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The completion of GSH synthesis is catalyzed by glutathione synthetase (GS), in a reaction in which -glutamyl-cysteine is covalently linked to glycine ( Figure 1 )

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When oxidized it becomes GSSG, which is then converted back to active GSH by glutathione reductase a continuous recycling system that makes glutathione one of the most efficient antioxidant mechanisms in the body

Although these methods have proven clinical efficacy, they fail to directly target the central pathophysiologic mechanisms at play in heart failure