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At the periphery, the production of neopterin and nitric oxide during inflammation consumes tetrahydrobiopterin to the detriment of the hydroxylase enzymes that use this compound as a cofactor.[ref] Genetic variants can also significantly influence BH4 levels when the body is under stress

Gene 248:5158 Hatzfeld Y, Maruyama A, Schmidt A, Noji M, Ishizawa K, Saito K (2000b) -Cyanoalanine synthase is a mitochondrial cysteine synthase-like protein in spinach and Arabidopsis

10.1088/1741-2560/11/3/036008 31 DempsterT.VernonD

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