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Figure 3 | Cardiovascular Diabetology

Figure 3

From: Is type 2 diabetes mellitus a vascular disease (atheroscleropathy) with hyperglycemia a late manifestation? The role of NOS, NO, and redox stress.

Figure 3

Hcy (demethylated Methionine) can enter the remethylation cycle with the aid of Folic Acid (5-Methyl-tetrahydrofolate) and the Folate cycle, the enzyme Methionine Synthase, and the necessary Cofactor B12. Folic Acid in addition to being a methyl-donor can serve as an electron or hydrogen donor to restore the required BH4 Cofactor to recouple the eNOS enzyme necessary for the production of eNO from L-arginine. Hcy may also enter the Transsulfuration Pathway with the assistance of Cystathionine Beta Synthase (CBS) enzyme and the necessary Cofactor B6 to form Cystathionine and Cysteine which can then be excreted in the urine or converted to the very important antioxidant Glutathione. The substrate Folic Acid and the Cofactors B6 and B12 are very important not only for improving hyperhomocysteinemia but also important for the recoupling of the BH4 cofactor to the eNOS enzyme for the production of eNO.

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