New perspectives on folate status: a differential role for the vitamin in cardiovascular disease, birth defects and other conditions

In recent years, there has been heightened interest in the B vitamin folic acid, initially through its role in reducing neural tube defects, such as s pina bifida, and, more recently, through its relationship with homocysteine and consequently the beneficial role it would seem to play in occlusive va scular disease. In addition, its sphere of influence may extend beyond thes e important conditions to include several cancers, Alzheimer's disease and affective disorders. The beneficial effects of folate in the above conditio ns can be explained largely within the context of folate-dependent pathways , such as methionine, purine and pyrimidine biosynthesis. However, the prec ise detail of folate metabolism is extremely complex and difficult to study because folate-dependent one-carbon metabolism is compartmentalised, invol ves an enormous number of low-abundance, difficult-to-measure, highly labil e folyl coenzymes, and is the subject of genetic variability. Here we integ rate some of the most recent findings in the field to provide a new perspec tive on folate status and some of the varied mechanisms by which folate ame liorates disease.