As pointed out by others there seems to be a discrepancy as to whether BH4 is high or low in MECFS.
High—this study looks legit
https://www.s4me.info/threads/detection-of-elevated-level-of-tetrahydrobiopterin-in-serum-samples-of-me-cfs-patients-with-orthostatic-intolerance-a-pilot-study-2023-gottschalk-ea.33317/
Or low? No data presented here
https://www.s4me.info/threads/genet...rs-of-bh4-deficiency-in-long-covid-omf.34882/
Seems like they should try to measure queuine
https://en.m.wikipedia.org/wiki/Queuine
“BH4 is a cofactor for the biopterin-dependent aromatic amino acid hydroxylaseenzymes, which catalyze the conversion of phenylalanine to tyrosine, tyrosine to L-DOPA, and tryptophan to 5-HTP, oxidizing BH4 to dihydrobiopterin (BH2) in the process. BH2 must then be converted back to BH4 by the enzyme dihydropteridine reductasebefore it can be used again. Queuine depletion appears to impair this "recycling" process, resulting in a deficit of BH4 and an excess of BH2, which in turn impairs the activity of the aromatic amino acid hydroxylase enzymes.[8]”
If BH4 is high then maybe queuine is not depleted? If BH4 is low then perhaps supplementing with queuine might help.
Anyway measuring queuine should help sort things out a bit.
High—this study looks legit
https://www.s4me.info/threads/detection-of-elevated-level-of-tetrahydrobiopterin-in-serum-samples-of-me-cfs-patients-with-orthostatic-intolerance-a-pilot-study-2023-gottschalk-ea.33317/
Or low? No data presented here
https://www.s4me.info/threads/genet...rs-of-bh4-deficiency-in-long-covid-omf.34882/
Seems like they should try to measure queuine
https://en.m.wikipedia.org/wiki/Queuine
“BH4 is a cofactor for the biopterin-dependent aromatic amino acid hydroxylaseenzymes, which catalyze the conversion of phenylalanine to tyrosine, tyrosine to L-DOPA, and tryptophan to 5-HTP, oxidizing BH4 to dihydrobiopterin (BH2) in the process. BH2 must then be converted back to BH4 by the enzyme dihydropteridine reductasebefore it can be used again. Queuine depletion appears to impair this "recycling" process, resulting in a deficit of BH4 and an excess of BH2, which in turn impairs the activity of the aromatic amino acid hydroxylase enzymes.[8]”
If BH4 is high then maybe queuine is not depleted? If BH4 is low then perhaps supplementing with queuine might help.
Anyway measuring queuine should help sort things out a bit.