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Weber B, Marculescu R, Radakovic S, Tanew A. Serum levels of folate, 25-hydroxyvitamin D3 and cobalamin during UVB phototherapy: findings in a large prospective trial. J Eur Acad Dermatol Venereol 2019; 34:385-391. [PMID: 31494977 PMCID: PMC7027503 DOI: 10.1111/jdv.15941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/21/2019] [Indexed: 11/29/2022]
Abstract
Background Narrowband UVB phototherapy (NB‐UVB) is a mainstay in the treatment of numerous inflammatory dermatoses. Whereas, a wealth of studies has shown that NB‐UVB treatment increases 25‐hydroxyvitamin D3 (25(OH)D) levels, only sparse and controversial data exist on its effect on serum folate and cobalamin. Objectives To determine whether exposure to NB‐UVB alters serum folate or cobalamin levels. Methods A single‐centre, prospective, open observational study on 101 patients subjected to NB‐UVB phototherapy between late fall and early spring. Serum folate, 25(OH)D and cobalamin levels were measured after 0, 12, 24 and 36 NB‐UVB exposures. Results After 12 NB‐UVB exposures a significant decrease of mean serum folate (−1.0 nmol/L; P = 0.03) and cobalamin (−14.5 pmol/L, P = 0.03) levels was observed whereas serum levels of 25(OH)D showed a significant increase (35.4 nmol/L, P < 0.0001). Conclusions A standard course of NB‐UVB induces a small but significant decrease of serum folate and cobalamin levels.
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Affiliation(s)
- B Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - S Radakovic
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Yousefkhani L, Rafiei R, Darjani A, Alizadeh N, Eftekhari H, Gharaei Nejad K, Rafiei E, Rafiee B. Evaluation of serum folate level before and after bath PUVA therapy in patients referred to Razi Hospital, Rasht, Iran. Dermatol Ther 2019; 32:e13000. [PMID: 31215747 DOI: 10.1111/dth.13000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
Ultraviolet (UV) radiation could disintegrate folate molecule, so phototherapy may reduce folate levels in the patients. The effect of phototherapy on serum folate in human body is questionable. We investigated the effect of bath PUVA therapy on serum folate level. This study was designed as a before-after study. Thirty-two patients completed study during 2 years. Our variables were demographic data, folate levels before and 8 weeks after treatment and cumulative dosage of UVA during 8 weeks of treatment. Serum folate was evaluated with chemiluminescence immunoassay technique. All data were analyzed using SPSS 18 software. Folate level changes were statistically significant before and after bath PUVA therapy. There was no significant difference in folate levels in psoriasis patients compared with nonpsoriasis patients. In psoriasis patients, folate levels had no significant correlation with psoriasis activity index before treatment. Decrease in folate levels was more significant in fair-skinned patients. There was no association between folate status and cumulative dosage of UVA. Bath PUVA therapy reduced serum folate level in our patients although none of them were folate deficient. Folate deficiency should be evaluated and corrected especially in fair-skinned cases, as it may be aggravated by phototherapy.
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Affiliation(s)
- Leila Yousefkhani
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Rana Rafiei
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Darjani
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Narges Alizadeh
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hojat Eftekhari
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kaveh Gharaei Nejad
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Rafiei
- Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnam Rafiee
- Department of Pathology, NYU Winthrop Hospital, Mineola, New York
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Effect of pterin impurities on the fluorescence and photochemistry of commercial folic acid. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2018; 181:157-163. [DOI: 10.1016/j.jphotobiol.2018.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/19/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
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4
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Zhang M, Goyert G, Lim HW. Folate and phototherapy: What should we inform our patients? J Am Acad Dermatol 2017; 77:958-964. [DOI: 10.1016/j.jaad.2016.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/23/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
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5
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Stability of folic acid under several parameters. Eur J Pharm Sci 2016; 93:419-30. [DOI: 10.1016/j.ejps.2016.08.045] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
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6
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Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, Lim HW. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2015; 74:27-58. [PMID: 26547257 DOI: 10.1016/j.jaad.2015.09.033] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ultraviolet light (UVL) is a long established treatment for mycosis fungoides (MF) and Sézary syndrome (SS), subtypes of cutaneous T-cell lymphoma (CTCL). Treatments have traditionally included broadband, narrowband ultraviolet B light (UVB) and psoralen plus ultraviolet A light photochemotherapy (PUVA), but more recently, treatment options have expanded to include UVA1 and excimer laser. UVL is used either as monotherapy or as an adjuvant to systemic therapy, demonstrating efficacy in many cases that equal or surpass systemic medications. Despite its utility and duration of use, the current practice of using UVL guidelines for psoriasis to treat patients with MF/SS is problematic because the goals of prolonging survival and preventing disease progression are unique to CTCL compared to psoriasis. OBJECTIVES We sought to develop separate guidelines for phototherapy for MF/SS for both clinical practice and for clinical trials. METHODS Literature review and cutaneous lymphoma expert consensus group recommendations. RESULTS This paper reviews the published literature for UVB and UVA/PUVA in MF/SS and suggests practical standardized guidelines for their use. LIMITATIONS New standardization of phototherapy. CONCLUSIONS These guidelines should allow the comparison of results with phototherapy in MF/SS across different stages of patients, centers, and in combination with other agents in practice and in clinical trials.
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Affiliation(s)
- Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Emilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Anderson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Joi B Carter
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marsha Henderson
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Kevin Cooper
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
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Bruserud Ø, Tvedt THA, Paulsen PQ, Ahmed AB, Gedde-Dahl T, Tjønnfjord GE, Slåstad H, Heldal D, Reikvam H. Extracorporeal photopheresis (photochemotherapy) in the treatment of acute and chronic graft versus host disease: immunological mechanisms and the results from clinical studies. Cancer Immunol Immunother 2014; 63:757-77. [PMID: 24997173 PMCID: PMC11029168 DOI: 10.1007/s00262-014-1578-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
Extracorporeal photopheresis (ECP) is an immunomodulatory alternative for treatment of graft versus host disease (GVHD). The blood is then separated into its various components through apheresis; buffy coat cells are thereafter treated with 8-methoxypsoralen before exposure to ultraviolet light and finally reinfused into the patient. There is a general agreement that this treatment has an anti-GVHD effect, but the mechanisms of action behind this effect are only partly understood. However, altered maturation of dendritic cells (DC) and thereby indirect modulation of T-cell reactivity seems to be one important mechanism together with DC-presentation of antigens derived from apoptotic donor T cells and induction of regulatory T cells. The treatment has been best studied in patients with chronic GVHD (both pediatric and adult patients), but most studies are not randomized and it is difficult to know whether the treatment is more effective than the alternatives. The clinical studies of ECP in adults with acute GVHD are few and not randomized; it is not possible to judge whether this treatment should be a preferred second- or third-line treatment. There is no evidence for increased risk of leukemia relapse or suppression of specific graft versus leukemia reactivity by this treatment, so specific antileukemic immunotherapy may still be possible. Thus, even though the treatment seems effective in patients with GVHD, further clinical (especially randomized) as well as biological studies with careful standardization of the treatment are needed before it is possible to conclude how ECP should be used in acute and chronic GVHD.
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Affiliation(s)
- Øystein Bruserud
- Section for Hematology, Institute of Clinical Science, University of Bergen, Bergen, Norway,
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Juzeniene A, Thu Tam TT, Iani V, Moan J. The action spectrum for folic acid photodegradation in aqueous solutions. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2013; 126:11-6. [DOI: 10.1016/j.jphotobiol.2013.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/08/2013] [Accepted: 05/29/2013] [Indexed: 12/14/2022]
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9
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Trautinger F, Just U, Knobler R. Photopheresis (extracorporeal photochemotherapy). Photochem Photobiol Sci 2013; 12:22-8. [DOI: 10.1039/c2pp25144b] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Solar cycle predicts folate-sensitive neonatal genotypes at discrete phases of the first trimester of pregnancy: A novel folate-related human embryo loss hypothesis. Med Hypotheses 2012; 79:210-5. [DOI: 10.1016/j.mehy.2012.04.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/24/2012] [Accepted: 04/26/2012] [Indexed: 12/14/2022]
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11
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Borradale DC, Kimlin MG. Folate degradation due to ultraviolet radiation: possible implications for human health and nutrition. Nutr Rev 2012; 70:414-22. [DOI: 10.1111/j.1753-4887.2012.00485.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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12
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Beall CM, Jablonski NG, Steegmann AT. Human Adaptation to Climate: Temperature, Ultraviolet Radiation, and Altitude. Hum Biol 2012. [DOI: 10.1002/9781118108062.ch6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Marzullo G, Boklage CE. Bimodal rhythms of general conceptions and the birth-month phenomenon in schizophrenia, neural tube defects, and laterality: A solstitial hypothesis. ACTA ACUST UNITED AC 2011; 91:249-57. [DOI: 10.1002/bdra.20806] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 01/22/2011] [Accepted: 02/11/2011] [Indexed: 11/09/2022]
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14
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Juzeniene A, Stokke KT, Thune P, Moan J. Pilot study of folate status in healthy volunteers and in patients with psoriasis before and after UV exposure. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2010; 101:111-6. [DOI: 10.1016/j.jphotobiol.2010.01.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 01/22/2010] [Accepted: 01/30/2010] [Indexed: 02/06/2023]
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15
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Dántola ML, Denofrio MP, Zurbano B, Gimenez CS, Ogilby PR, Lorente C, Thomas AH. Mechanism of photooxidation of folic acid sensitized by unconjugated pterins. Photochem Photobiol Sci 2010; 9:1604-12. [PMID: 20922252 DOI: 10.1039/c0pp00210k] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Folic acid, or pteroyl-l-glutamic acid (PteGlu), is a precursor of coenzymes involved in the metabolism of nucleotides and amino acids. PteGlu is composed of three moieties: a 6-methylpterin (Mep) residue, a p-aminobenzoic acid (PABA) residue, and a glutamic acid (Glu) residue. Accumulated evidence indicates that photolysis of PteGlu leads to increased risk of several pathologies. Thus, a study of PteGlu photodegradation can have significant ramifications. When an air-equilibrated aqueous solution of PteGlu is exposed to UV-A radiation, the rate of the degradation increases with irradiation time. The mechanism involved in this "auto-photo-catalytic" effect was investigated in aqueous solutions using a variety of tools. Whereas PteGlu is photostable under anaerobic conditions, it is converted into 6-formylpterin (Fop) and p-aminobenzoyl-l-glutamic acid (PABA-Glu) in the presence of oxygen. As the reaction proceeds and enough Fop accumulates in the solution, a photosensitized electron-transfer process starts, where Fop photoinduces the oxidation of PteGlu to Fop, and H(2)O(2) is formed. This process also takes place with other pterins as photosensitizers. The results are discussed with the context of previous mechanisms for processes photosensitized by pterins, and their biological implications are evaluated.
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Affiliation(s)
- M Laura Dántola
- INIFTA, Departamento de Química, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, CCT La Plata-CONICET. C.C. 16, Suc. 4, (1900), La Plata, Argentina
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Chaplin G, Jablonski NG. Vitamin D and the evolution of human depigmentation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2009; 139:451-61. [PMID: 19425101 DOI: 10.1002/ajpa.21079] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- George Chaplin
- Department of Anthropology, The Pennsylvania State University, University Park, PA 16802, USA.
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Cicarma E, Mørk C, Porojnicu AC, Juzeniene A, Tam TTT, Dahlback A, Moan J. Influence of narrowband UVB phototherapy on vitamin D and folate status. Exp Dermatol 2009; 19:e67-72. [DOI: 10.1111/j.1600-0625.2009.00987.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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18
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Juzeniene A, Thu Tam TT, Iani V, Moan J. 5-Methyltetrahydrofolate can be photodegraded by endogenous photosensitizers. Free Radic Biol Med 2009; 47:1199-204. [PMID: 19647791 DOI: 10.1016/j.freeradbiomed.2009.07.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/29/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
Folate deficiency is linked to serious birth defects, pregnancy complications, male infertility, cardiovascular diseases, and even the evolution of human skin color. Conflicting data exist on whether exposure to sun or artificial UV sources may deplete the levels of blood folate in humans. Blood contains several photosensitizers and proteins, as well as antioxidants, which when exposed to UV radiation and visible light may be involved in the degradation of folate. In this study the photodegradation of 5-methyltetrahydrofolate (5MTHF) in aqueous and deuterious solutions exposed to UVB, UVA, or visible light in the absence or presence of riboflavin, uroporphyrin, and conjugated bilirubin was investigated by absorption spectroscopy. 5MTHF is stable under exposure to visible light and UVA radiation, whereas it is slowly photooxidized under UVB exposure. However, it is rapidly oxidized by UVA or visible radiation in the presence of riboflavin or uroporphyrin, but not in the presence of conjugated bilirubin, which acts in a protective manner. Reactive oxygen species produced in type I and/or type II reactions were involved. This study suggests that 5MTHF in blood can be photodegraded in the presence of the flavins and porphyrins, but protected by bilirubins. This may have health and evolutionary implications.
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Affiliation(s)
- Asta Juzeniene
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, 0310 Oslo, Norway.
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Rose RF, Batchelor RJ, Turner D, Goulden V. Narrowband ultraviolet B phototherapy does not influence serum and red cell folate levels in patients with psoriasis. J Am Acad Dermatol 2009; 61:259-62. [DOI: 10.1016/j.jaad.2009.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 03/03/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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20
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Steindal AH, Tam TTT, Lu XY, Juzeniene A, Moan J. 5-Methyltetrahydrofolate is photosensitive in the presence of riboflavin. Photochem Photobiol Sci 2008; 7:814-8. [PMID: 18597029 DOI: 10.1039/b718907a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
5-Methyltetrahydrofolate (5MTHF) is the main form of folate in human plasma, and an important vitamin for human health. Photodegradation of folates may have played a role in the development of different human skin colours. 5MTHF can be degraded directly by exposure to ultraviolet radiation or by exposure to visible light in the presence of endogenous sensitizers like riboflavin (RF). These photochemical reactions were studied by absorption spectroscopy. While 5MTHF is stable under UV and visible light exposure in pure aqueous media, it is quickly degraded in the presence of RF during UVA and blue light exposure. The degradation of 5MTHF is dependent on the concentration of RF, but not on the concentration of 5MTHF itself. UVA and blue light gave similar reactions. Further investigations are necessary to evaluate the consequences of large light exposures in vivo in humans. Our findings should be taken into the ongoing discussion about the development of human skin colours. Due to the presence of RF in human blood, folate can be significantly degraded during prolonged or intense blue light exposure. Thus, a dark skin colour may be favourable for prevention of folate degradation under high solar fluence rates, such as in equatorial areas.
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Affiliation(s)
- Arnfinn Hykkerud Steindal
- Department of Radiation Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Montebello, N-0310, Oslo, Norway
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