has been detected on histone lysines that are also known to be acetylated and methylated. Thus, formylation may block other post-translational modifications. Formylation is detected most frequently on 19 different modification sites on Histone H1. The genetic expression of the cell is highly disrupted by formylation, which may cause diseases such as cancer. The development of these modifications may be due to oxidative stress. In histone proteins, lysine is typically modified by Histone Acetyl-Transferases (HATs) and Histone Deacetylases (HDAC or KDAC). The acetylation of lysine is fundamental to the regulation and expression of certain genes. Oxidative stress creates a significantly different environment in which acetyl-lysine can be quickly outcompeted by the formation of formyl-lysine due to the high reactivity of formylphosphate species. This situation is currently believed to be caused by oxidative DNA damage. A mechanism for the formation of formylphosphate has been proposed, which it is highly dependent on oxidatively damaged DNA and mainly driven by radical chemistry within the cell. The formylphosphate produced can then be used to formylate lysine. Oxidative stress is believed to play a role in the availability of lysine residues in the surface of proteins and the possibility of being formylated. Formylation in medicine Formylation reactions as a drug target Inhibition of enzymes involved in purine biosynthesis has been exploited as a potential drug target for chemotherapy. Cancer cells require high concentrations of purines to facilitate division and tend to rely on de novo synthesis rather than the nucleotide salvage pathway. Several folate based inhibitors have been developed to inhibit formylation reactions by GAR transformylase and AICAR transformylase. The first GAR transformylase inhibitor Lometrexol [(6R)5,10-dideazatetrahydrofolate] was developed in the 1980s through a collaboration between Eli Lilly and academic laboratories. Although similar in structure to N10-formyl-THF, lometrexol is incapable of carrying out one carbon transfer reactions. Additionally, several GAR based inhibitors of GAR transformylase have also been synthesized. Development of folate based inhibitors have been found to be particularly challenging as the inhibitors also down regulate the enzyme folypolyglutamate synthase, which adds additional γ-glutamates to monoglutamate folates and antifolates after entering the cell for increased enzyme affinity. This increased affinity can lead to antifolate resistance. Leigh Syndrome Leigh syndrome is a neurodegenerative disorder that has been linked to a defect in an enzymatic formylation reaction. Leigh syndrome is typically associated with defects in oxidative phosphorylation, which occurs in the mitochondria. Exome sequencing, has been used