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Fumarate – Function, Effects & Medical Uses

Fumarate is the ionized form of fumaric acid and plays a key role in the citric acid cycle. It is also used medically in treatments for psoriasis and multiple sclerosis.

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Things worth knowing about "Fumarate"

Fumarate is the ionized form of fumaric acid and plays a key role in the citric acid cycle. It is also used medically in treatments for psoriasis and multiple sclerosis.

What is Fumarate?

Fumarate is the ionized form of fumaric acid, an organic dicarboxylic acid. In the human body, fumarate occurs naturally as an intermediate in the citric acid cycle (also known as the Krebs cycle) – a central metabolic pathway that takes place in the mitochondria of every cell. In addition to its metabolic role, fumarate is used as a food additive and as an active ingredient in various medications.

Biological Function in Metabolism

Within the citric acid cycle, fumarate is produced from succinate by the enzyme succinate dehydrogenase. It is then converted to malate by the enzyme fumarase. This reaction sequence is essential for cellular energy production, contributing to the synthesis of ATP (adenosine triphosphate) – the primary energy carrier of the body.

Fumarate is also involved in the urea cycle, which is responsible for the excretion of nitrogen waste, and plays a role in the synthesis of certain amino acids.

Medical Applications

Treatment of Psoriasis

Fumaric acid esters (e.g., dimethyl fumarate) have been successfully used for decades in the treatment of moderate to severe plaque psoriasis. They exert immunomodulatory effects by inhibiting pro-inflammatory immune cells while promoting anti-inflammatory processes.

Multiple Sclerosis

Dimethyl fumarate is also approved as a treatment for multiple sclerosis (MS). It activates the Nrf2 signaling pathway, which reduces oxidative stress and helps protect nerve cells from damage.

Iron Supplementation

Ferrous fumarate (iron(II) fumarate) is a widely used form of iron in dietary supplements and medications for treating iron deficiency. The fumarate molecule acts as an organic carrier that can improve the bioavailability of iron compared to some inorganic iron compounds.

Fumarate as a Food Additive

Fumaric acid and its salts (fumarates) are used in the food industry as acidulants and preservatives, for example in baking mixes, powdered beverages, and desserts. In the European Union, fumaric acid is approved under the designation E297 and is considered safe for consumption.

Side Effects and Safety

Fumarate-based medications can cause side effects, including:

Gastrointestinal complaints such as abdominal pain, diarrhea, and nausea
Flushing (skin redness and warmth) – commonly occurring at the start of treatment
Changes in blood counts, particularly a reduction in lymphocytes
Rarely: kidney function impairment with long-term use

Fumarate-containing preparations should always be taken under medical supervision.

References

Berg, J.M., Tymoczko, J.L., Stryer, L. (2018). Biochemistry, 9th edition. W.H. Freeman and Company.
European Medicines Agency (EMA): Tecfidera (dimethyl fumarate) – Product Information. Available at: https://www.ema.europa.eu
Mrowietz, U. et al. (2018). Definition of treatment goals for moderate-to-severe psoriasis: A European consensus. Archives of Dermatological Research, 310(1), 1–10.

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