The pathophysiological process is explained by another in vitro study, noting that folate deficiency triggers oxidative-nitrosative stress, and subsequently endoplasmic reticulum stress in the insulin-producing pancreatic islet RINm5F cells, resulting in RINm5F cell apoptosis as well as impairment of the biosynthesis and secretion of insulin [142]. Here, INS is linked to hyperinsulinemic hypoglycemia, familial, 4.