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BRS1-2-6 - Acetylcholine Synthesis Support
(Supplying the Two Substrates Used to Make Acetylcholine)
1. Mission & Overview + Dietary Levers
Mission
Maintain the capacity to form acetylcholine so cholinergic signalling for attention, working memory, and learning stays supplied.
Intervention Dominance: Diet-Dominant
- Choline
- Phosphatidylcholine
- Acetyl-CoA
- Vitamin B5 (pantothenate)
Choline and acetyl-CoA are the two reaction substrates. Choline reaches cholinergic terminals through transport, while acetyl-CoA is generated within cells. Pantothenate supports the coenzyme A route to acetyl-CoA; choline acetyltransferase does not use vitamin B12, folate, or pantothenate as direct enzyme cofactors.
- Vitamin B9 (folate)
Overview
Acetylcholine is made in nerve endings when choline is joined to acetyl-CoA, a cell-made acetate carrier. [4] [12] Diet can provide choline itself or choline from phosphatidylcholine, and vitamin B5 supports the acetyl-CoA side. [1] [7] [8] Entry into the nerve ending still controls access to the reaction. [6] The reaction supplies acetylcholine for later cholinergic signalling. [4] [3]
- Benefits: Acetylcholine is the transmitter cholinergic circuits use for attention and learning. [3] [1] That biological role is not a shown gain in attention from more choline. [1]
- Implementation Notes: Choline, phosphatidylcholine, and vitamin B5 are the provision routes. [1] [7] [8] Acetyl-CoA is made inside the cell and is not a dietary target. [12] No dose is established for raising brain acetylcholine. [1] [8]
2. Primary Biological Effects
↑ substrate availability in cholinergic terminals; ↑ capacity to synthesise acetylcholine
3. Intervention Levers
Only categories with a substantive evidence-qualified intervention are shown.
No evidence-qualified lifestyle relationship is projected.
4. Mechanistic Basis
Summary
Cholinergic signalling depends on a nerve terminal having both reaction substrates at the right place and time. Choline must first enter through a high-affinity transporter; choline acetyltransferase then transfers an acetyl group from acetyl-CoA. This synthesis capacity is different from the amount of acetylcholine stored, released, or detected at receptors.
(Choline entry is a regulated supply step)
Choline reaching the brain and choline entering a cholinergic nerve terminal are separate steps. CTL1/CTL2 transport systems operate at brain microvascular endothelium, whereas the high-affinity transporter CHT/SLC5A7 recovers choline into cholinergic nerve terminals. CHT activity and movement to the cell surface respond to neuronal activity, making terminal transport a major control point rather than a passive reflection of how much choline was eaten. Ojiakor and Rylett (2020) [6] review terminal transport; Inazu (2019) [13] reviews the blood–brain boundary.
(Two substrates form acetylcholine)
Inside the terminal, choline acetyltransferase transfers the acetyl group from acetyl-CoA to choline, forming acetylcholine and coenzyme A. Choline and acetyl-CoA are therefore reaction substrates; the enzyme does not use folate, vitamin B12, or pantothenate directly as cofactors. Oda (1999) [4] establishes the enzyme chemistry.
(Acetyl-CoA has its own compartmented supply route)
ChAT uses acetyl-CoA in the cytosol, but much neuronal acetyl-CoA is generated in mitochondria. Acetyl units can reach the cytosolic pool through routes including citrate export and ATP-citrate-lyase cleavage, alongside other proposed pyruvate-dependent or mitochondrial-export routes. Their relative contribution is not fully settled, but acetyl-CoA availability can regulate synthesis independently of choline transport. Jope (1979) [12] reviews this evidence. It does not make glucose, pyruvate, citrate, or dietary acetyl-CoA separate requirements on this page.
(Dietary provision reaches the two substrates by different routes)
Phosphatidylcholine is a choline-containing dietary form. Human tracer evidence shows that it is digested and remodelled, with labelled choline appearing in plasma; it is therefore a provision route to choline, not another ChAT substrate. Böckmann et al. (2023) [7] measured this route. Pantothenate supports the other side of the reaction by supplying coenzyme A for acetyl-CoA formation. Severe pantothenate depletion reduced labelled brain acetylcholine synthesis in a chronic rat model, and pantothenate co-administration increased it. Rivera-Calimlim et al. (1988) [8] do not establish a routine human supplementation effect.
(A shared one-carbon resource can change choline availability)
Choline can also be oxidised to betaine for one-carbon metabolism (the network that transfers methyl groups). Folate compromise and genetic impairment of B12-dependent methionine-cycle function lowered brain choline and acetylcholine in animal models, although regional responses were not uniform. Chan et al. (2008) [9], Crivello et al. (2010) [10], and Jadavji et al. (2014) [11] support a shared-resource constraint, not a claim that folate, B12, or betaine run the ChAT reaction.
(Boundaries of the mechanism)
Synthesis ends when acetylcholine has been formed. Packaging by the vesicular acetylcholine transporter, release into the synapse, receptor binding, breakdown by acetylcholinesterase, and the resulting cognitive effects are later stages. Acetylcholine concentration also reflects storage, release, and breakdown, so concentration alone is not a synthesis-rate measurement.
(Integration within BRS1)
This synthesis capacity supports BRS1(FM2) — Cholinergic Function. Choline allocation also intersects BRS2 remethylation and phosphatidylcholine biology, while the BRS2(KC1) — Methyl Donor Pool can constrain how much choline remains available for the synthesis substrate pool.
4.1 Scientific Findings
Summary
Transporter evidence identifies terminal choline uptake as a control step for acetylcholine synthesis, while human tracing demonstrates systemic assimilation of choline from dietary phosphatidylcholine. [6] [7] Animal depletion and rescue studies support bounded pantothenate and one-carbon dependencies, with acetylcholine responses varying by experimental condition, region and age. [8] [9] [10] The evidence therefore supports provision and local synthesis capacity without equating plasma choline delivery with neuronal release, attention benefit or a human dose response.
The high-affinity choline transporter recovers choline into cholinergic nerve endings and is a major control point for acetylcholine production.
What this means
Substrate supply is not only a food-intake question: choline must reach the nerve terminal through a regulated transporter before choline acetyltransferase can use it.
Evidence confidence: Not yet scored
Finding ID: PM6-F1
Finding Statement: Sodium-coupled high-affinity choline uptake through CHT/SLC5A7 is required to recover choline into cholinergic nerve terminals and commonly limits acetylcholine production under physiological demand.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A focused transporter review shows that CHT recovers synaptic choline into cholinergic terminals, that inhibiting or genetically impairing this transport reduces cholinergic capacity, and that activity-dependent trafficking changes uptake capacity. This establishes terminal uptake as a control step upstream of the ChAT reaction.
Synthesis Limitations: Transporter biology is largely mechanistic and preclinical. It does not show that ordinary choline intake changes CHT capacity in humans or that more dietary choline overcomes a transporter defect.
Evidence Considered:
- Study
- Review of CHT function, trafficking, genetic disruption, and pharmacological manipulation.
- Population
- Cellular, animal, human genetic, and neuropathology evidence; not a dietary trial.
- Result
- Reduced CHT function or availability limits choline uptake and cholinergic transmission, while neuronal activity recruits transport capacity.
- Effect / Magnitude
- No pooled dietary effect estimate.
- Evidence Summary
- Establishes the regulated choline-entry step required before acetylcholine synthesis.
- Limitations
- Does not test ordinary food intake or human brain synthesis after a meal.
- Evidence Source
- Bounded external search
- Reference
- [6]
Connected / Supportive Evidence:
- Inazu (2019) [13] — MechanisticWhy relevant: Separates CTL1/CTL2-mediated choline handling at brain microvascular endothelium from CHT/SLC5A7 uptake at cholinergic terminals.Why excluded from the primary synthesis: Does not test whether an oral choline exposure increases delivery to terminals or acetylcholine synthesis in humans.
Informs: Focus / Attention Stability; Cognitive Clarity
Choline combines with acetyl-CoA through choline acetyltransferase to form acetylcholine. Necessity of those reactants is not proof that extra choline raises human brain acetylcholine.
What this means
Choline and acetyl-CoA are the two substrates. Phosphatidylcholine and pantothenate matter through provision routes assessed separately; vitamin B12 and folate do not act as ChAT cofactors.
Evidence confidence: Not yet scored
Finding ID: PM6-F2
Finding Statement: Acetylcholine is formed from choline and acetyl-CoA by choline acetyltransferase; biochemical necessity is not intake-responsive human brain acetylcholine.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A choline-acetyltransferase review and a modern choline-transporter review agree that ChAT transfers the acetyl group from acetyl-CoA to choline in cholinergic neurons. Together they establish the defining reaction and both substrates.
Synthesis Limitations: Reaction and review evidence does not establish which substrate limits synthesis in every physiological state, an ordinary dietary dose response, or a human functional benefit.
Evidence Considered:
- Study
- Review of choline-acetyltransferase structure, distribution and pathology.
- Population
- Experimental and neuropathology literature; not a dietary sample.
- Result
- Identified choline and acetyl-CoA as the enzyme’s substrates.
- Effect / Magnitude
- No dietary or clinical effect estimate.
- Evidence Summary
- Establishes the acetylcholine-forming reaction.
- Limitations
- Enzyme and pathology review; not an intake-to-acetylcholine trial.
- Evidence Source
- Bounded external search
- Reference
- [4]
- Study
- Review of CHT function and cholinergic terminal biology.
- Population
- Mechanistic, animal, and human genetic literature.
- Result
- Describes substrate entry followed by ChAT-dependent synthesis from choline and acetyl-CoA.
- Effect / Magnitude
- No dietary effect estimate.
- Evidence Summary
- Independently confirms the reaction participants within the presynaptic synthesis pathway.
- Limitations
- Does not measure human synthesis after dietary exposure.
- Evidence Source
- Bounded external search
- Reference
- [6]
Connected / Supportive Evidence:
- Kennedy (2016) [5] — MechanisticWhy relevant: Reviews B-vitamin roles in brain energy and one-carbon chemistry.Why excluded from the primary synthesis: Does not establish vitamin B12 or folate as acetylcholine-synthesis cofactors.
Evidence Dependency:
- Ojiakor and Rylett (2020) is also primary evidence in PM6-F1; reuse here establishes reaction placement after choline transport, not independent replication.
Informs: Cognitive Clarity
Phosphatidylcholine is a choline-containing dietary form that is digested, absorbed, and remodelled. It provides choline but is not a second substrate in the ChAT reaction.
What this means
Represent phosphatidylcholine as Derived provision to choline, not as an independent acetylcholine-synthesis requirement.
Evidence confidence: Not yet scored
Finding ID: PM6-F4
Finding Statement: Dietary phosphatidylcholine is digested and remodelled into circulating phosphatidylcholine and free choline, establishing a dietary provision route to the direct choline substrate.
Synthesised Evidence Confidence: Not yet scored
Synthesis: In a randomized crossover tracer study in six healthy men, labelled phosphatidylcholine produced a delayed rise in labelled plasma choline and a larger phosphatidylcholine exposure than water-soluble choline forms. The tracer results directly establish digestion and systemic assimilation as a choline-containing dietary route.
Synthesis Limitations: Small single-dose study in healthy men. Plasma appearance does not measure delivery to cholinergic terminals, acetylcholine synthesis, neurotransmitter release, attention, or clinical benefit.
Evidence Considered:
- Study
- Randomized crossover stable-isotope comparison of four oral choline forms.
- Population
- Six healthy adult men.
- Result
- Phosphatidylcholine was digested and remodelled, with delayed plasma choline appearance and higher plasma phosphatidylcholine exposure.
- Effect / Magnitude
- Delayed choline peak and approximately 2.3-fold higher peak labelled phosphatidylcholine than water-soluble forms.
- Evidence Summary
- Establishes phosphatidylcholine as an assimilated choline-provision route.
- Limitations
- Small sample; supplement bolus rather than whole food; no brain or acetylcholine measurement.
- Evidence Source
- Bounded external search
- Reference
- [7]
Pantothenate (vitamin B5) is needed to make coenzyme A, which cells use to form acetyl-CoA. Acetyl-CoA supplies the acetyl group in acetylcholine.
What this means
Vitamin B5 is a biochemical precursor route to acetyl-CoA, not a ChAT cofactor or a second Direct Dietary Requirement. The evidence supports dependency and an animal depletion effect, not routine high-dose supplementation.
Evidence confidence: Not yet scored
Finding ID: PM6-F5
Finding Statement: Pantothenate supports acetylcholine-synthesis capacity through coenzyme A and acetyl-CoA formation, and severe chronic pantothenate depletion can reduce brain acetylcholine synthesis in rats.
Synthesised Evidence Confidence: Not yet scored
Synthesis: In rats exposed chronically to ethanol, brain pantothenate fell to 7% of control and labelled acetylcholine synthesis from pyruvate was inhibited; pantothenate co-administration raised brain pantothenate and acetylcholine synthesis. Together with the established acetyl-CoA reaction requirement, this closes the pantothenate → coenzyme A/acetyl-CoA → synthesis chain.
Synthesis Limitations: The intervention used chronic high-dose ethanol and pharmacological pantothenate doses in rats. It does not establish that ordinary B5 intake limits acetylcholine synthesis or that supplementation benefits adequately nourished humans.
Evidence Considered:
- Study
- Chronic and acute ethanol exposure with or without oral pantothenate in rats, measuring labelled acetylcholine synthesis.
- Population
- Rats; no human participants.
- Result
- The chronic four-month condition reduced brain pantothenate and acetylcholine synthesis; pantothenate co-treatment partly restored both.
- Effect / Magnitude
- Brain pantothenate fell to 7% of control with chronic ethanol; synthesis differences were statistically significant but no transferable human effect size is available.
- Evidence Summary
- Directly links severe pantothenate depletion to reduced acetylcholine synthesis through acetyl-CoA provision.
- Limitations
- Ethanol-specific animal model, very high pantothenate doses, and no ordinary-diet or human outcome.
- Evidence Source
- Bounded external search
- Reference
- [8]
Folate- and B12-dependent one-carbon metabolism shares choline-related methyl resources. Dietary or genetic impairment can lower brain choline and acetylcholine in animal models.
What this means
This supports a constrained-by mapping to the Methyl Donor Pool. It does not make folate, B12, or betaine ChAT cofactors or separate Direct Dietary Requirements.
Evidence confidence: Not yet scored
Finding ID: PM6-F6
Finding Statement: Inadequate folate-dependent or B12-dependent methionine-cycle capacity can disturb brain choline metabolism and lower acetylcholine availability, creating a supported shared-resource constraint on acetylcholine-synthesis capacity.
Synthesised Evidence Confidence: Not yet scored
Synthesis: Dietary folate compromise lowered brain choline and acetylcholine in mice, with SAM restoring both under the deficient condition. Genetic methionine-synthase-reductase impairment likewise lowered hippocampal choline, betaine, and acetylcholine. A separate rat study found mixed, region- and age-dependent acetylcholine changes, showing that the effect is not uniform. Together these sources establish a shared-resource constraint while preserving biological variability.
Synthesis Limitations: Animal dietary and genetic models measure metabolite pools more often than synthesis flux. They do not show that folate, B12, betaine, or SAM supplementation raises acetylcholine synthesis in nutrient-replete humans.
Evidence Considered:
- Study
- Dietary folate deficiency across adult, aged, and genetically susceptible mouse models with SAM rescue.
- Population
- Mice of several genotypes and ages.
- Result
- Folate compromise reduced choline and acetylcholine; SAM restored these measures and cognitive performance in the deficient condition.
- Effect / Magnitude
- Directionally consistent rescue across several mouse contexts; no human effect estimate.
- Evidence Summary
- Supports the link from one-carbon donor insufficiency to loss of the choline resource used for acetylcholine.
- Limitations
- Mixed dietary, oxidative, age, and genotype contexts; pool concentrations rather than direct synthesis flux.
- Evidence Source
- Bounded external search
- Reference
- [9]
- Study
- Genetic mouse model of impaired methionine synthase reductase.
- Population
- Three-month-old wild-type and Mtrr-deficient mice.
- Result
- Deficiency reduced hippocampal choline, betaine, and acetylcholine and impaired short-term memory.
- Effect / Magnitude
- Significant group differences reported; no dietary or human effect estimate.
- Evidence Summary
- Adds B12-dependent methionine-cycle evidence to the shared-resource constraint.
- Limitations
- Genetic mouse model; altered concentration and enzyme expression do not quantify synthesis flux.
- Evidence Source
- Bounded external search
- Reference
- [11]
- Study
- Controlled folate-deficient versus control diets in young and adult male rats.
- Population
- Male Sprague Dawley rats starting at four weeks or nine months.
- Result
- Brain choline and acetylcholine responses depended on age and region rather than moving uniformly.
- Effect / Magnitude
- Significant regional differences; no whole-brain or human synthesis estimate.
- Evidence Summary
- Qualifies the constraint as context-dependent and prevents a universal lower-acetylcholine claim.
- Limitations
- Concentrations rather than synthesis flux; animal model; mixed regional direction.
- Evidence Source
- Bounded external search
- Reference
- [10]
Choline acetyltransferase works in the neuronal cytosol, while much acetyl-CoA is generated in mitochondria. Acetyl-unit transfer and local regeneration therefore form a separate substrate-supply control.
What this means
Acetyl-CoA availability can constrain synthesis, but this does not make glucose, pyruvate, citrate, or dietary acetyl-CoA separate Dietary Requirements for this PM.
Evidence confidence: Not yet scored
Finding ID: PM6-F7
Finding Statement: Cytosolic acetyl-CoA for acetylcholine synthesis is supplied through compartmented neuronal metabolism, and its availability can regulate synthesis independently of choline transport.
Synthesised Evidence Confidence: Not yet scored
Synthesis: A focused review of brain acetylcholine synthesis distinguishes mitochondrial acetyl-CoA production from the cytosolic ChAT reaction and reviews citrate cleavage, pyruvate-dependent production, and possible direct mitochondrial export routes. The evidence supports acetyl-CoA availability as a control point while leaving the proportional contribution of each route context-dependent.
Synthesis Limitations: The source literature is mechanistic and largely preclinical, and competing acetyl-unit transfer routes were not fully resolved. It does not establish glucose, pyruvate, citrate, or acetyl-CoA as useful dietary targets for this PM.
Evidence Considered:
- Study
- Review of high-affinity choline transport, acetyl-CoA production, compartmentation, and regulation of brain acetylcholine synthesis.
- Population
- Biochemical, synaptosomal, and animal literature; no dietary human trial.
- Result
- Distinguished mitochondrial acetyl-CoA generation from cytosolic use by ChAT and identified several supported supply routes.
- Effect / Magnitude
- No pooled dietary or clinical effect estimate.
- Evidence Summary
- Establishes compartmented acetyl-CoA provision as a second upstream substrate-control problem.
- Limitations
- Older mechanistic literature; the relative contribution of proposed routes remains context-dependent.
- Evidence Source
- Bounded external search
- Reference
- [12]
Connected / Supportive Evidence:
- Szutowicz et al. (2010) [14] — PreclinicalWhy relevant: Pyrithiamine-induced thiamine deficiency reduced pyruvate-dehydrogenase flux and mitochondrial and cytosolic acetyl-CoA in rat nerve terminals, supporting the compartmented acetyl-unit supply model.Why excluded from the primary synthesis: The reported cholinergic endpoint was altered quantal acetylcholine release, while ChAT activity was unchanged; it does not establish vitamin B1 as a PM6 synthesis requirement or intake-responsive lever.
5. BRS Pathways and Connections
5.1 BRS Pathways
- None listed
5.2 Cross-BRS Mechanism Relationships
Primary Mechanisms in other Biological Regulatory Systems that directly interact with, constrain or support this mechanism.
- BRS2-FM1-PM1 — Folate/B12-Dependent Homocysteine Remethylation — Folate- and B12-dependent remethylation provides an alternative to choline-derived betaine for methyl donation. When this route is impaired, animal evidence shows lower brain choline and acetylcholine, creating a downstream substrate constraint here.
- BRS2-FM1-PM2 — Betaine/BHMT Remethylation — Oxidation of choline supplies betaine to this remethylation route. That competing use links methyl-donor demand to choline availability, but dietary betaine has not been shown here to increase human brain acetylcholine synthesis.
- BRS2-FM3-PM7 — Phosphatidylcholine Formation — Phosphatidylcholine is a major choline-containing membrane and dietary form. Its digestion can provide circulating choline, while its synthesis and membrane roles remain distinct from the ChAT reaction.
5.3 Local BRS Mechanism Relationships
Related Primary Mechanisms within the same Biological Regulatory System that collectively support the integrated biological function.
- None listed. This FM currently contains no second Primary Mechanism.
7. Phenome Connections
These mappings are translational relationships, not single-mechanism outcome claims. Phenomes are emergent functional patterns supported by multiple interacting PMs across the BRAIN Framework.
Each Phenome relationship has two independent ratings. They are not combined or averaged.
Biology → Phenome Relationship Strength
How direct and important is this biological mechanism expected to be to the Phenome within the BRAIN model?
Evidence Confidence
How strongly does the adjudicated evidence support this particular biology → Phenome relationship?
- Biology → Phenome Relationship Strength: Low–Medium
- Evidence Confidence: Low–Medium
- Rationale: Acetylcholine is the cholinergic transmitter used in attention and learning circuits Johansson et al. (2013) [3] Derbyshire and Maes (2023) [1]. Receptor-binding differences in boys with ADHD and choline/neurodevelopment reviews supply translational context. They do not show that changing choline intake treats ADHD or raises brain acetylcholine.
Supporting evidence
Acetylcholine-receptor and choline-status findings sit near attention biology in ADHD-related samples. That is translational context, not an ADHD treatment rule.
What this means
Use these studies as attention-relevant cholinergic context. They do not show that choline supplementation treats ADHD.
Evidence confidence: Not yet scored
Finding ID: PM6-F3
Finding Statement: Human ADHD-related muscarinic-binding and choline-status evidence is translationally relevant to attention; it is not a demonstration that changing choline intake treats ADHD.
Synthesised Evidence Confidence: Not yet scored
Synthesis: Lower muscarinic binding in boys with ADHD and choline-status discussion in a neurodevelopmental review together support a cholinergic context for attention. They do not isolate acetylcholine synthesis as a treatment target and they do not measure attention after a choline intervention designed to change synthesis.
Synthesis Limitations: Cross-sectional receptor binding and a narrative review. No choline intervention arm for ADHD or attention scores is attached.
Evidence Considered:
- Study
- Same fibroblast binding comparison used in PM6-F1, reused here for the attention relationship.
- Population
- Boys with ADHD and comparison boys.
- Result
- Lower muscarinic binding in the ADHD group.
- Effect / Magnitude
- Binding contrast only; no attention-score change after diet.
- Evidence Summary
- Anchors the attention relationship in human cholinergic biology.
- Limitations
- Not brain imaging of acetylcholine and not a dietary trial.
- Evidence Source
- Inherited repository evidence
- Reference
- [3]
- Study
- Same narrative review used in PM6-F1 and PM6-F2, reused here for phenome context.
- Population
- ADHD and other neurodevelopmental subgroups summarised in the review.
- Result
- Discussed choline as a possible modifiable neurodevelopmental factor.
- Effect / Magnitude
- No ADHD treatment-effect estimate.
- Evidence Summary
- Supplies choline-status context for attention, not a dosing rule.
- Limitations
- Review synthesis; not a choline-for-ADHD trial.
- Evidence Source
- Inherited repository evidence
- Reference
- [1]
Informs: Focus / Attention Stability
- Biology → Phenome Relationship Strength: Medium
- Evidence Confidence: Low
- Rationale: Cholinergic signalling is a biological context for working-memory and cognitive precision Derbyshire and Maes (2023) [1] Briguglio et al. (2018) [2]. The attached sources do not measure cognitive-clarity scores after a choline change aimed at acetylcholine synthesis.
8. References
- [1] Derbyshire and Maes (2023) — Role of Choline in Neurodevelopmental Disorders
- [2] Briguglio et al. (2018) — Dietary Neurotransmitters: A Narrative Review on Current Knowledge
- [3] Johansson et al. (2013) — Decreased Muscarinic Acetylcholine Receptor Binding in Boys with ADHD
- [4] Oda (1999) — Choline Acetyltransferase Structure, Distribution and Pathologic Changes
- [5] Kennedy (2016) — B Vitamins and the Brain: Mechanisms, Dose and Efficacy
- [6] Ojiakor and Rylett (2020) — High-Affinity Choline Transport Controls Acetylcholine Supply
- [7] Böckmann et al. (2023) — Human Tracing of Dietary Choline Forms
- [8] Rivera-Calimlim et al. (1988) — Pantothenate Depletion and Brain Acetylcholine Synthesis
- [9] Chan et al. (2008) — Folate–SAM Constraint on Brain Choline and Acetylcholine
- [10] Crivello et al. (2010) — Folate Deficiency Alters Regional Choline and Acetylcholine
- [11] Jadavji et al. (2014) — Methionine-Cycle Deficiency Disturbs Brain Choline Metabolism
- [12] Jope (1979) — Choline Transport and Acetyl-CoA Production in Acetylcholine Synthesis
- [13] Inazu (2019) — Choline Transporters at the Blood–Brain Barrier
- [14] Szutowicz et al. (2010) — Thiamine Deficiency, Nerve-Terminal Acetyl-CoA and Acetylcholine Release