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 4:123,059,989...123,106,471
Ensembl chr 4:123,060,008...123,106,465
G
Aldh1l2
aldehyde dehydrogenase 1 family, member L2
IEA
KEGG
rno:00670
NCBI chr 7:20,254,246...20,305,793
Ensembl chr 7:20,254,233...20,305,776
G
Amt
aminomethyltransferase
IEA
KEGG
rno:00670
NCBI chr 8:108,981,620...108,988,127
Ensembl chr 8:108,976,472...108,988,126
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 9:73,164,846...73,184,897
Ensembl chr 9:73,164,846...73,184,889
G
Dhfr
dihydrofolate reductase
IDA IEA ISO
KEGG RGD
PMID:11502523 PMID:22332074
rno:00670, RGD:1298877 , RGD:7242561
NCBI chr 2:23,585,876...23,611,199
Ensembl chr 2:23,586,031...23,613,713
G
Dmgdh
dimethylglycine dehydrogenase
TAS
RGD
PMID:15358367
RGD:1547831
NCBI chr 2:24,912,600...24,987,533
Ensembl chr 2:24,912,578...24,987,528
G
Folh1
folate hydrolase 1
TAS
RGD
PMID:9501243
RGD:728645
NCBI chr 1:140,428,101...140,501,563
Ensembl chr 1:140,428,101...140,501,379
G
Ftcd
formimidoyltransferase cyclodeaminase
IEA
KEGG
rno:00670
NCBI chr20:12,055,203...12,068,717
Ensembl chr20:12,055,208...12,068,735
G
Gart
phosphoribosylglycinamide formyltransferase, phosphoribosylglycinamide synthetase, phosphoribosylaminoimidazole synthetase
ISO IEA
KEGG RGD
PMID:12450384 PMID:22332074
rno:00670, RGD:1547842 , RGD:7242561
NCBI chr11:30,864,896...30,891,125
Ensembl chr11:30,865,889...30,891,125
G
Gnmt
glycine N-methyltransferase
TAS
RGD
PMID:8278367
RGD:1545057
NCBI chr 9:14,254,675...14,258,028
Ensembl chr 9:14,254,675...14,258,434
G
Mtfmt
mitochondrial methionyl-tRNA formyltransferase
IEA
KEGG
rno:00670
NCBI chr 8:65,953,787...65,971,841
Ensembl chr 8:65,953,767...65,971,841
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
IEA ISO TAS
KEGG RGD
PMID:22332074 PMID:2186031
rno:00670, RGD:7242561 , RGD:1299513
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
IEA
KEGG
rno:00670
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 IEA
KEGG RGD
PMID:9454603
rno:00670, RGD:1540378
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
IEA
KEGG
rno:00670
NCBI chr14:17,089,947...17,170,036
Ensembl chr14:17,089,952...17,170,112
G
Mthfr
methylenetetrahydrofolate reductase
ISO IEA
KEGG RGD
PMID:11933257 PMID:22332074
rno:00670, RGD:1535021 , RGD:7242561
NCBI chr 5:158,465,248...158,484,999
Ensembl chr 5:158,465,296...158,483,797
G
Mthfs
methenyltetrahydrofolate synthetase
IEA
KEGG
rno:00670
NCBI chr 8:89,729,498...89,801,998
Ensembl chr 8:89,729,508...89,799,089
G
Mtr
5-methyltetrahydrofolate-homocysteine methyltransferase
IEA ISO IDA
KEGG RGD
PMID:20814827 PMID:15845641
rno:00670, RGD:7242426 , RGD:1359026
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:20814827
RGD:7242426
NCBI chr 1:34,866,991...34,899,425
Ensembl chr 1:34,867,089...34,899,425
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 chr10:45,468,698...45,490,833
Ensembl chr10:45,468,700...45,497,820
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 7:63,358,961...63,364,293
Ensembl chr 7:63,358,961...63,364,236
G
Tyms
thymidylate synthetase
IEA IDA ISO
KEGG RGD
PMID:9894005 PMID:22332074
rno:00670, RGD:1545055 , RGD:7242561
NCBI chr 9:113,313,454...113,329,551
Ensembl chr 9:113,313,452...113,329,536
G
Mthfd1
methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1
ISO
RGD
PMID:22353665
RGD:7242562
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:22353665
RGD:7242562
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:22353665
RGD:7242562
NCBI chr17:58,219,998...58,308,560
Ensembl chr17:58,220,071...58,304,822
Altered Pathway:
Pathway Gene Annotations
Disease Annotations Associated with Genes in the folate mediated one-carbon metabolic pathway
Aldh1l1 alkaptonuria , autism spectrum disorder , cholestasis , Experimental Liver Cirrhosis , High Myopia , Hypoxia , obesity , Primary Lymphedema with Myelodysplasia Aldh1l2 Chemical and Drug Induced Liver Injury , COVID-19 , Experimental Liver Cirrhosis , metabolic dysfunction-associated steatotic liver disease , Neurodevelopmental Disorders Amt Acidoses , Aicardi-Goutieres Syndrome 1 , autosomal recessive limb-girdle muscular dystrophy type 2P , carnitine-acylcarnitine translocase deficiency , epilepsy , genetic disease , glycine encephalopathy , Glycine Encephalopathy 1 , Glycine Encephalopathy 2 , Pierson syndrome Atic AICAR Transformylase Inosine Monophosphate Cyclohydrolase Deficiency , blindness , brain disease , Breast Cancer, Familial , chronic kidney disease , Drug-Related Side Effects and Adverse Reactions , Experimental Arthritis , genetic disease , Glomerulopathy with Giant Fibrillar Deposits , intellectual disability , megacolon , nephrotic syndrome , Neurodevelopmental Disorders , osteoporosis , purine-pyrimidine metabolic disorder , rheumatoid arthritis , spondylometaphyseal dysplasia corner fracture type 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 Dmgdh dimethylglycine dehydrogenase deficiency , hepatocellular carcinoma , Neurodevelopmental Disorders Folh1 abdominal aortic aneurysm , amyotrophic lateral sclerosis type 1 , cerebral infarction , intellectual disability , Prostatic Neoplasms Ftcd autistic disorder , Axenfeld-Rieger syndrome type 3 , Bethlem myopathy , Bethlem Myopathy 1A , Burkitt lymphoma , cataract 9 multiple types , Collagen VI-related Myopathy , developmental and epileptic encephalopathy 30 , Experimental Liver Cirrhosis , genetic disease , glutamate formiminotransferase deficiency , homocystinuria , intellectual disability , myoepithelioma , Myosclerosis, Autosomal Recessive , primary ciliary dyskinesia , progressive myoclonus epilepsy , Ullrich congenital muscular dystrophy 1A Gart amyotrophic lateral sclerosis type 1 , Animal Disease Models , autosomal dominant intellectual developmental disorder 7 , Down syndrome , Familial Platelet Disorder with Associated Myeloid Malignancy , immunodeficiency 28 , intellectual disability , lung adenocarcinoma , Parkinson's disease 20 , rheumatoid arthritis , Tracheoesophageal Fistula , ZTTK syndrome Gnmt Chronic Hepatitis , glycine N-methyltransferase deficiency , hepatitis , hepatocellular carcinoma , hyperhomocysteinemia , hypermethioninemia , infantile Refsum disease , Liver Neoplasms , metabolic dysfunction-associated steatotic liver disease , Prostatic Neoplasms , Zellweger syndrome Mtfmt Bloom syndrome , colorectal cancer , combined oxidative phosphorylation deficiency 15 , Dwarfism , genetic disease , Leigh disease , microcephaly , mitochondrial complex I deficiency , nemaline myopathy 6 , nuclear type mitochondrial complex I deficiency 27 , Subacute Necrotizing Encephalopathy of Leigh, Infantile 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 Mthfs Bloom syndrome , 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 , 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 , 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 , 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 cataract 15 multiple types , Charcot-Marie-Tooth disease axonal type 2U , familial melanoma , genetic disease , INTERSTITIAL LUNG AND LIVER DISEASE , lung non-small cell carcinoma , neurodevelopmental disorder with cardiomyopathy, spasticity, and brain abnormalities , Neurodevelopmental Disorders , paraplegia Tyms abdominal aortic aneurysm , acute lymphoblastic leukemia , acute myeloid leukemia , anemia , Animal Disease Models , autistic disorder , brain disease , Breast Neoplasms , cerebral infarction , cleft lip , cleft palate , colon carcinoma , Colonic Neoplasms , colorectal adenocarcinoma , Colorectal Neoplasms , COVID-19 , Digestive System Neoplasms , Drug-Related Side Effects and Adverse Reactions , dyskeratosis congenita , DYSKERATOSIS CONGENITA, DIGENIC , 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 , Neurodevelopmental Disorders , 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 Aicardi-Goutieres Syndrome 1 Amt Albuminuria Mthfr alcoholic liver cirrhosis Mthfr alkaptonuria Aldh1l1 allergic disease Mthfr alopecia Mthfr Alzheimer's disease Mthfr amyotrophic lateral sclerosis Mthfr amyotrophic lateral sclerosis type 1 Folh1 , Gart anemia Mthfr , Tyms anencephaly Mtrr angle-closure glaucoma Mthfr Animal Disease Models Gart , Shmt1 , Tyms 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 , Mthfr , Mtr autistic disorder Dhfr , Ftcd , Mthfr , Mtr , Shmt1 , Tyms autosomal dominant intellectual developmental disorder 7 Gart autosomal recessive limb-girdle muscular dystrophy type 2P Amt Axenfeld-Rieger syndrome type 3 Ftcd B-Cell Chronic Lymphocytic Leukemia Mthfr Banti's Syndrome Mthfr Bethlem myopathy Ftcd Bethlem Myopathy 1A Ftcd bipolar disorder Mthfr blindness Atic Bloom syndrome Mtfmt , Mthfs brain disease Atic , Tyms brain ischemia Mthfr breast cancer Shmt1 Breast Cancer, Familial Atic Breast Neoplasms Dhfr , Mthfr , Mtr , Shmt1 , Tyms Budd-Chiari syndrome Mthfr Burkitt lymphoma Ftcd cardia cancer Mthfr cardiovascular system disease Mthfr carnitine-acylcarnitine translocase deficiency Amt carotid stenosis Mthfr cataract Mthfr cataract 15 multiple types Shmt2 cataract 9 multiple types Ftcd catecholaminergic polymorphic ventricular tachycardia Mtr catecholaminergic polymorphic ventricular tachycardia 1 Mtr cavernous sinus meningioma Dhfr cerebral infarction Folh1 , Mthfr , Mtr , Tyms cervical cancer Mthfr cervix uteri carcinoma in situ Mthfr Charcot-Marie-Tooth disease axonal type 2U Shmt2 Charcot-Marie-Tooth disease type 2 Mthfr Chemical and Drug Induced Liver Injury Aldh1l2 , Dhfr , Mthfr cholangiocarcinoma Mthfr cholestasis Aldh1l1 chromosome 1p36 deletion syndrome Mthfr chromosome 6q24-q25 deletion syndrome Mthfd1l Chronic Hepatitis Gnmt chronic kidney disease Atic , 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 Cognitive Dysfunction Mthfr Collagen VI-related Myopathy Ftcd colon carcinoma Tyms Colonic Neoplasms Mthfr , Tyms colorectal adenocarcinoma Tyms colorectal cancer Mtfmt , Mthfs Colorectal Neoplasms Dhfr , Mthfr , Mtrr , Tyms Combined Immunodeficiency and Megaloblastic Anemia with or without Hyperhomocysteinemia Mthfd1 combined oxidative phosphorylation deficiency 15 Mtfmt common variable immunodeficiency 2 Shmt1 congenital disorder of glycosylation type IIb Mthfd2 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 and epileptic encephalopathy 30 Ftcd 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 Digestive System Neoplasms Tyms dilated cardiomyopathy 1AA Mtr 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 DYSKERATOSIS CONGENITA, DIGENIC Tyms dystonia Mthfd2 Ehlers-Danlos syndrome kyphoscoliotic type 1 Mthfr end stage renal disease Mthfr endometrial cancer Dhfr endometrial carcinoma Dhfr Endometrial Neoplasms Mthfr epilepsy Amt , Mtr epilepsy with generalized tonic-clonic seizures Mthfr 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 adenomatous polyposis 4 Dhfr Familial Atrial Fibrillation 6 Mthfr familial Mediterranean fever Mthfr familial melanoma Shmt2 Familial Platelet Disorder with Associated Myeloid Malignancy Gart 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 Dhfr , Mthfr , Mtr , Mtrr , Shmt1 gastrointestinal system disease Mthfr , Mtr genetic disease Amt , Atic , Dhfr , Ftcd , Mtfmt , Mthfd1 , Mthfr , Mtr , Mtrr , Shmt2 glomerulonephritis Mthfr Glomerulopathy with Giant Fibrillar Deposits Atic 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 Ftcd , 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 immunodeficiency 28 Gart infantile Refsum disease Gnmt inflammatory bowel disease Mthfr Inherited Blood Coagulation Disease Mthfr inherited metabolic disorder Dhfr , Mtr , Mtrr intellectual disability Atic , Folh1 , Ftcd , Gart , Mthfr , Mtr INTERSTITIAL LUNG AND LIVER DISEASE Shmt2 intracranial sinus thrombosis Mthfr ischemia Mthfr Joubert syndrome 1 Shmt1 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 megacolon Atic 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 Methylmalonyl-CoA Epimerase Deficiency Mthfd2 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 Myosclerosis, Autosomal Recessive Ftcd Necrosis Mthfr nemaline myopathy 6 Mtfmt Neoplasm Metastasis Dhfr , Mthfr , Tyms Neoplasm Recurrence, Local Tyms nephroblastoma Mthfr nephrosclerosis Mthfr nephrotic syndrome Atic 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 , Atic , Dhfr , Dmgdh , Shmt2 , Tyms 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 paraplegia Shmt2 parathyroid carcinoma Mtr Parkinson's disease Mthfr , Mtrr Parkinson's disease 20 Gart peripheral artery disease Mthfr Pierson syndrome Amt placental abruption Mthfd1 portal vein thrombosis Mthfr Potocki-Lupski syndrome Shmt1 Prenatal Exposure Delayed Effects Mthfr , Mtr primary ciliary dyskinesia Ftcd Primary Lymphedema with Myelodysplasia Aldh1l1 progressive myoclonus epilepsy Ftcd 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 spondylometaphyseal dysplasia corner fracture type Atic 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 Subacute Necrotizing Encephalopathy of Leigh, Infantile Mtfmt 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 Tracheoesophageal Fistula Gart transitional cell carcinoma Mthfr type 1 diabetes mellitus Mthfr type 2 diabetes mellitus Mthfr , Mtr ulcerative colitis Mtrr Ullrich congenital muscular dystrophy 1A Ftcd urinary bladder cancer Mthfr , Mtr , Tyms Uterine Cervical Neoplasms Mthfr Vascular Calcification Mthfr vascular dementia Mthfr vascular disease Mthfr Venous Thromboembolism Mthfr Venous Thrombosis Mthfr vitamin B12 deficiency Mtr Zellweger syndrome Gnmt ZTTK syndrome Gart