The use of folic acid for the correction of folate metabolism disorders in respiratory diseases (systematic review)

Abstract

Rationale for the study. Folates are necessary substrates for the methylation of proteins and nucleotides, maintaining antioxidant potential and the formation of a biological regulator of hydrogen sulfide. A key indicator of impaired folate metabolism is hyperhomocysteinemia. Materials and methods. A systematic review of studies on the role of homocysteine as a predictor of adverse outcomes and assessing the effectiveness of folic acid as a homocysteine-lowering therapy for respiratory diseases was conducted. Results. Materials from 1,935 publications in electronic bibliographic databases of scientific citations PubMed Central, WHO COVID-19 Research Database, Russian Science Citation Index 8 studies of patients with COVID-19, 4 studies of patients with chronic obstructive pulmonary disease, and 1 study of patients with hospitalacquired pneumonia were selected. Studies have shown the importance of increasing homocysteine levels as a predictor of intensive care unit admission and death in adult patients with COVID-19, and an association with COVID-19 disease in children. Increased levels of homocysteine in the blood of patients with chronic obstructive pulmonary disease were associated with a more severe course of the disease according to spirometry and in a comprehensive assessment of groups at risk of adverse outcomes. The use of folic acid in adult patients with COVID-19 was associated with a decrease in the duration of symptoms of the disease and the period of elimination of SARS-CoV-2 coronavirus from the respiratory tract of patients. The use of folic acid supplements in patients with traumatic brain injury was associated with a reduced risk of hospital-acquired pneumonia and a decrease in the length of stay in the intensive care unit. Conclusion. Data from a systematic analysis generally indicates the beneficial effects of folic acid use in patients with lung lesions of viral and bacterial etiology. Despite convincing data on the impact of increased blood homocysteine levels on the prognosis of chronic obstructive pulmonary disease, a systematic review did not confirm the clinical effectiveness of the use of folic acid as homocysteine-lowering therapy.