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When HCY is elevated and its usual metabolism route via MS is inoperative due to insufficient 5MTHF from the inactive, MTHFR 677TT coded enzyme, its metabolism must proceed by the betaine [trimethyl glycine (TMG)] degradation pathway, served by the BHMT enzyme (4) Therefore, in such a flavin-sufficient, methylating state, there is a theoretical risk that catecholamines will be excessively degraded by both MAO and COMT to a degree that depleted catecholamine levels lead to depression and adrenal re-synthesis exhaustion with cognitive and motor retardation (109)
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Oxidized and reduced forms of folate are absorbed to a similar degree
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