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In the model proposed by Lee, homocysteine is shunted away from the methionine synthesis pathway and toward the GSH synthesis pathway, creating a relative deficiency of methyl donors in order to keep up with increased demand for the glutathione needed for POP conjugation ( Fig 3 )

doi: 10.1056/NEJM197306072882312 3 ElrickHStimmlerLHladCJAraiY

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Importantly, sudden onset of unilateral swelling, especially with pain, warmth, or redness, requires urgent medical evaluation to rule out deep vein thrombosis or acute infection