Compartmentalized reactions in the cytosol and mitochondrion are depicted. Variants in several genes regulating these steps have been linked with NTD risk and various epigenetic modifications - including DNA methylation requiring the primary methyl donor, S-adenosylmethionine (SAM) and histone homocysteinylation - have been shown to influence neural tube closure through aberrant expression of genes critical for neurulation. MTHFR, Methylenetetrahydrofolate Reductase; BHMT, Betaine-Homocysteine Methyltransferase; SLC25A3, Solute Carrier Family 25 Member 3; CECR2, CECR2 Histone Acetyl-Lysine Reader; DNMT3B, DNA Methyltransferase 3 Beta; SMARCA4, SWI/SNF Related, Matrix Associated, Actin Dependent Regulator of Chromatin, Subfamily A, Member 4.