Actifol 5, a derivative of tetrahydrofolic acid, bypasses dihydrofolate reductase for its conversion, allowing it to remain active even when this enzyme is inhibited by drugs such as methotrexate. This mechanism supports purine and pyrimidine synthesis in normal cells, enabling DNA replication despite the presence of folic acid antagonists.
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Folinic acid, a 5-formyl derivative of tetrahydrofolic acid, is easily converted into other reduced folic acid derivatives like tetrahydrofolate, allowing it to exhibit equivalent vitamin activity to folic acid. Unlike folic acid, folinic acid does not require dihydrofolate reductase for activation, making it functional even in the presence of enzyme inhibitors like methotrexate.
While initially understood as merely aiding rescue therapy during methotrexate treatment, it was later discovered that folinic acid could reactivate dihydrofolate reductase directly, even in the presence of methotrexate. This effect, believed to involve polyglutamylation of methotrexate and dihydrofolate in malignant cells, selectively reactivates normal cells’ DNA synthesis. By facilitating some purine and pyrimidine synthesis, folinic acid helps maintain normal DNA replication processes.
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