Formic
Acid in the Drinking patient and the expectant mother
Dr. Bhushan. M. Kapur
Departments of Laboratory Medicine,
St. Michael's Hospital , Toronto, Ontario, Canada
Abstract
Methanol
is produced endogenously in the pituitary glands of humans and is
present as a congener in almost all alcoholic beverages. Ethanol
and methanol are both bio-transformed by alcohol dehydrogenase;
however, ethanol has greater affinity for the enzyme. Since ethanol
is preferentially metabolized by the enzyme, it is not surprising
that trace amounts of methanol, most likely originating from both
sources, have been reported in the blood of people who drink alcohol.
Toxicity resulting from methanol is very well documented in both
humans and animals and is attributed to its toxic metabolite formic
acid. To understand ethanol toxicity and Fetal Alcohol Spectrum
Disorders, it is important to consider methanol and its metabolite,
formic acid, as potential contributors to the toxic effects of alcohol.
Accumulation
of methanol suggests that alcohol-drinking population should have
higher than baseline levels of formic acid. Our preliminary studies
do indeed show this. Chronic low-level exposure to methanol has
been suggested to impair human visual functions. Formic acid is
known to be toxic to the optic nerve. Ophthalmological abnormalities
are a common finding in children whose mothers used alcohol during
pregnancy. Formic acid, a low molecular weight substance, either
crosses the placenta or may be formed in-situ from the water soluble
methanol that crosses the placenta. Embryo toxicity from formic
acid has been reported in an animal model
To assess
neurotoxicity we applied low doses of formic acid to rat brain hippocampal
slice cultures. We observed neuronal death with a time and dose
response. Formic acid requires folic acid as a cofactor for its
elimination. Animal studies have shown that when folate levels are
low, the elimination of formic acid is slower and formate levels
are elevated. When folic acid was added along with the formic acid
to the brain slice cultures, neuronal death was prevented.
Therefore,
folate deficient chronic drinkers may be at higher risk of organ
damage. Women who are folic acid deficient and consume alcohol may
have higher levels of formic acid and should they become pregnant,
their fetus may be at risk. To our knowledge low level chronic exposure
to formic acid and its relationship to folic acid in men or women
who drink alcohol has never been studied. Our hypothesis is that
the continuous exposure to low levels of formic acid is toxic to
the fetus and may be part of the etiology of Fetal Alcohol Spectrum
Disorders.
Folic acid
slows brain damage caused by formic acid in alcohol abuse
Attention: Assignment Editor, Health/Medical Editor, Media Editor,
News Editor
TORONTO, ONTARIO, MEDIA RELEASE--(Marketwire - Nov. 22, 2007) -
A new study with groundbreaking public health implications for treating
alcoholism and preventing Fetal Alcohol Syndrome has shown that
a byproduct of methanol, a contaminant found in many alcoholic beverages,
causes neurotoxicity that can be mitigated by folic acid.
Formic acid, a byproduct of methanol, is known to alter the normal
functioning of the nervous system and was found in higher quantities
in alcoholics. The toxicity of formic acid was significantly slowed
down by administering folic acid in an animal model.
The study was led by Dr. Bhushan Kapur, Department of Clinical
Pathology, Sunnybrook Health Sciences Centre in collaboration with
Dr. Peter Carlen, Department of Neurosciences, Toronto Western Division
of the University Health Network. Supported by a grant from the
Canadian Institutes of Health Research and appearing in today's
edition of Alcoholism: Clinical and Experimental Research, the study
examined formic acid levels in alcoholics as compared with those
in a control group. The serum formic acid levels were significantly
higher in alcoholics as compared to the controls. Formic acid was
not detected in the cerebrospinal fluid (a clear fluid bathing the
entire surface of central nervous system) in the control group,
but was found in three of the four alcoholic cases.
When the equivalent amount of formic acid that is found in alcoholics
was added to rat brain slice cultures, the acid caused neuronal
cell death. When folic acid was added with formic acid, neuronal
cell death could be prevented.
"Our studies suggest that formic acid may indeed be the mechanism
for many alcohol-related diseases, such as liver disease and central
nervous system disorders," says Dr. Bhushan Kapur. "Because
the neurotoxicity of formic acid can be greatly slowed by administering
folic acid, which is inexpensive and readily available, the public
health impact is staggering in terms of treating alcohol abusers
and possibly preventing the serious affects of Fetal Alcohol Syndrome."
Dr. Kapur, also a scientist with Motherisk at the Hospital for
Sick Children, notes that chronic exposure to low levels of formic
acid gradually harms the body, citing that liver damage in alcoholics
does not take place overnight. It is conceivable that a continuous
exposure to low, but above normal, formic acid levels may be toxic
to cells and contribute to alcohol-related organ damage.
This research resulted in a CIHR New Emerging Team Grants, intended
to support the creation or development of teams of investigators
undertaking collaborative, multidisciplinary research. Drs. Kapur
and Carlen are collaborating with researchers at Queen's University
on an ongoing study on folic acid supplementation as a potential
therapeutic intervention in preventing Fetal Alcohol Spectrum Disorders
using an animal model.
"This research will certainly raise some interesting discussions
for frontline healthcare providers, including the challenges of
how much folic acid to recommend per day to their patients who drink,
as well as factors such as absorption of folic acid, which is poor
in chronic drinkers, and also the issue of compliance in this population,"
adds Dr. Kapur.
Contact:
Marie Sanderson
Senior Communications Advisor
416.967.8554 or 416.480.4040
marie.sanderson@sunnybrook.ca
IN: HEALTH
For more information, please contact
Marie Sanderson, Senior Communications Advisor
Primary Phone: 416-967-8554
Secondary Phone: 416-480-4040
E-mail: marie.sanderson@sunnybrook.ca
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