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The study by Liang et al

Homocysteine is then directed through the transsulfuration pathway: homocysteine cystathionine (enzyme: CBS, requires B6) cysteine (enzyme: CSE, requires B6 again)

Nevertheless, emerging data allow us to propose that severe hyperhomocysteinemia might primarily have homocysteinylation effects related to homocysteine and/or its by-products (as homocysteine thiolactone) that would affect the vascular wall structure through a mechanism independent of an oxidant stress

399 These EVs contain elevated levels of miR-28, miR-31a, and miR-130a, which reduce the expression of target proteins