Nadph

5,10-methyleneTHF

5,10 methylene THF reductase

Urine

Fig. 1. Methionine cycle: metabolic cycle of homocysteine metabolism. THF = tetrahydrofolate; DMG = dimethylglycine; SAH = S-adenosyl homocysteine; SAM = S-adenosylmethionine; NADP+ = nicotinamide adenine dinucleotide phosphate (oxidized form); NADPH = nicotinamide adenine dinucleotide phosphate (reduced form).

enzymes or deficiencies in folic acid, vitamin B6, or vitamin B12 cofactors can lead to elevated tHcy levels (24) (see Fig. 1).

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