High-dose folate and dietary purines promote scavenging of peroxynitrite-derived radicals--clinical potential in inflammatory disorders.

Reduced folates have been shown to reconstitute the proper activity of "uncoupled" endothelial nitric oxide synthase in inflamed endothlelium. There is recent evidence that this phenomenon may reflect an ability of reduced folates to scavenge peroxynitrite - or, more likely, nitrogen dioxide and carbonate radicals derived from carbonate-induced decomposition of peroxynitrite. This suggests that, at least in those tissues capable of achieving high intracellular levels of reduced folates following high-dose folate administration, high-dose folate may have important anti-inflammatory potential. It would be of interest to examine the impact of high-dose folate in rodent models of disorders in which peroxynitrite plays a key pathogenic role - including diabetes, septic or hemorrhagic shock, ischemia-reperfusion, congestive heart failure, and inflammatory mutagenesis. In particular, this strategy may be useful in many pathologies in which oxidant-mediated PARP activation leads to cell death or dysfunction. Recent evidence that high-dose folate administration preserves myocyte viability following cardiac ischemia-reperfusion likely reflects folate's impact on the cytotoxicity of peroxynitrite. For use in medical emergencies, parenteral leucovorin (racemic 5-formyltetrahydrofolate) is already clinically available. Since uric acid can also function physiologically as a scavenger of peroxynitrite-derived radicals, supplemental inosine or dietary nucleic acids - which raise tissue levels of urate more effectively than does oral uric acid - may usefully complement the protective impact of high-dose folate on nitroxidative stress. Epidemiological associations of high urate levels with low risk for Parkinson's disease may reflect urate's radical scavenging activity, and suggest the possible utility of dietary purines in prevention or treatment of CNS inflammatory disorders.