Schematic illustration of one-carbon metabolism pathway. Key genes involved in one-carbon metabolism include methylenetetrahydrofolate reductase (MTHFR), thymidylate synthase (TYMS), methionine synthase (MTR), methionine synthase reductase (MTRR), cytosol serine hydroxymethyltransferase (cSHMT), dihydrofolate reductase (DHFR), and betaine-homocysteine methyltransferase (BHMT). Reduced folate carrier (RFC1) and human folate receptor (hFR) transport the dietary polyglutamyl folate (the predominant form of folate in diet) in intestinal absorption. B vitamins are co-factors of one-carbon enzymes as shown. Chemotherapy drugs 5-fluorouracil (5-FU) targets TYMS and methotrexate targets DHFR to block DNA synthesis. Hcy, homocysteine; SAM, S-adenosylmethionine; SAH, adenosylhomocysteine; THF, tetrahydrofolate; DHF, dihydrofolate; dUMP, deoxyuridine monophosphate; dUTP, deoxythymidine monophosphate.