Neopterin is a byproduct of the tetrahydrobiopterin (BH4) biosynthetic pathway, which requires Mg2+, Zn2+, and NADPH as cofactors. Tetrahydrobiopterin is an obligatory cofactor for phenylalanine, tyrosine, tryptophan hydroxylases and alkylglycerol monooxygenase, and for all isoforms of nitric oxide synthase (NOS). BH4 is synthesized by multiple metabolic routes, namely the de novo, salvage and recycling pathways. The de novo via generates BH4 from guanosine triphosphate (GTP) by the concert action of guanosine triphosphate Cyclohydrolase I (GTPCH), 6-pyruvoyl Tetrahydropterin synthase (PTPS) and sepiapterin reductase. GTPCH catalyzes the conversion of GTP to 7,8-dihydroneopterin triphosphate. Then, Alkaline Phosphatases removes the phosphates to generate, 8-dihydroneopterin, which is further converted to Neopterin by non-enzymatic oxidation. Neopterin is a recognized biomarker for immune system activation. IFN-g, which is released from activated Th1 cells during the initiation of the immunological cellular response, is one of the main stimuli for neopterin formation. The source of neopterin in the central nervous system (CNS) is not well understood. The evidence available in the literature has suggested that neopterin crosses the blood-brain barrier, therefore the CSF levels may reflect the serum or plasma neopterin concentrations. Cell culture studies strongly suggest that neopterin is not an inert compound, but a cytoprotective molecule synthesized and secreted by nerve cells as a response to damage or inflammation.