Chemico-Biological Interactions 111 112 (1998) 1 14

Glutathione: an overview of biosynthesis and

modulation
Mary E. Anderson *
Department of Microbiology and Molecular Cell Sciences, The Uni6ersity of Memphis, Memphis,
TN 38152, USA

Abstract
Glutathione (GSH; g-glutamylcysteinylglycine) is ubiquitous in mammalian and other
living cells. It has several important functions, including protection against oxidative stress.
It is synthesized from its constituent amino acids by the consecutive actions of g-glutamylcysteine synthetase and GSH synthetase. g-Glutamylcysteine synthetase activity is modulated
by its light subunit and by feedback inhibition of the end product, GSH. Treatment with an
inhibitor, buthionine sulfoximine (BSO), of g-glutamylcysteine synthetase leads to decreased
cellular GSH levels, and its application can provide a useful experimental model of GSH
deficiency. Cellular levels of GSH may be increased by supplying substrates and GSH
delivery compounds. Increasing cellular GSH may be therapeutically useful. 1998 Elsevier
Science Ireland Ltd. All rights reserved.
Keywords: Glutathione; g-Glutamylcysteine synthetase; GSH synthetase; 2-Oxothiazolidine
4-carboxylate; GSH esters

1. Introduction
This chapter seeks to give a brief overview of glutathione function, synthesis and
modulation of its intracellular levels. There are too many papers on glutathione to
cite them all, but for reviews see [16]. Many of the pioneering studies on glutathione
synthesis, metabolism and function were led by the late Dr Alton Meister.
* Tel.: + 1 901 6782985; fax: + 1 901 6784457; e-mail: mary@mmcs.memphis.edu
0009-2797/98/$19.00 1998 Elsevier Science Ireland Ltd. All rights reserved.
PII S0009-2797(97)00146-4

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

Fig. 1. The Stucture of glutathione (GSH); L-g-glutamyl-L-cysteinylglycine.

Glutathione (GSH) is a tripeptide of glutamate, cysteine and glycine that

contains an unusual g-peptide bond between glutamate and cysteine (Fig. 1). Such
a bond prevents GSH from being hydrolyzed by most peptidases. GSH is less easily
oxidized than its precursors, cysteine and g-glutamylcysteine. GSH is found in most
mammalian and many prokaryotic cells and is the most abundant intracellular thiol
(0.2 10 mM). Intracellularly, GSH is kept in its thiol form by glutathione disulfide
(GSSG) reductase, a NADPH-dependent enzyme. GSH has several important
cellular functions (Fig. 2). GSH participates as a coenzyme and is involved in
amino acid transport. It is involved in metabolism and the maintenance of the thiol
moieties of proteins and low molecular weight compounds, such as cysteine and
coenzyme A. GSH is also involved in maintaining ascorbic acid in its reduced form
and in the formation of deoxyribonucleotides. GSH reacts enzymatically (GSH
S-transferase family) or non-enzymatically with toxic compounds to form GSH

Fig. 2. Overview of glutathione (GSH) metabolism.

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

conjugates. It also protects against oxidative damage caused by reactive oxygen

species (ROS) that may be formed normally in metabolism. GSH may react with
ROS non-enzymatically. Hydrogen peroxides and other peroxides are detoxified by
GSH peroxidase.
2. GSH biosynthesis
GSH is synthesized intracellularly by the consecutive actions of g-glutamylcysteine (reaction 1) and GSH (reaction 2) synthetases:
L-Glu+ L-Cys+ ATPUL-g-Glu L-Cys+ADP+ Pi

L-g-Glu-Cys +Gly + ATPUGSH + ADP+ Pi

(1)

(2)

Cysteine is usually the limiting substrate in the synthesis of GSH. Intracellular

GSH is exported from most cells, but it is not significantly taken up by cells under
normal conditions [5]. Once outside of the cell, the g-glutamyl bond of GSH may
be cleaved by the membrane bound g-glutamyl transpeptidase whose active site is
on the outside of some cells/organs. Transpeptidase is found in the kidney, choroid
plexus, lymphocytes, biliary duct, ciliary body, intestine and pancreas. The product
of the reaction is a g-glutamyl enzyme which can accept an amino acid to form
g-glutamyl amino acid. After transport, the g-glutamyl amino acid is cleaved by
g-glutamyl cyclotransferase to yield free amino acid and 5-oxoproline (a cyclic form
of glutamate). 5-Oxoproline is ring opened by 5-oxoprolinase to give glutamate.
The biosynthetic enzymes, together with these latter three enzymes, form the
g-glutamyl cycle [7]. One of the best acceptor amino acids for transpeptidase is
cystine; thus, its product is g-glutamylcystine [8]. This may be transported into
certain cells, such as kidney, and reduced to cysteine and g-glutamylcysteine.
Cysteine can be used to synthesize GSH using reactions (1) and (2) or be used for
other cellular needs. g-glutamylcysteine can be used directly by GSH synthetase
(reaction 2) to form GSH, bypassing the first enzyme. These series of reactions
constitutes the alternative or salvage pathway of GSH biosynthesis [2].

2.1. g-Glutamylcysteine synthetase

g-Glutamylcysteine synthetase has been purified from a variety of sources
[2,9,10]. The E. coli enzyme has been cloned and sequenced and is a single
polypeptide chain [11]. The rat kidney enzyme was the first mammalian form to be
cloned and sequenced [10]; it is a heterodimer. The enzymes from both sources
catalyze the same reaction, have similar apparent Km values, turnover numbers,
substrate specificity, are feedback inhibited by about the same amount, but there is
no significant sequence homology between the E. coli and the heavy subunit of the
kidney enzyme [10]. The rat kidney and human [12] enzyme, however, are highly
homologous.

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

The E. coli and rat enzymes are feedback inhibited by GSH [13,14], but not by
its non-thiol analog ophthalmic acid (g-glutamyl-a-aminobutyrylglycine). The apparent Ki value of GSH for the rat kidney enzyme is about 1.5 mM [13,14]. This
inhibition is non-allosteric and competitive with glutamate. Intracellular GSH levels
are high, for example, about 4 mM for mouse kidney, while those for glutamate are
about 3 mM. These findings suggest that g-glutamylcysteine synthetase is probably
not acting at its maximal rate in vivo. Both the rat kidney and the E. coli enzyme
are also inhibited by amino acid sulfoximines that are transition state analogs, such
as L-prothionine-SR-sulfoximine [15] and L-buthionine-SR-sulfoximine (BSO) [16].
The rat kidney, but not the E. coli enzyme, is also inhibited by cystamine [17],
D-g-methylene glutamate [18], S-sulfocysteine and S-sulfohomocysteine [19], Lamino-4-oxo-5-chloropenoate [20] and D- and L-3-amino-1-chloro-2-pentanone [21].
These studies suggested that the enzyme has an active site thiol at or near its active
site.
The heavy subunit of the rat kidney enzyme is catalytically active [22,23];
however, the apparent Km value for glutamate is much higher ( 13 times) than
that of the holoenzyme [23]. The light subunit has no catalytic activity, but when
co-expressed or separately expressed and mixed with the heavy subunit, the
apparent Km value for glutamate returns to about the normal value [24]. While both
the heavy subunit and the holoenzyme are inhibited by GSH, the heavy subunit is
more sensitive to GSH inhibition [23]. In contrast to the holoenzyme, the heavy
subunit is inhibited by ophthalmic acid. When the holoenzyme was pretreated with
dithiothreitol, it was inhibited by ophthalmic acid [23], suggesting that a reductive
step is necessary for inhibition and that the light subunit has a regulatory function.
The two subunits cannot readily be separated by native gel filtration and only
partially separated by native gel electrophoresis under highly reducing conditions
[22 24]. After isolation, about 70% of the enzyme is found to be disulfide linked
[23]. Mild treatment with GSH (1 min., 1.5 mM) followed by SDS-PAGE, in the
absence of dithiothreitol, leads to about a 50% dissociability of the subunits. In
contrast, harsher treatment with dithiothreitol (10 mM; 60 min.) or 2-mercaptoethanol (0.7M, 5 min, 100C) are required to obtain the same dissociability as
with 1.5 mM GSH for 1 min. The interaction of GSH with the enzyme is not
apparently via disulfide bond formation because the interactions are reversible by
dialysis and even when radioactive GSH is used, no labeled enzyme could be
obtained [23]. These findings suggest that the two subunits are tightly bound by
hydrophobic interactions.

2.2. GSH synthetase

GSH synthetase catalyzes the ATP-dependent formation of GSH from g-glutamylcysteine and glycine. It has been purified from a variety of sources [2,9,25
27]. The E. coli enzyme is a tetramer of identical subunits (Mr, 35,559) and has been
extensively studied [28 34]. The rat kidney enzyme was the first mammalian
glutathione synthetase to be cloned and sequenced [35]. It is composed of two
identical subunits (Mr, 52,344) and contains about 2% carbohydrate (neutral sugar,

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

amino sugar and sialic acid) [26]. There are two asparagine residues and one serine
residue that match the signature for glycosylation. Like g-glutamylcysteine synthetase, rat kidney GSH synthetase shares no significant homology between the E.
coli enzyme. There is similarity with the fission yeast (about 30%) [36], putative frog
(65%) [37] and human (88%) [38]. The rat kidney enzyme is inhibited by pchloromercuribenzoate like the E. coli enzyme, but it is not inhibited by either
N-ethylmaleamide or 5,5%-dithiobis(2-nitrobenzoic acid) (DTNB) as is the E. coli
enzyme. Recent studies [39] with the human enzyme fusion protein suggest that
Cys-422 is important for enzyme activity.
The rat kidney enzyme has the highest reported specific activity. Substrate
specificity studies [26] showed that the enzyme is highly specific for glycine and the
cysteinyl moiety of g-glutamylcysteine but not at the g-glutamyl moiety. D-g-glutamyl- and other glutamyl analogs are active using a-aminobutyrate in place of
cysteine. This is not likely to be problematic in vivo because the first enzyme,
g-glutamylcysteine synthetase is highly specific for L-glutamate [9]. The apparent
Km values for glycine and ATP are 0.37 mM and 34 mM, respectively. The apparent
Km determination for g-glutamyl-a-aminobutyrate (a non-thiol analog of g-glutamylcysteine) gave non-linear double reciprocal plots that indicated Km apparent
values of 20 or 200 mM [26,40]. Further studies on this phenomena are underway

3. Modulation of cellular GSH levels

3.1. GSH deficiency

3.1.1. Inborn errors of glutathione biosynthesis enzymes
Inborn metabolic deficiencies have been described for several GSH-related enzymes [41 45]. While rare, there are cases of g-glutamylcysteine synthetase deficiency. Deficiencies of GSH synthetase occur more frequently than with the first
enzyme. Both g-glutamylcysteine synthetase and GSH synthetase deficiencies are
characterized by hemolytic anemia and neurological symptoms. It should be noted
that these are deficiencies not complete absence of enzyme activities. For a more
detailed review, see the chapter by Agne Larsson et al. in this volume.
3.1.2. Experimental GSH deficiency
Although cells from patients with genetic deficiencies of GSH biosynthesis are
available and useful for some studies, the nature of the deficiencies is not yet
understood. GSH metabolism is dynamic, involving many tissues; therefore, in vivo
studies of the effects of GSH deficiency are desirable. Non-specific compounds,
such as diamide, phorone, diethylmaleate, t-butylhydroperoxide, have been used to
reduce GSH levels. Such compounds usually cause non-specific oxidation and other
effects on cells [5]. Thus, it was desirable to develop a specific method for depleting
cellular GSH.
Glutamine is a g-glutamyl compound. Methionine sulfoximine (MSO) resembles
glutamine, and it was shown to inhibit glutamine synthetase [46]. Both glutamine

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

synthetase and g-glutamylcysteine synthetase catalyze the formation of product

via a g-glutamyl phosphate intermediate, so it is not surprising that MSO also
inhibits g-glutamylcysteine synthetase [47]. Administration of MSO to rodents
leads to convulsions, but it was not known whether inhibition of glutamine
synthetase or of g-glutamylcysteine synthetase produces convulsions. Since acceptor substrates of the two enzymes are very different (ammonia vs. cysteine), it
was possible to develop selective inhibitors of each enzyme. Glutamine synthetase, but not g-glutamylcysteine synthetase, is inhibited by a-ethyl methionine
sulfoximine (a-EtMSO); administration of a-EtMSO to rodents leads to decreased glutamine levels and produced convulsions [47]. Conversely, g-glutamylcysteine synthetase, but not glutamine synthetase, is inhibited prothionine
sulfoximine [15] and more effectively by BSO [16]. Administration of BSO to
rodents leads to dramatically decreased GSH levels (about 1020% of control
values) with little effect on glutamine levels and there were no convulsions. GSH
is transported out of most cells, so when BSO is administered and GSH synthesis
is inhibited, GSH levels decrease.
Treatment of rodents and/or cells with BSO sensitizes them to the harmful
effects of radiation, melphalan, cyclophosphamide, mercuric ions, cadmium ions
and cisplatin ([5] and references therein). When human lymphocytes and T-cells
are treated with BSO [48], they are no longer able to be activated. Treatment of
neonatal rodents with BSO leads to cataracts [49]. Long term treatment of mice
with BSO produces severe GSH deficiency. Mitochondria do not synthesize GSH,
rather they obtain their GSH from intracellular GSH [50]. While the electron
transport system is highly efficient, some ROS leak. Since mitochondria do not
contain catalase, they depend upon GSH peroxidase and non-enzymatic reaction
with GSH to protect against ROS toxicity. When GSH levels are severely depleted by long term BSO administration, mitochondria swell and cells contain
vacuoles and give a model of endogenous oxidative stress [51,52]. Such mitochondrial damage has been observed in skeletal muscle, jejunum, colon and lung type
2 lamellar bodies [51 57]. Such oxidative damage is prevented by GSH esters
(see below) and by ascorbate which appears to spare GSH [5157]. The use of
the BSO model of GSH deficiency has produced some interesting studies that
elucidate some of the functions of GSH and provides a model for test therapies
designed to increase cellular GSH levels.

3.2. Diseases associated with GSH deficiency

A deficiency of GSH occurs in patients with inborn errors of GSH biosynthesis
and in the BSO model of oxidative stress. Low GSH levels have been associated
with the pathology of a number of diseases, such as HIV, hepatitis C, type II
diabetes, ulcerative colitis, burn models, idopathetic pulmonary fibrosis and adult
respiratory distress syndrome (ARDS) and cataracts [35,5759]. GSH is intimately involved in protection against reactive oxygen species (ROS). ROS has been
associated with diseases such as atherosclerosis, ARDS, HIV, rheumatoid arthritis,
cancer, to name a few. GSH deficiency models are useful for understanding the role

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

Fig. 3. The structure of 2-oxothiezolidine-4-carboxylic acid.

of GSH in health and disease and for assessing potential therapies for raising
cellular GSH levels.
4. Methods for increasing cellular GSH levels
Increased cellular GSH levels may be beneficial in conditions where GSH levels
are decreased. Administration of cysteine may raise cellular GSH levels because it
is usually the limiting amino acid in GSH biosynthesis [5]. Besides the problems of
oxidation to cystine which has low solubility, cysteine has been reported to be toxic
to cultured cells [60] and to newborn mice [61]. While the mechanism of toxicity is
not known, there are several possibilities [62,63]. Methionine is a precursor of
cysteine through the cystathionase pathway; this pathway may not be active in
newborns and in patients with liver disease. N-acetyl cysteine (NAC) treatment may
increase GSH levels, but it must first be deacetylated to cysteine and both enzymes
for GSH synthesis need to be active. GSH is not taken up by cells to a significant
degree [5]. Administered GSH is degraded extracellularly and the products transported and used for intracellular GSH biosynthesis. GSH, like methionine and
NAC, is a cysteine delivery agent.

4.1. L -2 -oxothiazolidine-4 -carboxylic acid

Substrate specificity studies of the g-glutamyl cycle enzyme, 5-oxoprolinase
showed that a 5-oxoproline analog, 2-oxothiazolidine-4-carboxylate (OTC), is a
substrate [64] (Fig. 3). The product of the reaction is thought to be S-carboxycysteine that is then hydrolyzed to cysteine and CO2. 5-Oxoprolinase is found in many
tissues, with the exception of the lens and erythrocyte. Administration of OTC to
rodents leads to increase tissue cysteine and GSH levels, and such increases are
prevented by treatment with BSO which blocks GSH biosynthesis; thus, OTC is a
cysteine delivery compound [65,66]. OTC protects against acetaminophen toxicity
and is more effective than NAC [66]. When 35S[OTC] was administered to mice,
label was found in all tissues and fluids examined [67]. Radioactive cysteine and
GSH were found in tissues; unmetabolized OTC was found in urine. Administered
OTC increases brain cysteine, but has little effect on brain GSH levels [68]. When
given to sulfur deficient rats, OTC promoted growth and led to increased cellular
GSH levels [69].

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

Treatment of cultured human peritoneal mesothelial cells with OTC stimulates

cell proliferation and decreases cell death, suggesting that OTC may be useful in
peritoneal dialysis [70]. OTC treatment protected CHO cells from oxidative stress
[71] and protected isolated rat hearts from ischemic damage [72]. Preliminary
reports [73,74] suggest that OTC treatment decreases AZT induced bone marrow
hypoplasia in mice and augmented the antiviral effects of AZT in cultured cells.
OTC treatment of human lymphocytes is reported [75] to inhibit HIV expression,
HIV-1 promoter activity and NF-KB binding activity in Jurkat cells.
Human clinical trials [76] showed that OTC plasma levels peak in about 60 min.
In low dose, plasma cysteine and GSH levels were unaffected over the 8-h study
period. However, lymphocyte cysteine and GSH levels increased 23-fold between
2 and 3 h after OTC administration. In HIV-infected patients [77], treatment with
OTC (100 mg/kg, twice weekly) increased whole blood GSH levels increased over
a 6-week study period and B2-microglobulin levels decreased. Such studies suggest
that further clinical trials are warranted.

4.2. g-Glutamylcysteine
Cysteine delivery compounds, such as NAC, GSH, methionine and GSH, may
increase cellular GSH levels, but both enzymes of GSH biosynthesis are needed.
Also, the maximum increase is limited by the feedback inhibition of g-glutamylcysteine synthetase by GSH. Compounds that bypass this feedback inhibited step are
candidates for increasing cellular GSH levels. g-Glutamyl amino acids are transported into kidney and perhaps other tissues. g-Glutamylcysteine, its disulfide, and
g-glutamylcysteine mixed disulfide with cysteine (g-glutamylcystine) are readily
transported into the kidney, reduced, and used by GSH synthetase to form GSH
[78]. When g-glutamylcystine was labeled in each cysteine moiety separately and
administered to mice, the cysteine labeled g-glutamylcysteine gave rise to a higher
specific activity in GSH than did the labeled cysteine in the mixed disulfide portion
[1,2,5]. These studies support the alternative pathway of GSH biosynthesis discussed above. Intraventricular administration of g-glutamylcysteine led to increased
rat brain GSH levels [79]. Such increases in cellular GSH levels produced after by
g-glutamylcysteine administration require that GSH synthetase be active.

4.3. GSH monoester

Since GSH is not significantly taken up by cells [5], an effective approach to
increase cellular GSH levels is to supply a GSH analog that is well transported into
cells and converted into GSH. GSH monoesters, where the ester is in the glycyl
moiety and the ester moiety is ethyl (Fig. 4) or isopropyl, were synthesized [80].
When administered to mice, these GSH monoesters increase cellular GSH levels.
Studies [81] using 35S-labeled GSH monoester showed that it is transported into
many tissues, such as kidney, liver, spleen, lung, heart and red blood cells.
Additional studies showed that GSH levels increase in cerebrospinal fluid [82] and
the lens and brains of newborn rats [83,84]. GSH monoesters have been shown to

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

protect even in the presence of BSO, thus showing that GSH monoester does not
have to be degraded and resynthesized into GSH as with GSH itself. GSH ester
treatment protects against toxicity [1,3,5,85] caused by mercuric ions, cadmium
ions, cisplatin, cyclophosphamide, melphalan, radiation, ischemic rat brain damage,
vitamin C deficiency (scurvy) and the BSO model of GSH deficiency. Although
GSH monoester is relatively easy to make, there have been a few reports of toxicity
[85,86]. In the course of our studies, we found that impurities, especially metal ions
may lead to toxicity. We have had no toxicity when copper ions are carefully kept
to a minimum [85,87].

4.4. GSH diester

Some of the many preparations of GSH monoester we made, contained GSH
diester (a-carboxyl and glycyl) impurities (115%). It was observed that the more
diester impurity, the higher the GSH levels. GSH diester was synthesized [8688]
and was found to be effectively transported into many cells and increased cellular
GSH levels [86,87]. Our studies showed that GSH diester is rapidly transported
into, and out of cells. However, once GSH diester is inside cells, it is rapidly split
into GSH monoester which is more slowly transported than GSH diester. Rodents
are not recommended for studies with the diester because they contain a plasma
diesterase activity that converts GSH diester into GSH monoester. Certain species,
such as humans and hamsters, do not have such a diesterase activity. The
monoester is transported more slowly than the diester, and it is hydrolyzed into
cellular GSH. Preliminary studies suggest that GSH diester raises GSH levels about
four times more effectively than does GSH monoester in hamster liver. In contrast
to GSH monoester, metal ions are not apparently toxic with GSH diester. In our
limited in vivo studies, no toxicity was observed. GSH diester is effective in raising
cellular GSH monoester and GSH levels, and it is a GSH monoester and GSH
delivery compound.

Fig. 4. The structure of gluthathione monoethyl ester; GSH monoethyl ester.

10

M.E. Anderson / Chemico-Biological Interactions 111112 (1998) 114

Acknowledgements
The support by (AI 31804) from the National Institutes of Health and Transcend
Therapeutics is acknowledged.

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glutathione synthetase, (in preparation).
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cycle, in: C.R. Scriver, A.L. Beaudet, W.S. Sly, D. Valle (Eds.), The Metabolic Basis of Inherited
Disease, 7th ed, McGraw Hill, New York, 1995, pp 1461 1477.
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of metabolism involving the g-glutamyl cycle in patients with 5-oxoprolinuria (pyroglutamic
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by a-alkyl analogs of methionine sulfoximine that induce convulsions, J. Biol. Chem. 253 (1978)
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Proc. Natl. Acad. Sci. U.S.A. 87 (1990) 3343 3347.
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cataracts induced by buthionine sulfoximine in mice, Science 233 (1986) 553 555.
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U.S.A. 82 (1985) 46684672.
[51] J. Martensson, A. Meister, Mitochondrial damage in muscle occurs after marked depletion of
glutathione and is prevented by giving glutathione monoester, Proc. Natl. Acad. Sci. U.S.A. 867
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[52] J. Martensson, A. Jain, E. Stole, W. Frayer, P.A.M. Auld, A. Meister, Inhibition of glutathione
synthesis in the newborn rat: a model for endogenously produced oxidative stress, Proc. Natl. Acad.
Sci. U.S.A. 88 (1991) 93609364.
[53] J. Martensson, A. Jain, W. Frayer, A. Meister, Glutathione metabolism in the lung; mitochondrial
defects, Proc. Natl. Acad. Sci. U.S.A. 86 (1989) 5296 5930.
[54] J. Martensson, A. Jain, A. Meister, Glutathione is required for intestinal function, Proc. Natl.
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[55] A. Jain, J. Martensson, T. Mehta, A.N. Krauss, P.A.M. Auld, A. Meister, Ascorbic acid prevents
oxidative stress in glutathione-deficient mice: effects on lung type 2 cell lamellar bodies, lung
surfactant, and skeletal muscle, Proc. Natl. Acad. Sci. U.S.A. 89 (1992) 5093 5097.
[56] J. Martensson, A. Meister, Glutathione deficiency decreases tissue ascorbate levels in newborn rats:
ascorbate spares glutathione and protects, Proc. Natl. Acad. Sci. U.S.A. 88 (1991) 4656 4660.
[57] A. Meister, Glutathione-ascorbate acid antioxidant system in animals, J. Biol. Chem. 269 (1994)
93979400.
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in Health and Disease, Marcel Dekker, New York, 1995, pp. 165 188.
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[62] M.E. Anderson, A. Meister, Intracellular delivery of cysteine, Methods Enzymol. 143 (1987)
313325.
[63] A.J.L. Cooper, M.T. Haber, A. Meister, On the chemistry and biochemistry of 3-mercaptopyruvate
acid, the a-keto acid analog of cysteine, J. Biol. Chem. 257 (1982) 816 826.
[64] J.M. Williamson, A. Meister, New substrates of 5-oxo-L-prolinase, J. Biol. Chem. 257 (1982)
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[65] J.M. Williamson, A. Meister, Stimulation of hepatic glutathione formation by administration of
L-2-oxothiazolidine-4-carboxylate, a 5-oxo-L-prolinase substrate, Proc. Natl. Acad. Sci. U.S.A 78
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[66] J.M. Williamson, B. Boettcher, A. Meister, Intracellular cysteine delivery system that protects
against toxicity by promoting glutathione synthesis, Proc. Natl. Acad. Sci. U.S.A. 79 (1982)
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[67] A. Meister, M.E. Anderson, O. Huang, Intracellular delivery of cysteine and glutathione delivery
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[68] M.E. Anderson, A. Meister, Marked increase of cysteine levels in many regions of the brain after
administration of 2-oxothiazolidine-4-carboxylate, FASEB J. 3 (1989a) 1632 1636.
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L-2-oxothiazolidine-4-carboxylate, a cysteine precursor, stimulates growth and normalizes tissue
glutathione concentrations in rats fed a sulfur amino acid deficient diet, J. Nutr. 125 (1995)
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Mutat. Res. 191 (1987) 189191.
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AZT-induced bone marrow hypoplasia in mice cotreated with glutathione prodrug, Procysteine
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in cultured peripheral blood mononuclear cells (PBMC), abstract 230. 10th Int. Conf. AIDS, June
611, 1993, Berlin.
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prodrug: pharmacokinetics and effects on thiols in plasma and lymphocytes in human, J. Pharmacol. Exp. Ther. 257 (1991) 331334.
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K.H. Mayer, J.B. Jackson, B. Yen-Lieberman, K.O. Story, W.B. Rowe, K. Thompson, D.
Goldberg, S. Trimbo, M.M. Lederman, A phase I/II trial of intravenous L-2-oxothiazolidine-4-carboxylic acid (procysteine) in asymptomatic HIV infected subjects, J. Acq. Immune Def. Syndr. 7
(1994) 369374.
[78] M.E. Anderson, A. Meister, Transport and direct utilization of g- glutamylcyst(e)ine for glutathione
synthesis, Proc. Natl. Acad. Sci. U.S.A. 80 (1983) 707 711.
[79] E. Pileblad, T. Magusson, Increase in rat brain glutathione following intracerebroventricular
administration of g-glutamylcysteine, Biochem. Pharmacol. 44 (1992) 895 903.
[80] R.N. Puri, A. Meister, Transport of glutathione, as g-glutamylcysteinylglycyl ester, into liver and
kidney, Proc. Natl. Acad. Sci. U.S.A. 80 (1983) 5258 5260.
[81] M.E. Anderson, F. Powrie, R.N. Puri, A. Meister, Glutathione monoethyl ester: preparation,
uptake by tissues, and conversion to glutathione, Arch. Biochem. Biophys. 239 (1985) 538 548.
[82] M.E. Anderson, M. Underwood, R.J. Bridges, A. Meister, Glutathione metabolism at the bloodcerebrospinal fluid barrier, FASEB J. 3 (1989) 2527 2531.
[83] J. Martensson, R. Steinherz, A. Jain, A. Meister, Glutathione ester prevents buthionine sulfoximine-induced cataracts and lens epithelial cell damage, Proc. Natl. Acad. Sci. U.S.A. 86 (1989)
87278731.
[84] R. Steinherz, J. Martensson, D. Wellner, A. Meister, Transport of into the brain of buthionine
sulfoximine, an inhibitor of glutathione synthesis, is facilitated by esterification and administration
of dimethylsulfoxide, Brain Res. 518 (1990) 115 119.
[85] M.E. Anderson, E.J. Levy, A. Meister, Preparation and use of glutathione monoesters, Methods
Enzymol. 234 (1994) 492499.
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related derivatives, Methods Enzymol. 234 (1994) 499 505.

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[87] E.J. Levy, M.E. Anderson, A. Meister, Transport of glutathione diethyl ester into human cells,
Proc. Natl. Acad. Sci. U.S.A. 90 (1993) 9171 9175.
[88] H. Minhas, P.J. Thornalley, Comparison of the delivery of reduced glutathione into P388D1 cells
by reduced glutathione and its mono- and diethyl-ester derivatives, Biochem. Pharmacol. 49 (1995)
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