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In cells, homocysteine is metabolized in three ways :[ref] It can be remethylated to form methionine (requires folate, MTHFR, and vitamin B12, MTR gene or needs betaine, interacting with BHMT and PEMT genes) Can be converted to cysteine (CBS gene, serine and B6 as a cofactor), which is used in the synthesis of glutathione It can be converted to homocysteine thiolactone, which can be a problem at higher levels Lets dig into each of these pathways further: Methylation Cycle: Homocysteine, Methionine, SAMe, and SAH Homocysteine is maintained at a relatively constant level by several mechanisms in the methionine cycle

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J Clin Invest 117(11):33693382 Jakobsson L et al (2010) Endothelial cells dynamically compete for the tip cell position during angiogenic sprouting