ensembl chr 5:163,748,321...163,768,105
G
Mthfs
methenyltetrahydrofolate synthetase
IEA
KEGG
rno:00670
NCBI chr 8:98,609,410...98,681,901
Ensembl chr 8:98,609,399...98,752,036
G
Mtr
5-methyltetrahydrofolate-homocysteine methyltransferase
IEA ISO IDA
KEGG RGD
PMID:20814827 PMID:15845641
rno:00670, RGD:7242426 , RGD:1359026
NCBI chr17:62,911,705...62,996,544
Ensembl chr17:62,911,771...62,996,541
G
Mtrr
5-methyltetrahydrofolate-homocysteine methyltransferase reductase
ISO
RGD
PMID:20814827
RGD:7242426
NCBI chr 1:36,695,376...36,727,341
Ensembl chr 1:36,695,460...36,727,807
G
Shmt1
serine hydroxymethyltransferase 1
TAS ISO IEA IDA
KEGG RGD
PMID:15671219 PMID:22332074 PMID:3110140
rno:00670, RGD:1359815 , RGD:7242561 , RGD:2300383
NCBI chr10:45,968,959...45,990,341
Ensembl chr10:45,960,434...45,997,326
G
Shmt2
serine hydroxymethyltransferase 2
TAS ISO IEA IDA
KEGG RGD
PMID:15671219 PMID:22332074 PMID:3110140
rno:00670, RGD:1359815 , RGD:7242561 , RGD:2300383
NCBI chr 7:65,244,247...65,249,580
Ensembl chr 7:65,244,247...65,249,567
G
Tyms
thymidylate synthetase
IEA IDA ISO
KEGG RGD
PMID:9894005 PMID:22332074
rno:00670, RGD:1545055 , RGD:7242561
NCBI chr 9:120,760,057...120,776,149
Ensembl chr 9:120,763,386...120,776,097
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
ISO
RGD
PMID:22353665
RGD:7242562
NCBI chr 6:100,713,510...100,781,013
Ensembl chr 6:100,713,681...100,781,957
G
Mthfr
methylenetetrahydrofolate reductase
ISO
RGD
PMID:22353665
RGD:7242562
NCBI chr 5:163,748,346...163,768,141
Ensembl chr 5:163,748,321...163,768,105
G
Mtr
5-methyltetrahydrofolate-homocysteine methyltransferase
ISO
RGD
PMID:22353665
RGD:7242562
NCBI chr17:62,911,705...62,996,544
Ensembl chr17:62,911,771...62,996,541
Altered Pathway:
Pathway Gene Annotations
Disease Annotations Associated with Genes in the folate mediated one-carbon metabolic pathway
Aldh1l1 autism spectrum disorder , cholestasis , Experimental Liver Cirrhosis , High Myopia , Hypoxia , obesity Aldh1l2 Chemical and Drug Induced Liver Injury , COVID-19 , Experimental Liver Cirrhosis , metabolic dysfunction-associated steatotic liver disease , Neurodevelopmental Disorders Amt Acidoses , genetic disease , glycine encephalopathy , glycine encephalopathy 1 , glycine encephalopathy 2 Atic AICAR Transformylase Inosine Monophosphate Cyclohydrolase Deficiency , blindness , Drug-Related Side Effects and Adverse Reactions , Experimental Arthritis , intellectual disability , osteoporosis , purine-pyrimidine metabolic disorder , rheumatoid arthritis Dhfr acute lymphoblastic leukemia , autistic disorder , Breast Neoplasms , Chemical and Drug Induced Liver Injury , Colorectal Neoplasms , Drug-Related Side Effects and Adverse Reactions , Female Infertility , folic acid deficiency anemia , 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 , osteosarcoma , pancytopenia , rheumatoid arthritis , Spontaneous Abortions Dmgdh dimethylglycine dehydrogenase deficiency , hepatocellular carcinoma Folh1 abdominal aortic aneurysm , amyotrophic lateral sclerosis type 1 , cerebral infarction , Prostatic Neoplasms Ftcd Burkitt lymphoma , Experimental Liver Cirrhosis , genetic disease , glutamate formiminotransferase deficiency , intellectual disability , myoepithelioma Gart Animal Disease Models , Down syndrome , esophageal atresia/tracheoesophageal fistula , lung adenocarcinoma , rheumatoid arthritis Gnmt Chronic Hepatitis , glycine N-methyltransferase deficiency , hepatitis , hepatocellular carcinoma , hyperhomocysteinemia , hypermethioninemia , Liver Neoplasms , metabolic dysfunction-associated steatotic liver disease , Prostatic Neoplasms Mtfmt combined oxidative phosphorylation deficiency 15 , Dwarfism , genetic disease , Leigh disease , microcephaly , mitochondrial complex I deficiency , nuclear type mitochondrial complex I deficiency 27 , Waardenburg Syndrome Type 2F 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 Craniofacial Abnormalities , neural tube defect Mthfd2 congestive heart failure , COVID-19 , hepatocellular carcinoma , Hodgkin's lymphoma 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 , 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 , Chemical and Drug Induced Liver Injury , cholangiocarcinoma , chronic kidney disease , chronic myeloid leukemia , clear cell renal cell carcinoma , cleft lip , clubfoot , coarctation of the aorta , 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 , end stage renal disease , Endometrial Neoplasms , epilepsy with generalized tonic-clonic seizures , Experimental Diabetes Mellitus , eye disease , factor VIII deficiency , 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 Dysplasia , Uterine Cervical Neoplasms , Vascular Calcification , vascular dementia , vascular disease , Venous Thromboembolism , Venous Thrombosis Mthfs cleft lip , cleft palate , colorectal cancer , Neurodevelopmental Disorder with Microcephaly, Epilepsy, and Hypomyelination Mtr abdominal aortic aneurysm , acute lymphoblastic leukemia , autism spectrum disorder , autistic disorder , Breast Neoplasms , cerebral infarction , cleft lip , cleft palate , 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 , 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 , homocystinuria-megaloblastic anemia cblG type , hyperhomocysteinemia , inherited metabolic disorder , male infertility , meningioma , methylmalonic aciduria and homocystinuria type cblG , multiple myeloma , myelodysplastic syndrome , nervous system disease , non-Hodgkin lymphoma , pancreatic cancer , Parkinson's disease , spina bifida , Temporomandibular Joint Disorders , ulcerative colitis Shmt1 Animal Disease Models , breast cancer , Breast Neoplasms , COVID-19 , Drug-Related Side Effects and Adverse Reactions , gastrointestinal stromal tumor , lung adenocarcinoma , nervous system disease , non-Hodgkin lymphoma , ovarian cancer Shmt2 genetic disease , lung non-small cell carcinoma , neurodevelopmental disorder with cardiomyopathy, spasticity, and brain abnormalities , Neurodevelopmental Disorders Tyms abdominal aortic aneurysm , acute lymphoblastic leukemia , acute myeloid leukemia , anemia , Animal Disease Models , brain disease , Breast Neoplasms , cerebral infarction , cleft lip , cleft palate , colon carcinoma , Colonic Neoplasms , colorectal adenocarcinoma , Colorectal Neoplasms , COVID-19 , digenic dyskeratosis congenita , Digestive System Neoplasms , Drug-Related Side Effects and Adverse Reactions , dyskeratosis congenita , Experimental Mammary Neoplasms , follicular lymphoma , Head and Neck Neoplasms , hepatocellular carcinoma , Hyperammonemia , lung adenocarcinoma , Lung Neoplasms , multiple myeloma , Neoplasm Metastasis , Neoplasm Recurrence, Local , nervous system disease , neuroendocrine tumor , non-Hodgkin lymphoma , Ovarian Neoplasms , pancreatic cancer , Prostatic Neoplasms , rectal benign neoplasm , rheumatoid arthritis , Splenomegaly , squamous cell carcinoma , Stomach Neoplasms , Tongue Neoplasms , urinary bladder cancer
abdominal aortic aneurysm Folh1 , Mthfd1 , Mthfr , Mtr , Mtrr , Tyms Acidoses Amt acute kidney failure Mthfr acute lymphoblastic leukemia Dhfr , Mthfr , Mtr , Mtrr , Tyms acute myeloid leukemia Mthfr , Mtrr , Tyms adenoma Mtrr AICAR Transformylase Inosine Monophosphate Cyclohydrolase Deficiency Atic Albuminuria Mthfr alcoholic liver cirrhosis Mthfr allergic disease Mthfr alopecia Mthfr Alzheimer's disease Mthfr amyotrophic lateral sclerosis Mthfr amyotrophic lateral sclerosis type 1 Folh1 anemia Mthfr , Tyms anencephaly Mtrr angle-closure glaucoma Mthfr Animal Disease Models Gart , Shmt1 , Tyms ankylosing spondylitis Mthfr aphthous stomatitis Mthfr Arsenic Poisoning Mthfr Arterial Occlusive Diseases Mthfr asthma Mthfr atherosclerosis Mthfr attention deficit hyperactivity disorder Mthfr autism spectrum disorder Aldh1l1 , Mthfr , Mtr autistic disorder Dhfr , Mthfr , Mtr B-Cell Chronic Lymphocytic Leukemia Mthfr Banti's Syndrome Mthfr bipolar disorder Mthfr blindness Atic brain disease Tyms brain ischemia Mthfr breast cancer Shmt1 Breast Neoplasms Dhfr , Mthfr , Mtr , Shmt1 , Tyms Budd-Chiari syndrome Mthfr Burkitt lymphoma Ftcd cardia cancer Mthfr cardiovascular system disease Mthfr carotid stenosis Mthfr cataract Mthfr cerebral infarction Folh1 , Mthfr , Mtr , Tyms cervical cancer Mthfr Chemical and Drug Induced Liver Injury Aldh1l2 , Dhfr , Mthfr cholangiocarcinoma Mthfr cholestasis Aldh1l1 Chronic Hepatitis Gnmt chronic kidney disease Mthfr chronic myeloid leukemia Mthfr clear cell renal cell carcinoma Mthfr cleft lip Mthfd1 , Mthfr , Mthfs , Mtr , Tyms cleft palate Mthfd1 , Mthfs , Mtr , Tyms clubfoot Mthfr coarctation of the aorta Mthfr Cognitive Dysfunction Mthfr colon carcinoma Tyms Colonic Neoplasms Mthfr , Tyms colorectal adenocarcinoma Tyms colorectal cancer Mthfs Colorectal Neoplasms Dhfr , Mthfr , Mtrr , Tyms Combined Immunodeficiency and Megaloblastic Anemia with or without Hyperhomocysteinemia Mthfd1 combined oxidative phosphorylation deficiency 15 Mtfmt congenital heart disease Mthfr congestive heart failure Mthfd2 Conotruncal Cardiac Defects Mthfr coronary artery disease Mthfr Coronary Disease Mthfr coronary restenosis Mthfr COVID-19 Aldh1l2 , Mthfd2 , Shmt1 , Tyms Craniofacial Abnormalities Mthfd1l Crohn's disease Mthfr Cytomegalovirus Infections Mthfr depressive disorder Mthfr developmental cardiac valvular defect Mthfd1 Developmental Disabilities Mthfr dextro-looped transposition of the great arteries Mthfr diabetes mellitus Mthfr diabetic angiopathy Mthfr Diabetic Nephropathies Mthfr , Mtrr diabetic retinopathy Mthfr diffuse large B-cell lymphoma Mthfr digenic dyskeratosis congenita Tyms Digestive System Neoplasms Tyms dimethylglycine dehydrogenase deficiency Dmgdh Down syndrome Gart , Mthfd1 , Mthfr , Mtrr Drug Eruptions Mthfr Drug-Related Side Effects and Adverse Reactions Atic , Dhfr , Mthfr , Mtr , Mtrr , Shmt1 , Tyms Dwarfism Mtfmt dyskeratosis congenita Tyms end stage renal disease Mthfr Endometrial Neoplasms Mthfr epilepsy Mtr epilepsy with generalized tonic-clonic seizures Mthfr esophageal atresia/tracheoesophageal fistula Gart Experimental Arthritis Atic Experimental Diabetes Mellitus Mthfr , Mtr Experimental Liver Cirrhosis Aldh1l1 , Aldh1l2 , Ftcd Experimental Mammary Neoplasms Tyms eye disease Mthfr factor VIII deficiency Mthfr familial Mediterranean fever Mthfr Female Infertility Dhfr , Mthfr fetal alcohol spectrum disorder Mtr Fetal Growth Retardation Mthfd1 Folate-Sensitive Neural Tube Defects Mthfd1 , Mthfr , Mtr , Mtrr folic acid deficiency anemia Dhfr follicular lymphoma Mthfr , Mtr , Tyms gastrointestinal stromal tumor Mthfr , Mtr , Mtrr , Shmt1 gastrointestinal system disease Mthfr , Mtr genetic disease Amt , Dhfr , Ftcd , Mtfmt , Mthfd1 , Mthfr , Mtr , Mtrr , Shmt2 glomerulonephritis Mthfr glutamate formiminotransferase deficiency Ftcd glycine encephalopathy Amt glycine encephalopathy 1 Amt glycine encephalopathy 2 Amt glycine N-methyltransferase deficiency Gnmt graft-versus-host disease Mthfr Graves' disease Mthfr Habitual Abortions Mthfr Head and Neck Neoplasms Tyms Hearing Loss Mthfr , Mtr heart disease Mtr , Mtrr heart septal defect Mtrr Helicobacter Infections Mthfr Hematologic Neoplasms Mthfr hematopoietic system disease Mthfr , Mtr hepatic veno-occlusive disease Mthfr hepatitis Gnmt hepatitis B Mthfr hepatocellular carcinoma Dhfr , Dmgdh , Gnmt , Mthfd2 , Mthfr , Mtrr , Tyms Hereditary Neoplastic Syndromes Dhfr High Myopia Aldh1l1 Hodgkin's lymphoma Mthfd2 homocystinuria Mtr , Mtrr homocystinuria-megaloblastic anemia cblE type Mtrr homocystinuria-megaloblastic anemia cblG type Mtr , Mtrr Hyperammonemia Tyms hyperhomocysteinemia Gnmt , Mthfr , Mtr , Mtrr hypermethioninemia Gnmt hypertension Mtr hyperthyroidism Mthfr hypopituitarism Mthfr hypothyroidism Mthfr Hypoxia Aldh1l1 IgA glomerulonephritis Mtr inflammatory bowel disease Mthfr Inherited Blood Coagulation Disease Mthfr inherited metabolic disorder Dhfr , Mtr , Mtrr intellectual disability Atic , Ftcd , Mthfr , Mtr intracranial sinus thrombosis Mthfr ischemia Mthfr kidney disease Mthfr kidney failure Mthfr Kidney Reperfusion Injury Dhfr Kuhnt-Junius degeneration Mthfr Left Ventricular Hypertrophy Mthfr Leigh disease Mtfmt Leukoencephalopathies Mthfr , Mtr leukopenia Mthfr liver benign neoplasm Mthfr liver cirrhosis Mthfr liver disease Mthfr Liver Neoplasms Gnmt lung adenocarcinoma Gart , Shmt1 , Tyms lung cancer Dhfr Lung Neoplasms Mthfr , Tyms lung non-small cell carcinoma Shmt2 lung small cell carcinoma Mthfr lymphoma Mthfr , Mtr male infertility Mthfr , Mtr , Mtrr Malnutrition Mthfr , Mtr Maxillofacial Abnormalities Mthfr megaloblastic anemia Dhfr Megaloblastic Anemia due to Dihydrofolate Reductase Deficiency Dhfr Meniere's disease Mthfr meningioma Mtrr metabolic dysfunction-associated steatotic liver disease Aldh1l2 , Gnmt , Mthfr Methylenetetrahydrofolate Reductase Deficiency Mthfr methylmalonic aciduria and homocystinuria type cblG Mtr , Mtrr microcephaly Mtfmt Microsatellite Instability Mthfr Microvascular Angina Mthfr migraine Mthfr migraine with aura Mthfr mitochondrial complex I deficiency Mtfmt mitral valve disease Mthfr Mthfr Deficiency, Thermolabile Type Mthfr mucositis Mthfr multiple myeloma Mthfr , Mtr , Mtrr , Tyms myelodysplastic syndrome Mtrr myeloid leukemia Dhfr myeloid neoplasm Mthfr myelomeningocele Mthfr myocardial infarction Mthfr myoepithelioma Ftcd Necrosis Mthfr Neoplasm Metastasis Dhfr , Mthfr , Tyms Neoplasm Recurrence, Local Tyms nephroblastoma Mthfr nephrosclerosis Mthfr nervous system disease Dhfr , Mthfr , Mtrr , Shmt1 , Tyms neural tube defect Mthfd1 , Mthfd1l , Mthfr neurodevelopmental disorder with cardiomyopathy, spasticity, and brain abnormalities Shmt2 Neurodevelopmental Disorder with Microcephaly, Epilepsy, and Hypomyelination Mthfs Neurodevelopmental Disorders Aldh1l2 , Shmt2 neuroendocrine tumor Tyms neutropenia Mthfr non-arteritic anterior ischemic optic neuropathy Mthfr non-Hodgkin lymphoma Mthfr , Mtrr , Shmt1 , Tyms nuclear type mitochondrial complex I deficiency 27 Mtfmt obesity Aldh1l1 open-angle glaucoma Mthfr oral squamous cell carcinoma Mthfr osteonecrosis Mthfr osteoporosis Atic osteosarcoma Dhfr , Mthfr ovarian cancer Shmt1 Ovarian Neoplasms Tyms pancreatic cancer Mthfr , Mtr , Mtrr , Tyms pancytopenia Dhfr papillomavirus infectious disease Mthfr Parkinson's disease Mthfr , Mtrr peripheral artery disease Mthfr placental abruption Mthfd1 portal vein thrombosis Mthfr Prenatal Exposure Delayed Effects Mthfr , Mtr prostate cancer Mthfr Prostatic Neoplasms Folh1 , Gnmt , Mthfr , Tyms pulmonary embolism Mthfr purine-pyrimidine metabolic disorder Atic rectal benign neoplasm Mthfr , Tyms renal artery disease Mthfr renal cell carcinoma Mthfr retinal disease Mthfr retinal vein occlusion Mthfr retinoblastoma Mtr rheumatoid arthritis Atic , Dhfr , Gart , Mthfr , Tyms schizophrenia Mthfr severe combined immunodeficiency Mthfd1 sickle cell anemia Mthfr skin disease Mthfr smallpox Mthfr spina bifida Mthfd1 , Mthfr , Mtr , Mtrr spinal cord disease Mthfr Splenomegaly Tyms Spontaneous Abortions Dhfr sporadic breast cancer Mthfr squamous cell carcinoma Mthfr , Tyms steatotic liver disease Mthfr stomach cancer Mthfr Stomach Neoplasms Mthfr , Tyms stroke Mthfr 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 Tongue Neoplasms Tyms transitional cell carcinoma Mthfr type 1 diabetes mellitus Mthfr type 2 diabetes mellitus Mthfr , Mtr ulcerative colitis Mtrr urinary bladder cancer Mthfr , Mtr , Tyms Uterine Cervical Dysplasia Mthfr Uterine Cervical Neoplasms Mthfr Vascular Calcification Mthfr vascular dementia Mthfr vascular disease Mthfr Venous Thromboembolism Mthfr Venous Thrombosis Mthfr vitamin B12 deficiency Mtr Waardenburg Syndrome Type 2F Mtfmt