叶酸与神经管畸形相关研究进展

神经管畸形(neural tube defects,NTDs)是胚胎发育过程中由于神经管闭合失败所导致的出生缺陷,也是新生儿最常见的先天畸形之一。神经管畸形的发生是一个多因素、多步骤的复杂过程。近年来,叶酸已逐渐成为NTDs研究中专注度最高的一个环境因素,但其在神经管闭合过程中的作用机制尚不完全清楚。本文就近年来叶酸在神经管发育中的作用机制作一综述,简要阐明叶酸转运机制、叶酸代谢、叶酸与DNA甲基化、叶酸与组蛋白修饰等方面在早期胚胎发育神经管形成过程中的作用。     

神经管畸形的表观遗传学研究进展

神经管畸形(neural tube defects,NTDs)是胚胎在早期发育过程中,由于神经管闭合不全或障碍引起的一组以脑和(或)脊髓发育异常为主的先天畸形。目前,对于神经管畸形的发病机制和病因没有明确的定论。很多因素参与神经管畸形的发生,主要涉及遗传、环境、以及二者的相互作用。遗传因素的研究主要着重于寻找神经管畸形的致病基因并进行基因功能缺陷研究,但是神经管畸形是多因素参与的结果,基因功能缺陷研究并不能完全解释其发病机制。基于目前的研究现状,近年来,环境因素通过调控表观遗传的修饰进而参与调节NTDs发生相关基因表达的研究逐渐受到重视。     

组蛋白 H3K79同型半胱氨酸修饰位点在神经管畸形中的作用

目的:探讨人类胚胎脑组织中是否存在H3K79同型半胱氨酸修饰(H3K79Hcy)及其在神经管畸形(NTDs)中的作用。方法:通过质谱检测组蛋白H3K79是否存在同型半胱氨酸修饰位点。进一步合成包含组蛋白H3K79位点的同型半胱氨酸(Hcy)修饰的肽段,并与牛血清白蛋白(BSA)偶联后免疫兔子得到抗组蛋白H3K79Hcy多克隆抗体,并对抗体进行特异性检测;采用此抗H3K79Hcy抗体比较人类高Hcy NTDs样本和正常对照样本的H3K79Hcy水平。结果:(1)人胚胎组织组蛋白H3K79位点存在同型半胱氨酸修饰;(2)高Hcy水平NTDs脑组织中H3K79Hcy修饰水平高于正常对照(P0.05)。结论:人胚胎组织存在H3K79Hcy修饰,此修饰异常可能促进神经管畸形的发生。     

与神经管畸形相关的基因学研究进展

神经管畸形（neural tube defects,NTDs）是指由于在胚胎发育过程中,神经管闭合不全所引起的一组出生缺陷,包括无脑儿、脊柱裂、脑积水、脑或脑脊膜膨出等,其危害极大,严重影响患儿的生理发育和生活质量,给家庭和社会带来沉重的精神压力和经济负担。大多数研究认为神经管畸形是多因素多基因的遗传疾病,是遗传、环境、营养因素共同作用、交互影响的结果,目前还不能用一种单一原因解释该疾病的发生。本文主要从导致神经管畸形发生的叶酸代谢酶基因多态性、神经管形态学方面的相关基因研究等做一综述。     

MTX诱导神经管畸形动物模型的建立

目的:通过二氢叶酸还原酶(DHFR)竞争性抑制剂甲氨蝶呤(MTX)建立叶酸缺乏的神经管畸形(NTDs)动物模型。方法:本研究用孕7.5天C57BL/6J小鼠,采用腹腔注射(ip)不同剂量的MTX建立叶酸代谢障碍的小鼠NTDs模型,LC/MS/MS及酶学方法检测胚胎组织中叶酸相关代谢产物水平及DHFR活性。结果:最佳的致畸剂量为,MTX 4.5 mg/kg,其NTDs发生率最高为31.4%。畸形的胎鼠表型多数为后脑泡未闭,且其身长(4.21±0.76),体重(9.49±3.48)均明显低于对照组(6.32±0.56;22.76±3.23)(P0.05;P0.05)。MTX实验组的胚胎组织中DHFR的活性较对照组显著降低(P0.05),5-MeTHF和5-FoTHF的浓度和对照组相比也明显降低(P0.05)。结论:本研究成功的建立了叶酸缺乏的神经管畸形动物模型。     

警惕高同型半胱氨酸血症

血清同型半胱氨酸浓度增高使老年人容易发生骨折,也使患心脏病的危险性增加。现认为,可能是由于高水平的同型半胱氨酸能抑制胶原蛋白的交联,而亚甲基四氢叶酸还原酶（MTHFR）有TT突变基因型的患者．因为此酶的活性降低,通常伴有同型半胱氨酸水平增高和叶酸水平降低。此外,雌二醇能通过增强抗氧化剂系统以防止高同型半胱氨酸血症引起的动脉粥样硬化症。故服用B族维生素和应用雌激素替代疗法是有益的。     

同型半胱氨酸与不同类型卒中的相关性研究

目的：探讨同型半胱氨酸（Hcy）与不同类型脑卒中的关系,并对高Hcy血症成因作初步分析。方法：测定225例缺血性脑卒中和40例出血性脑卒中患者以及85例同龄健康受试者的血浆Hcy水平以及叶酸、维生素B12的浓度,将缺血性卒中按照TOAST分型分为不同临床亚组--动脉粥样硬化性脑血栓形成组,腔隙性脑梗死组,心源性脑栓塞组以及其他或不明原因脑梗死组,并分别与健康组进行对照研究。结果：血浆同型半胱氨酸平均水平在动脉粥样硬化性脑梗死组患者为（16.19±4.35）μmol/L,腔隙性脑梗死患者为（16.89±6.41）μmol/L,心源性脑栓塞组为（18.23±4.83）μmol/L,其他或不明原因脑梗死患者为（17.31±2.56）μmol/L,脑出血组患者为（14.91±4.54）μmol/L,均高于对照组（7.20±7.91）μmol/L,P〈0.05;各缺血性卒中组间同型半胱氨酸水平差异无显著性（P〈0.05）;缺血性卒中组患者血浆同型半胱氨酸水平高于出血性卒中组（P〈0.05）。卒中各组叶酸和维生素B12浓度均显著低于对照组（P〈0.05）。结论：血浆同型半胱氨酸在不同类型卒中中均升高,高血浆Hcy水平可能是脑卒中的独立危险因素,叶酸和VitB12缺乏可能是导致高Hcy血症的重要原因。     

急性脑梗死患者血浆同型半胱氨酸水平及其相关因素分析*

目的:探讨急性脑梗死患者血浆同型半胱氨酸水平及相关因素。方法:采用高效液相色谱法检测232例急性脑梗死患者血浆Hcy水平,并对其相关因素进行统计学分析。结果:急性脑梗死组患者血浆Hcy水平明显升高(P<0.05);并与叶酸及维生素B12水平显著相关。不同年龄段急性脑梗死患者血浆Hcy水平具有差异。并与颈动脉粥样硬化斑块相关联。结论:血浆Hcy水平增高是脑梗死的危险因素之一,并与患者年龄、血液中叶酸、维生素B12水平及脑梗死性质相关联。     

ERK1/2在高温致神经管畸形神经上皮细胞中的表达变化

目的 探讨高温致神经管畸形(NTDs)作用的分子机制,为防治NTDs的发生提供理论依据.方法 在高温致金黄地鼠NTDs模型的基础上,应用免疫荧光染色技术,观察NTDs发生过程中p-ERK1/2在鼠胚神经上皮细胞中的表达变化.结果 对照组和实验组孕鼠在高温水浴处理后16、24h,p-ERK1/2免疫阳性产物分布于鼠胚神经上皮细胞和周围间充质细胞的胞浆中;水浴后36、60h,p-ERK1/2表达部位出现了由细胞浆向细胞核的转移;高温处理后,p-ERK1/2在实验组各期胚胎神经上皮细胞内的表达均比对照组减弱.结论 ERK1/2参与胚胎神经管的发育过程,其表达降低在高温致神经管畸形的发生中起重要作用.     

血浆同型半胱氨酸水平与轻度认知功能障碍的相关性分析

目的:探讨轻度认知功能障碍(MCI)与血浆同型半胱氨酸(Hcy)水平的关系。方法:测定96例MCI及85例健康体检者得血浆Hcy、叶酸及维生素B12水平;MCI患者中选择高Hcy血症者62例,按照是否接受叶酸、维生素B12治疗随机分为治疗组和非治疗组,观察治疗前后Hcy水平及MMSE评分变化。结果:MCI组血浆Hcy水平显著高于对照组(P<0.05),叶酸、维生素B12及MMSE评分低于对照组(P<0.05);MCI组中Hcy水平与叶酸、维生素B12及MMSE评分均呈负相关(P<0.05);治疗后治疗组Hcy水平较治疗前显著下降(P<0.05);治疗组Hcy低于非治疗组(P<0.05);治疗组MMSE评分较治疗前升高,但无显著性差异(P>0.05),治疗组MMSE评分与非治疗组相比差异无统计学意义(P>0.05)。结论:血浆Hcy升高是MCI的重要因素,补充叶酸、维生素B12可降低血浆Hcy水平。     

Does prenatal screening for 5,10-methylenetetrahydrofolate reductase (MTHFR) mutations in high-risk neural tube defect pregnancies make sense?

Despite the fact that neural tube defects (NTDs) are the most common congenital malformations of the central nervous system, investigators have yet to identify responsible gene(s). Research efforts have been productive in the identification of environmental factors, such as periconceptional folic acid supplementation, that modulate risk for the development of NTDs. Studies of the folic acid biosynthetic pathway led to the discovery of an association between elevated levels of homocysteine and NTD risk. Researchers subsequently identified single nucleotide polymorphisms in the gene coding for the enzyme 5,10-methylenetetrahydrofolate reductase (MTHFR). Association studies suggested it was a potential risk factor for NTDs, because the thermolabile form of the enzyme led to elevated homocysteine concentrations when folic acid intake is low. Numerous studies analyzing MTHFR variants have resulted in positive associations with increased NTD risk only in certain populations, suggesting that these variants are not large contributors to the etiology of NTDs. With our limited understanding of the genes involved in regulating NTD susceptibility, the paucity of data on how folic acid protects the developing embryo, as well as the observed decrease in birth prevalence of NTDs following folic acid supplementation and food fortification, it makes little sense for prospective parents to be tested for MTHFR variants, or for variants of other known folate pathway genes.     

Plasma vitamin values and antiepileptic therapy: case reports of pregnancy outcomes affected by a neural tube defect

BACKGROUND: Folic acid supplementation reduces the occurrence of neural tube defects (NTDs); however, it is not clear whether it protects against teratogenic effects of antiepileptic drugs. METHODS: We report the cases of four pregnant women receiving valproic acid therapy, who all had NTD-affected offspring, despite periconceptional 5 mg/day of folic acid supplementation (cases), and investigated homocysteine metabolism, linked with folate metabolism. Their plasma homocysteine, folates, and vitamin B6 and B12 results were compared with values of two other women, who were also receiving valproic acid and folic acid complement, but who had normal pregnancies (valproic acid controls), and values of 40 pregnant women who had normal pregnancies and were not receiving any therapy (controls without therapy). Because of the possible existence of a genetic susceptibility, polymorphisms in homocysteine metabolism were sought. RESULTS: Two cases showed a decreased phosphopyridoxal level, compared with levels in the controls not receiving therapy. The genotype TT (C677T) is an NTD genetic susceptibility, but it was observed in only one valproic acid control. Various polymorphisms were observed in the cases, but were also common in the controls. Several studies have reported that valproic acid therapy lowers vitamin B6 levels. Our case with the greatest decrease in plasma phosphopyridoxal, who was taking periconceptional folic acid plus pyridoxine therapy, had a normal second pregnancy outcome. CONCLUSIONS: In addition to folates, other vitamins, such as vitamin B6, may have played a role in NTDs in our patients taking an antiepileptic drug.     

A new perspective on neural tube defects: Folic acid and microRNA misexpression

Neural tube defects (NTDs) are the second most common birth defects in the United States. It is well known that folic acid supplementation decreases about 70% of all NTDs, although the mechanism by which this occurs is still relatively unknown. The current theory is that folic acid deficiency ultimately leads to depletion of the methyl pool, leaving critical genes unmethylated, and, in turn, their improper expression leads to failure of normal neural tube development. Recently, new studies in human cell lines have shown that folic acid deficiency and DNA hypomethylation can lead to misexpression of microRNAs (miRNAs). Misexpression of critical miRNAs during neural development may lead to a subtle effect on neural gene regulation, causing the sometimes mild to severely debilitating range of phenotypes exhibited in NTDs. This review seeks to cohesively integrate current information regarding folic acid deficiency, methylation cycles, neural development, and miRNAs to propose a potential model of NTD formation. In addition, we have examined the relevant gene pathways and miRNAs that are predicted to affect them, and based on our investigation, we have devised a basic template of experiments for exploring the idea that miRNA misregulation may be linked to folic acid deficiency and NTDs. genesis 48:282–294, 2010. © 2010 Wiley‐Liss, Inc.     

The emerging role of epigenetic mechanisms in the etiology of neural tube defects

The molecular requirements for neural tube closure are complex. This is illustrated by the occurrence of neural tube defects (NTDs) in many genetic mouse mutants, which implicate a variety of genes, pathways and cellular functions. NTDs are also prevalent birth defects in humans, affecting around 1 per 1,000 pregnancies worldwide. In humans the causation is thought to involve the interplay of fetal genes and the effect of environmental factors. Recent studies on the etiology of human NTDs, as well as analysis of mouse models, have raised the question of the possible involvement of epigenetic factors in determining susceptibility. A consideration of potential causative factors in human NTDs must now include both alterations in the regulation of gene expression, through mutation of promoter or regulatory elements and the additional analysis of epigenetic regulation. Alterations in the epigenetic status can be directly modified by various environmental insults or maternal dietary factors.Key words: neural tube defects, diet, folic acid, epigenome, epigenetic regulation, methylation, chromatin, histones, acetylation     

Folate-mediated one-carbon metabolism and neural tube defects: balancing genome synthesis and gene expression

Neural tube defects (NTDs) refer to a cluster of neurodevelopmental conditions associated with failure of neural tube closure during embryonic development. Worldwide prevalence of NTDs ranges from approximately 0.5 to 60 per 10,000 births, with regional and population-specific variation in prevalence. Numerous environmental and genetic influences contribute to NTD etiology; accumulating evidence from population-based studies has demonstrated that folate status is a significant determinant of NTD risk. Folate-mediated one-carbon metabolism (OCM) is essential for de novo nucleotide biosynthesis, methionine biosynthesis, and cellular methylation reactions. Periconceptional maternal supplementation with folic acid can prevent occurrence of NTDs in the general population by up to 70%; currently several countries fortify their food supply with folic acid for the prevention of NTDs. Despite the unambiguous impact of folate status on NTD risk, the mechanism by which folic acid protects against NTDs remains unknown. Identification of the mechanism by which folate status affects neural tube closure will assist in developing more efficacious and better targeted preventative measures. In this review, we summarize current research on the relationship between folate status and NTDs, with an emphasis on linking genetic variation, folate nutriture, and specific metabolic and/or genomic pathways that intersect to determine NTD outcomes.     

Effects of folate supplementation on the risk of spontaneous and induced neural tube defects in Splotch mice

BACKGROUND: Neural tube defects (NTDs) are among the most common human congenital malformations. Although clinical investigations have reported that periconceptional folic acid supplementation can reduce the occurrence of these defects, its mechanism remains unknown. Therefore, the murine mutant Splotch, which has a high incidence of spontaneous NTDs, along with the inbred strains SWV and LM/Bc, were used to investigate the relationship between folate and NTDs. METHODS: To investigate whether folates could reduce spontaneous NTDs, heterozygous Splotch dams (+/Sp) were treated with either folate or folinic acid throughout neurulation, gestational day (GD) 6.5 to 10.5. On GD 18.5 the dams were sacrificed and the fetuses examined for any neural tube defects. Subsequently, Sp/+ dams were treated with arsenic while receiving either a folate or folinic acid supplementation. Similar experiments were performed in the LM/Bc and SWV strains. RESULTS: Neither folate nor folinic acid supplements reduced the frequency of spontaneous NTDs in the embryos from Splotch heterozygote crosses. Arsenic increased the frequency of NTDs and embryonic death in the Splotch, LM/Bc and SWV litters and folinic acid failed to ameliorate the teratogenic effect of this metal. A folate supplement given to arsenic-treated dams proved to be maternally lethal in all three strains. CONCLUSIONS: Splotch embryos were not protected from either spontaneous or arsenic-induced NTDs by folinic or folic acid supplementation. Furthermore, folinic acid supplements did not reduce the incidence of arsenic-induced NTDs in either the LM/Bc or SWV litters.     

Prevalence of cystathionine beta synthase gene mutation 852Ins68 as a possible risk for neural tube defects in eastern India

Cystathionine beta synthase gene (CβS) catalyzes the condensation of homocysteine with serine, forming cystathionine by the transsulfuration pathway. Disruption of CβS enzyme activity due to defective folic acid metabolism increases the risk factor for neural tube defects. We evaluated the CβS gene mutation in 25 children with neural tube defects (NTDs), including lumbosacral and thoracic myelomeningocele and open NTDs and mothers of cases, along with 25 healthy children and their mothers, serving as controls. Genomic DNA was isolated to assess the polymorphism of 852Ins68 in the CβS gene using PCR-RFLP analysis and nucleotide sequencing techniques. The 68-bp insertion was observed in one of the 25 NTD cases (lumbosacral myelomeningocele), and in two of the mothers of NTD cases. Statistical analysis was carried out using the Fischer exact probability test, which showed a lack of significance (P > 0.05), but the odds ratio of 2.08 with 95% confidence interval of 0.17-24.6 in NTDs mother was quite high because of the small sample size. However, the study was further extended to find out the involvement of specific nucleotide sequences, which again confirmed the 852Ins68 insertion and replacement of nucleotides (TCCAT to GGGG) in lumbosacral myelomeningocele (due to other category of NTDs), suggesting that it could be an independent risk factor for birth defects, including NTDs.     

Metabolic effects and the methylenetetrahydrofolate reductase (MTHFR) polymorphism associated with neural tube defects in southern Brazil

BACKGROUND: The importance of metabolic factors in neural tube defects (NTDs) has been the focus of many investigations. Several authors have suggested that abnormalities in homocysteine metabolism, such as hyperhomocysteinemia, folate deficiency, and low vitamin B12, may be responsible for these malformations and that both nutritional factors and genetic abnormalities are associated with them. METHODS: We conducted a case-control study to investigate the influence of biochemical and genetic factors in NTDs in infants in southern Brazil. Levels of folate, vitamin B12, total homocysteine (t-Hcy) and the 677C>T and 1298A>C polymorphisms of the MTHFR gene were analyzed in 41 NTD child-mother pairs and 44 normal child-mother control pairs. RESULTS: Subjects in the case group had a higher mean blood folate level than those in the control group. The level of vitamin B12 was lower in mothers in the NTD group than in control mothers (p = 0.004). The level of t-Hcy was not different in the two groups, but t-Hcy and vitamin B12 were correlated (p = 0.002). There was no difference in the genotype distribution for 677C>T and 1298A>C polymorphisms of MTHFR in the case and control pairs. The level of t-Hcy was correlated with 677TT. CONCLUSIONS: Despite the small sample in this study, we suggest that low vitamin B12 and, consequently, hyperhomocysteinemia are important risk factors for NTDs in our population.     

Neural tube defects on the Texas‐Mexico border: What we've learned in the 20 years since the Brownsville cluster

We reviewed the published findings from the Texas Neural Tube Defect Project, a 6‐year case‐control study (1995–2000) of neural tube defects (NTDs) on the Texas‐Mexico border. In this review, we highlight what was learned about environmental, genetic, and nutritional factors (i.e., those related to the folate and other metabolic pathways) and the novel putative risk factors that emerged from this study of Mexican American women living on the Texas‐Mexico border. Our investigations of the micronutrients and metabolic pathways involved confirmed the findings of other researchers that increased folate intake has a protective effect and that low serum B₁₂, high serum homocysteine levels, and obesity independently contribute to risk. Studies of this population also have implicated hyperinsulinemia and low ferritin, metabolic risk factors, which require additional study to elucidate their physiologic mechanism. Environmental contaminants such as heavy metals, pesticides, and polychlorinated biphenyls (PCBs), which were of community concern, did little to explain NTD risk. Studies in this folic acid deficit‐population also revealed several novel risk factors, namely, diarrhea, stress, fumonisins, and the combination of nitrosatable drug exposure with high nitrate/nitrite intake. In conclusion, the 23 studies among the Mexican American women living along the Texas‐Mexico border have demonstrated the multifactorial nature of NTDs and that a population deficient in folic acid will be vulnerable to a variety of insults whether brought on by individual behaviors (e.g., obesity) or through the surrounding environment (e.g., fumonisins). Birth Defects Research (Part A), 2012. © 2012 Wiley Periodicals, Inc.