Moreover, one study demonstrated significant astrocytic end-foot disruptions and dislocalization of the AQP4 channel in the HHcy model, suggesting that astrocyte dysfunction is associated with hyperhomocysteinemia.[42,43] However, the involvement of the glymphatic system in this process has not been described; further investigations reporting the roles of astrocytes and hyperhomocysteinemia in the glymphatic system are required.[31] This patient showed high homocysteine levels, and mutations were found in MTHFR C677T, exacerbating the disruption of the astrocytic end-foot. This evidence concerns the gene AQP4 and hyperhomocysteinemia.