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The ubiquitous vitamin B 12 -dependent methionine synthase (MS) enzyme also catalyzes the re-methylation of homocysteine, using the folate derivative, 5-methyltetrahydrofolate, as a methyl donor (see Nutrient interactions)
Three main mechanisms leading to hyperhomocysteinemia are these: (1) an inhibition of the homocysteine remethylation pathway dependent on folate or cobalamin deficiency, on the C677T mutation of MTHFR, or on the functional deficiency in methionine synthase
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