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Here, homocysteine is converted back into methionine independently of B12 and the folate cycle, with trimethylglycine (TMG, also called betaine = methylated choline) functioning as a cofactor of the enzyme betaine homocysteine methyltransferase (BHMT)

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The GLS gene encodes two isozymes, kidney-shaped (GLS1) and liver-shaped (GLS2) [9]

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based on this, 53 pathways were identified as relevant to the pathological process, mainly involving the metabolism of D-glutamine and D-glutamate, linoleic acid, taurine and hypotaurine, beta-alanine, glutathione, and butanoate