Professional Documents
Culture Documents
www.elsevier.com/locate/biopha
Abstract
Reduced glutathione (GSH) is the most prevalent non-protein thiol in animal cells. Its de novo and salvage synthesis serves to maintain a
reduced cellular environment and the tripeptide is a co-factor for many cytoplasmic enzymes and may also act as an important post-
translational modification in a number of cellular proteins. The cysteine thiol acts as a nucleophile in reactions with both exogenous and
endogenous electrophilic species. As a consequence, reactive oxygen species (ROS) are frequently targeted by GSH in both spontaneous and
catalytic reactions. Since ROS have defined roles in cell signaling events as well as in human disease pathologies, an imbalance in expression
of GSH and associated enzymes has been implicated in a variety of circumstances. Cause and effect links between GSH metabolism and
diseases such as cancer, neurodegenerative diseases, cystic fibrosis (CF), HIV, and aging have been shown. Polymorphic expression of
enzymes involved in GSH homeostasis influences susceptibility and progression of these conditions. This review provides an overview of the
biological importance of GSH at the level of the cell and organism.
2003 ditions scientifiques et mdicales Elsevier SAS. All rights reserved.
Keywords: Glutathione (GSH); Glutathione transferases (GST); Reactive oxygen species (ROS); Human diseases
Fig. 1. Homeostasis of glutathione is maintained intracellularly through a de novo and salvage synthesis pathway. Tight regulation of the GSH:GSSG ratio is
maintained by glutathione reductase.
AP-1 site is critical to constitutive expression of the GPx is an 80 kDa protein that is composed of four identi-
c-GCS-HS subunit [7]. Post-translational modifications of cal subunits. Five distinct GPx isozymes have been charac-
c-GCS also influence GSH synthesis [10,11]. Specifically, terized in mammals, (Table 1) [12]. While GPxs are ubiqui-
phosphorylation of c-GCS leads to the inhibition of GSH tously expressed, individual isoforms are tissue specific. GPx
synthesis. GSH itself regulates the activity of c-GCS via a expression is induced by oxidative stress and aberrant ex-
negative feedback mechanism [3]. Hence, GSH depletion pression of GPxs has been associated with a wide variety of
increases the rate of GSH synthesis. pathologies, including hepatitis [13], HIV [14], and a wide
variety of cancers, including skin [15], kidney [16], bowel
[17] and breast [18].
3. GSH redox cycle
The formation of excessive amounts of reactive O2 species 4. Redox balance and glutathionylation in regulation
(ROS), including peroxide (H2O2) and superoxide anions pathways
(O2) is toxic to the cell. Hence, metabolizing and scaveng-
ing systems to remove them are functionally critical and Many drugs and chemicals can produce ROS as direct or
tightly controlled in the cell. GSH peroxidase (GPx) in con- indirect by-products. An interpretation of data from some
cert with catalase and superoxide dismutase (SOD) function cell survival assays suggests that low levels of ROS can have
to protect the cell from damage due to ROS. GPx detoxifies growth stimulatory effects. For example, Adriamycin under-
peroxides with GSH acting as an electron donor in the reduc- Table 1
tion reaction, producing GSSG as an end product. The reduc- Allelic variation in GPx and corresponding tissue distribution
tion of GSSG is catalyzed by GSH reductase (GR) in a Allele Tissue distribution
process that requires NADPH. GR is a member of the fla- GPX1 Erythrocytes, kidney, liver
voprotein disulfide oxidoreductase family and exists as a GPX2 GI tract
dimer [2]. Under conditions of oxidative stress, GR is regu- GPX3 Kidney
lated at the level of transcription as well as by post- GPX4 Ubiquitous, highest in renal epithelium and testis
translational modifications. Alterations in GR expression and GPX5 Ubiquitous
activity have been implicated in cancer and aging [2]. Adapted from reference [12].
D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155 147
Table 2
Proteins characterized as susceptible to glutathionylation
Actin
Vimentin
Myosin
Tropomyosin
Cofilin
Profilin
Pyruvate kinaseglyceraldehyde-3 phosphate dehydrogenase
Enolase
Aldolase
Adenylate kinase
Fig. 2
Phosphoglycerate kinase
goes redox cycling to produce quinone intermediates that 6-Phosphogluconolactonase
provide a potent source of ROS. Using standard colony
Ubiquitin conjugating enzyme
formation assays, low concentrations of Adriamycin (low Triosephosphate isomerase
nM) can actually stimulate proliferation resulting in survival Pyrophosphatase
above 100%. As concentrations increase, a normal exponen- Thioredoxin
tial decline in survival occurs. How ROS causes this prolif- Protein disulfide isomerase
erative effect is best addressed by examining the cellular Cytochrome c oxidase
protective mechanisms that deal with ROS, returning focus Peroxiredoxin 1
to GSH and thiol regulatory pathways. Redox status has dual Cyclophilin
effects on upstream signaling systems and downstream tran- HSP60
scription factors. Oxidants can stimulate many upstream ki- HSP70
Nucleophosmin
nases in signaling pathway cascades, and yet inhibit tran-
Transgelin
scription factors AP-1 and NFjB. Reductants can have
Galectin
opposite effects producing AP-1 and NFjB activation [19]. Fatty acid binding protein
GSH homeostasis and GST expression in non-mammalian Adapted from reference [35].
phyla can also influence proliferative signaling pathways.
Tobacco seedlings transgenically overexpressing both GST
and GPx cDNAs grew significantly faster than control seed- induce glutathionylation of the cysteine located in the DNA
lings when exposed to low temperatures or salt stress [20]. binding site of c-jun as well as produce a disulfide bond
During stress periods, GSSG levels were significantly higher between cysteines proximal to the leucine zipper motif. The
in the transgenic seedlings when compared to control. In impact of these changes is the capacity to induce a direct and
addition, growth of the control seedlings was accelerated by reversible control of transcriptional regulation through these
GSSG treatment and decreased by GSH or other sulfhydryl stress kinase pathways [22]. The transcription factor Nrf2 has
reducing agents. These authors concluded that oxidation of been shown to be a regulator of some members of the phase II
the GSH pool was stimulatory to the proliferative process. detoxification enzyme family (including GSTs) which are
While there was no specific explanation for the underlying controlled by the ARE. A negative regulatory protein, Keap1,
mechanism, S-thiolation of growth regulatory proteins could has been shown under non-stressed conditions to keep Nrf2
be implied. Site-specific reactive cysteines are found in many in a silent state [23]. Exposure to ROS dissociated Nrf2 from
proteins and these may be targets for thiol:disulfide exchange Keap1 and allowed relocation of Nrf2 to the nucleus, where
reactions. Experimentally, glutathionylation of these cys- ARE responsive genes became actively transcribed. It has
teines may be studied by using a number of different tech- been suggested that the Keap1 protein may contain critical
niques including radiolabeled GSSG that acts as the GS- cysteine residues, which upon oxidation alter the conforma-
donor (Fig. 2) . This post-translational modification adds the tion of the protein releasing any associated protein such as
tripeptide glycinecysteineglutamic acid to the acceptor Nrf2 [24]. In addition, GSH was shown to exert negative
cysteine with a subsequent change in redox state, charge and regulation on cellular PKC isozymes which have cysteine
three dimensional structure. By masking the thiol, the protein residues at, or near, the active site of the enzyme and this
will be altered in its capacity to form disulfide bonds and to control was removed when GSH pools were depleted by
fold into different functional (perhaps active) conformations. exposure to ROS [25]. Manipulation of intracellular GSH
Glutathionylation has been shown to occur on a number of pools by supplementation with GSH precursors was found to
proteins (Table 2) and in some cases, to alter their biological block induction of JNK activity by methylating agents [26]
activity [21]. Similarly p53 function has been reported to be redox sensi-
In many cases, alteration of the ratio of GSH:GSSG can tive, primarily through in vitro modification of its cysteine
have a direct effect upon signaling pathways. For example, a residues [27]. At the cellular level, thiol antioxidants induced
shift in ratio towards the oxidized pool has been shown to apoptosis in transformed cell lines but not in normal cells,
148 D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155
Table 3 Not surprisingly, therefore, GSTs have been linked with the
Allelic variation in c-GCS due to GAG trinucleotide repeat development of resistance toward chemotherapy agents, in-
Allele Number of GAG repeats Frequency (%) secticides, herbicides, and microbial antibiotics [4346].
c-GCS*A1 9 35 In addition to the transferase function, GSTs have been
c-GCS*A2 8 11
shown to form protein:protein interactions with members of
c-GCS*A3 7 54
the mitogen activated protein (MAP) kinase pathway thereby
* Adapted from reference [37].
serving a regulatory role in the balance between cell survival
there are examples of altered c-GCS activity associated with and apoptosis. By interacting directly with MAP kinases,
a variety of diseases. The essential role of c-GCS and GSH including c-Jun N-terminal kinase 1 (JNK1) and apoptosis
synthesis has been demonstrated in knockout mice that were signal-regulating kinase 1 (ASK1), GSTs function to seques-
incompetent to form the heavy chain of c-GCS [38]. The ter the ligand in a complex, preventing interactions with their
mutation was shown to be embryonic lethal, however, cell downstream targets [32,4749]. Many anticancer agents in-
lines were derived from the mutants when either GSH or duce apoptosis via activation of MAP kinase pathways, in
NAC was supplemented in the culture medium. In humans, particular those involving JNK and p38 [50,51]. This novel,
c-GCS activity is diminished in patients with haemolytic non-enzymatic role for GSTs has direct relevance to the
anemia [39]. These patients were shown to carry an AT GST over-expressing phenotypes of many drug resistant tu-
mutation at nucleotide 1109 that resulted in the substitution mors. As an endogenous switch for the control of signaling
of histidine with leucine at amino acid 370. Two additional cascade pathways, elevated expression of GST can alter the
alterations were identified in an intron (+206) and a CGC balance of regulation of kinase pathways during drug treat-
repeat in the 3' untranslated region [39]. Some patients with ment, thereby, conferring a potential selective advantage.
malignant mesothelioma have a deletion on chromosome 1 in This process can also provide a plausible explanation for the
the region that encompasses the c-GCS gene [40]. This numerous examples of drug resistance linking GST over-
deletion can lead to c-GCS deficiency and it was proposed expression with agents that are not substrates for these en-
that this could contribute to the malignant phenotype of this zymes.
disease.
5.3. Polymorphism of GSTs
5.2. Glutathione S-transferases
While polymorphisms have been identified within each
GSTs are a family of Phase II detoxification enzymes that class of GSTs, only the heterogeneity that may contribute to
have co-evolved with GSH and are abundant throughout variations in pathology or clinical response will be addressed
most life forms. GSTs catalyze the conjugation of GSH to a in this review. The and h class of GST have a null pheno-
wide variety of endogenous and exogenous electrophilic type (GSTM*0 and GSTT*0) whereby individuals do not
compounds (Fig. 1). Human GSTs are divided into two express catalytically active protein. The lack of enzyme ac-
distinct super family members; the membrane bound mi- tivity, and therefore, an inability to detoxify carcinogens is
crosomal and cytosolic family members. Microsomal GSTs associated with an increased risk toward a variety of cancers.
play a key role in the endogenous metabolism of leukotrienes The GSTM1*0 allele is observed in ~50% of the Caucasian
and prostaglandins [41]. Cytosolic GSTs are divided into six population [52] and is associated with an increased risk of
classes: a, , x, p, h and f (Table 4). lung, colon and bladder cancer and is a risk factor for pulmo-
GSTs can be induced by structurally unrelated com- nary asbestosis [53,54]. The GSTT*0 phenotype varies be-
pounds known to result in chemical stress and carcinogenesis tween ethnic groups and is found to be highest in Chinese
including, phenobarbital, planar aromatic compounds, (65%) and lowest in Mexican American (9%) populations
ethoxyquin, BHA, and trans-stilbene oxide [42]. Some of the [55]. The GSTT*0 phenotype is associated with an increased
compounds known to induce GSTs are themselves substrates risk of tumors of the head and neck, oral cavity, pharynx, and
of the enzyme, suggesting that induction is an adaptive re- larynx [56,57].
sponse mechanism. Many clinical useful drugs are also po- The class of GSTs has five genes (GSTM15) [58] that
tential substrates for GST and development of drug resis- are found in a gene cluster on chromosome 1 [59]. The
tance can frequently be a key element in treatment failure. GSTM1 gene contains four alleles and has been the most
Table 4 widely studied (Table 5). GSTM1*A has been associated
Cytosolic GSTs with a decreased risk of bladder cancer and has an allele
Class Gene Chromosome location frequency of 20% [52]. Neurodegenerative diseases such as
Alpha (a) GSTA1-2 6 PD and schizophrenia are characterized by the degeneration
Mu () GSTM1-5 1 of dopaminergic neurons. GSTM2-2 has been shown to cata-
Omega () GSTO1 10 lyze the conjugation of GSH to aminochrome, a ROS gener-
Pi (p) GSTP1 11 ated in the redox cycling of orthoquinones within dopamin-
Theta (h) GSTT1-2 22 ergic neurons [60]. Hence, GSTM2-2 has been proposed to
Zeta (f) GSTZ1 14
play a protective role against neurodegenerative diseases.
150 D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155
To date, hereditary defects have been described in four of Nearly 21.8 million deaths associated with HIV/AIDS
the major enzymes that mediate GSH metabolism through were reported worldwide between 1981 and 2000. Prior to
the c-glutamyl cycle [66]. As mentioned previously, poly- clinical manifestations of the disease, the immune system is
morphic variants of c-GCS have been linked to specific compromised. As stated in previous sections, GSH levels
diseases. However, where mutant enzyme expression occurs, have an impact on many immune functions, including activa-
the most prevalent syndromes include hemolytic anemia, tion of lymphocytes. Consequently, it was postulated that
either with or without hepatosplenomegaly. Hereditary de- GSH deficiency could lead to the progression of immune
fects in GSH synthetase are autosomal recessive and can lead dysfunction, a hallmark of AIDS. GSH levels are depleted in
to mental retardation and neuropsychiatric dysfunction in plasma, epithelial lining fluid (ELF), peripheral blood mono-
approximately 50% of patients, while this deficiency is rou- nuclear cells and monocytes in asymptomatic HIV-infected
tinely accompanied by metabolic acidosis and hemolytic individuals and in AIDS patients [76]. Systemic GSH defi-
anemia. The cycle intermediate 5-oxoproline is found in ciency has also been reported in symptom-free HIV seroposi-
excess in the bloodstream of these patients, presumably be- tive individuals [76]. Clinical studies have shown that GSH
cause of the lack of feedback inhibition by GSH on c-GCS. deficiency is correlated with morbidity [29]. It seems reason-
Where GSH synthetase deficiency is restricted to erythro- able to conclude that a generally impaired antioxidant system
cytes, the hemolytic anemia is not accompanied by a gener- is an obvious contributory factor that may contribute to these
alized oxoprolinuria [67]. Glutathionemia (excess GSH in clinical findings, however, the precise importance of GSH
the blood) occurs with aberrant expression of c-glutamyl- deficiency presents a more complex scenario. Decreased
transpeptidase. This can lead to an imbalance in glutamic GSH levels have been shown to activate NFjB, leading to a
acid homeostasis, classifying the disease as an inherited series of downstream signal transduction events that allow
disorder of dicarboxylic acid catabolism. Symptoms can HIV expression [77]. The long terminal repeat of HIV (HIV
D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155 151
LTR) contains an NFjB site. In vitro studies have shown that ditions were more pronounced in patients who had a con-
NFjB binds to and activates genes controlled by the HIV comitant HIV infection [86].
LTR [78]. NAC supplementation blocked HIV LTR gene
expression, thereby confirming the importance of thiol status
6.5. Cystic fibrosis
in HIV positive cells [77].
Depletion of the CD4+ T-cell lymphocytes accompanies
the etiology of HIV progression. Decreased GSH levels are CF is a genetic disorder affecting nearly 250 000 children
known to be one contributory factor in the induction of world-wide per year. The severe lung dysfunction that char-
apoptosis in CD4+ T lymphocytes [79]. Oxidative stress acterizes the disease is due to an alteration in an ion transport
indices were measured in blood samples from 85 HIV/AIDS protein, CF transmembrane conductance regulator (CFTR).
patients and compared to 40 healthy individuals [80]. These The recessive mutation renders the channel dysfunctional or
studies showed that reduced GSH levels were accompanied absent. CFTR is an organic anion efflux channel with func-
by an increase of DNA fragmentation in lymphocytes, in- tional properties that are redundant to MRP, a related class of
dicative of apoptosis [80]. ATP binding cassette transporters. CFTR maintains a cellular
These factors combined suggest that maintenance or res- homeostatic balance of ions, including sodium, chloride and
toration of GSH levels is a potential therapeutic approach in GSH. Normal levels of GSH in the ELF of the lung are 150
HIV patients. In fact, several studies have shown that NAC times higher than other tissues [87] where it serves as an
restores GSH levels, prevents the activation of NFjB and essential antioxidant that protects the tissue from inhaled
replication of HIV [81]. Interestingly, treatment with NAC toxins. However, the presence of GSH in the ELF also pro-
has provided beneficial effects for HIV-infected individuals, vides a sensor system for maintaining surfactant production,
even though GSH levels in lymphocytes are not altered [81]. as well as a trigger for inflammation. CF is characterized by
In separate studies, plasma GSH levels in HIV-infected indi- systemic GSH deficiency that progresses over time [88].
viduals were increased to 89% of the uninfected controls Cellular GSH deficiency has been associated with an in-
following an 8-week treatment with oral NAC [82]. One crease in transcription of NFjB, which participates in the
dietary manipulation, which proves to be effective is supple- regulation of the inflammatory cytokines [87]. Low levels of
mentation with cysteine-rich whey proteins, where short GSH lead to inflammation, a hallmark of CF, and oxidative
term increases in plasma GSH levels have been observed stress that can lead to damage to cell membranes, cellular
[83]. In concordance with other dietary protocols, GSH pre- proteins and DNA. In support of the causative influence of
cursor amino acid supplements seem, at least on the surface, ROS in CF, these patients frequently have higher levels of
to be a beneficial additive. lipid peroxidation byproducts [89,90].
Adding to the complexity of disease progression is the
6.4. Liver disease expression pattern of GSTs (specifically GSTM) in CF pa-
tients. GSTM1 plays a role in the detoxification of hydroper-
High intracellular content of GSH in liver are congruous oxides. Additionally, GSTM1 is a negative regulator of
with the detoxification functions of this organ. Inherited ASK1, a kinase involved in the apoptotic pathway [49]. CF
disorders in GSH synthesis and metabolism can significantly patients with the null phenotype for GSTM1 (GSTM*0) have
disrupt liver function and in some instances can be condition- a poorer prognosis than individuals with other GSTM1 alle-
ally lethal. In humans, regular dietary intake of precursor les [91]. At this time, the impact of allelic variation on the
sulfur containing amino acids will maintain hepatic intracel- regulation of kinase signaling is unknown. We do know,
lular GSH levels in the 510 mM range. Alterations in liver however, that CF patients have a diminished immune re-
GSH are either the cause or effect of a number of pathologies. sponse that is attributed to decreased GSH levels leading to
For example, in alcoholics, pools of mitochondrial GSH are premature apoptosis in macrophages and neutrophils re-
depleted with the concomitant result that ROS damage can be cruited to the lung [87].
exacerbated producing cell death and contributing to cirrho- Some therapeutic strategies for CF are aimed at restoring
sis. Interestingly, the defect that leads to reduced levels of GSH levels, particularly in the ELF. Cysteine supplementa-
mitochondrial GSH involves a partial inactivation of a spe- tion has been undertaken in other disorders associated with
cific mitochondrial membrane transport protein [84]. Thus GSH depletion, including PD. Because GSH deficiency is
while a build up of cytosolic GSH occurs, the inability to due to an aberration in efflux rather than synthesis, augmen-
transport this into mitochondria is caused by physicochemi- tation with GSH is desirable. Thus far three clinical strategies
cal alterations to the inner mitochondrial membrane caused to supplement GSH have been attempted including intrave-
by long term alcohol exposure. The selective depletion of nous and oral administration or inhalation [92]. Due to sta-
GSH in this organelle can sensitize hepatocytes to the oxida- bility and uptake, inhalation methods appear more promis-
tive effects of cytokines such as tumor necrosis factor (TNF) ing. Recent studies in seven CF patients treated with 600 mg
[85]. In patients with chronic hepatitis C infections, GSH of a GSH aerosol administered twice daily for 3 d showed an
levels were severely depleted in hepatic and plasma fractions increase in ELF GSH levels and should provide a platform
and also in peripheral blood mononuclear cells. These con- for future clinical trials [93].
152 D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155
by evidence of increased oxidative stress and disturbance in [7] Moinova HR, Mulcahy RT. An electrophilic responsive element
the redox balance of host cells [101]. (EpRE) regulates beta-naphthoflavone induction of the human
gamma-glutamylcysteine synthetase regulatory subunit gene. Consti-
As discussed earlier, the immune response with respect to tutive expression is mediated by an adjacent AP-1 site. J Biol Chem
balance of Th1 and Th2 production can also be influenced by 1998;273:146839.
redox conditions. For example, thioredoxin transgenic mice [8] Wild A, Gipp JJ, Mulcahy T. Overlapping antioxidant response ele-
had a longer life expectancy than their wild type counter- ment and PMA response element sequences mediate basal and beta-
parts. In these mice, peritoneal resident macrophages showed naphthoflavone-induced expression of the human gamma-
a higher ratio of GSH:GSSG compared to age-matched wild glutamylcysteine synthetase catalytic subunit gene. Biochem J 1998;
332(Pt 2):37381.
type animals [102]. These so-called reductive macrophages
[9] Rahman ISC, Antonicelli F, MacNee W. Characterisation of
predominated and were associated with sustained mainte- y-glutamylcysteine-heavy subunit gene promoter: critical role for
nance of Th1 prevalence during aging until 2 years in the AP-1. FEBS Lett 1998;427:12933.
transgenic mice, while wild type littermates showed a rapid [10] Bella DL, Hosokawa Y, Stipanuk MH. Mechanisms involved in the
polarization to Th2 at 8 months. Cytokine production was regulation of key enzymes of cysteine metabolism in rat liver in vivo.
different in these animals suggesting that altered redox bal- Am J Physiol 1999;276:E32635.
ance, particularly as a consequence of GSH changes could [11] Gomi AMT, Ishikawa T, Kuo MT. Posttranscriptional regulation of
influence immune response. MRP/GS-X pump and y-glutamylcysteine synthetase expression by
1(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-
Dietary supplements frequently claim to be enriched in
nitrosourea and by cycloheximide in human glioma cells. Biochem
anti-oxidants and free radical scavengers. Are such claims of Biophys Res Commun 1997;239:516.
value to prevention of aging and the diseases associated with [12] Brigelius-Flohe R. Tissue-specific functions of individual glutathione
age? In the absence of carefully controlled (and possibly long peroxidases. Free Radical Biol Med 1999;27:95165.
term) clinical studies, this is a difficult question to answer. [13] Downey JS, Bingle CD, Cottrell S, Ward N, Churchman D,
Inclusion of GSH in over-the-counter supplements is of lim- Dobrota M, et al. The LEC rat possesses reduced hepatic selenium,
ited value, since the reduced state will not be maintained contributing to the severity of spontaneous hepatitis and sensitivity to
carcinogenesis. Biochem Biophys Res Commun 1998;244:4637.
when exposed to normal atmospheric conditions and room
[14] Banki K, Hutter E, Gonchoroff NJ, Perl A. Molecular ordering in
temperature. Perhaps the product will provide a supply of the
HIV-induced apoptosis. Oxidative stress, activation of caspases, and
constituent amino acids, where, in particular, cysteine may cell survival are regulated by transaldolase. J Biol Chem 1998;273:
be useful in stimulating gastrointestinal synthesis of GSH. 1194453.
There is sufficient evidence that thiol containing compounds [15] Shisler JL, Senkevich TG, Berry MJ, Moss B. Ultraviolet-induced cell
can rescue patients from acute exposure to oxidative or elec- death blocked by a selenoprotein from a human dermatotropic poxvi-
trophilic stress (for example, NAC in acetaminophen over- rus. Science 1998;279:1025.
dose). It is also a general principle that cells prefer and thrive [16] Okamoto K, Toyokuni S, Uchida K, Ogawa O, Takenewa J,
in a mildly reduced environment and that mild oxidative Kakehi Y, et al. Formation of 8-hydroxy-2'-deoxyguanosine and
4-hydroxy-2-nonenal-modified proteins in human renal-cell carci-
stress can stimulate growth in a manner not conducive to noma. Int J Cancer 1994;58:8259.
benign cellular homeostasis. As such, there would seem to be [17] Chinery R, Beauchamp RD, Shyr Y, Kirkland SC, Coffey RJ, Mor-
no harm in supplementing a diet with reducing equivalents. row JD. Antioxidants reduce cyclooxygenase-2 expression, prostag-
However, whether this will prove to be the elixir of longevity landin production, and proliferation in colorectal cancer cells. Cancer
remains a contentious and difficult issue to answer accu- Res 1998;58:23237.
rately. [18] Lee YJ, Galoforo SS, Berns CM, Chen JC, Davis BH, Sim JE, et al.
Glucose deprivation-induced cytotoxicity and alterations in mitogen-
activated protein kinase activation are mediated by oxidative stress in
multidrug-resistant human breast carcinoma cells. J Biol Chem 1998;
References 273:52949.
[19] Kamata H, Hirata H. Redox regulation of cellular signalling. Cell
[1] Anderson ME. Glutathione: an overview of biosynthesis and modula- Signal 1999;11:114.
tion. Chem Biol Interact 1998;1112:114.
[20] Roxas VP, Smith RK, Allen ER, Allen RD. Overexpression of glu-
[2] Mullineaux P, Creissen GP. Glutathione reductase: regulation and role
tathione S-transferase/glutathione peroxidase enhances the growth of
in oxidative stress. Oxidative stress and the molecular biology of
transgenic tobacco seedlings during stress. Nat Biotechnol 1997;15:
antioxidant defenses. Cold Spring Harbor Laboratory Press; 1997.
98891.
[3] Meister MAA. Glutathione. Annu Rev Biochem 1983;52:71160.
[21] Lind C, Gerdes R, Schuppe-Koistinen I, Cotgreave IA. Studies on the
[4] Sierra-Rivera ESM, Dasouki M, Krishnamani MR, Phillips JA, Free-
mechanism of oxidative modification of human glyceraldehyde-3
man ML. Assignment of the gene (GLCLC) that encodes the heavy
phosphate dehydrogenase by glutathione: catalysis by glutaredoxin.
subunit of y-glutamylcysteine synthetase to human chromosome 6.
Biochem Biophys Res Commun 1998;247:4816.
Cytogenet Cell Genet 1995;70:2789.
[5] Sierra-Rivera EDM, Summar ML, et al. Assignment of the human [22] Klatt P, Pineda-Molina E, Garcia de Lacoba M, Padilla A, Martinez-
gene (GLCLR) that encodes the regulatory subunit of Galisteo E, Barcena JA, et al. Redox regulation of c-Jun DNA binding
y-glutamylcysteine synthetase to chromosome 1p21. Cytogenet Cell by reversible S-glutathiolation. FASEB J 1999;13:148190.
Genet 1996;72:2524. [23] Itoh K, Wakabayashi N, Katoh Y, Ishii T, Igarashi K, Engel JD, et al.
[6] Bannai S, Christensen HN, Vadgama JV, Ellory JC, Englesberg E, Keap1 represses nuclear activation of antioxidant responsive elements
Guidotti GG, et al. Amino acid transport systems. Nature 1984;311: by Nrf2 through binding to the amino-terminal Neh2 domain. Genes
308. Dev 1999;13:7686.
154 D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155
[24] Alam J, Camhi S, Choi AMK. Identification of a second region [43] Tew KD. Glutathione-associated enzymes in anticancer drug resis-
upstream of the mouse heme oxygenase-1 gene that functions as a tance. Cancer Res 1994;54:431320.
basal level and induce dependent transcriptional enhancer. J Biol [44] McLellan LI, Wolf CR. Glutathione and glutathione-dependent
Chem 1995;270:1197784. enzymes in cancer drug resistance. Drug Resist Update 1999;2:
[25] Ward NE, Pierce DS, Chung SE, Gravitt KR, OBrian CA. Irreversible 15364.
inactivation of protein kinase C by glutathione. J Biol Chem 1998; [45] Tang AH, Tu CP. Biochemical characterization of Drosophila glu-
273:1255866. tathione S-transferases D1 and D21. J Biol Chem 1994;269:
[26] Wilhelm D, Bender K, Knebeland AP. The level of intracellular 2787684.
glutathione is a key regulator for the induction of stress-activated [46] Ranson H, Prapanthadara L, Hemingway J. Cloning and characteriza-
signal transduction pathways including jun N-terminal protein tion of two glutathione S-transferases from a DDT-resistant strain of
kinases and p38 kinase by alkylating agents. Mol Cell Biol 1997;17: Anopheles gambiae. Biochem J 1997;324(Pt 1):97102.
4792800. [47] Adler V, Yin Z, Fuchs SY, Benerza M, Rosario L, Tew KD, et al.
[27] Rainwater R, Parks D, Anderson ME, Tegtmeyer P, Mann K. Role of Regulation of JNK signaling by GSTp. EMBO J 1999;18:132134.
cysteine residues in regulation of p53 function. Mol Cell Biol 1995; [48] Yin Z, Ivanov V, Habelhah H, Tew KD, Ronai Z. Glutathione
15:3892903. S-transferase p elicits protection against hydrogen peroxide-induced
[28] Liu M, Pelling JC, Ju J, Chu E, Brash DE. Antioxidant action via cell death via coordinated regulation of stress kinases. Cancer Res
p53-mediated apoptosis. Cancer Res 1998;58:17239. (Adv. In Brief) 2000;60:40537.
[29] Herzenberg LA, DeRosa SC, Dubs JG, Roederer M, Anderson MT, [49] Cho SG, Lee YH, Park HS, Ryoo K, Kang KW, Park J, et al. Glu-
Ela SW, et al. Glutathione deficiency is associated with impaired tathione S-transferase mu modulates the stress-activated signals by
survival in HIV disease. Proc Natl Acad Sci USA 1997;94:196772. suppressing apoptosis signal-regulating kinase 1. J Biol Chem 2001;
[30] Dong C, Yang DD, Wysk M, Whitmarsh AJ, Davis RJ, Flavell RA. 276:1274955.
Defective T-cell differentiation in the absence of JNK1. Science 1998; [50] Davis RJ. Signal transduction by the JNK group of MAP kinases. Cell
281:20925. 2000;103:23952.
[31] Powis G, Kirkpatrick DL, Angulo M, Baker A. Thioredoxin redox [51] Ono K, Han J. The p38 signal transduction pathway: activation and
control of cell growth and death and the effects of inhibitors. Chem function. Cell Signal 2000;12:113.
Biol Interact 1998;111112:234. [52] Smith G, Stanley LA, Sim E, Strange RC, Wolf CR. Metabolic
[32] Saitoh M, Nishitoh H, Fujii M, Takeda K, Tobiume K, Sawada Y, et al. polymorphisms and cancer susceptibility. Cancer Surv 1995;25:
Mammalian thioredoxin is a direct inhibitor of apoptosis signal- 2765.
regulating kinase (ASK) 1. EMBO J 1998;17:2596606. [53] Strange RC, Jones PW, Fryer AA. Glutathione S-transferase: genetics
[33] Gotoh Y, Cooper JA. Reactive oxygen species and dimerization- and role in toxicology. Toxicol Lett 2000;1123:35763.
induced activation of apoptosis signal-regulating kinase 1 in tumor [54] Smith CM, Kelsey KT, Wiencke JK, Leyden K, Levin S, Chris-
necrosis factor-alpha signal transduction. J Biol Chem 1998;273: tiani DC. Inherited glutathione-S-transferase deficiency is a risk factor
1747782. for pulmonary asbestosis. Cancer Epidemiol Biomarkers Prev 1994;
[34] Makino Y, Yoshikawa N, Okamoto K, Hirota K, Yodoi J, 3:4717.
Makino I, et al. Direct Association with thioredoxin allows redox [55] Nelson HH, Wiencke JK, Christiani DC, Cheng TJ, Zuo ZF,
regulation of glucocorticoid receptor function. J Biol Chem 1999;274: Schwartz BS, et al. Ethnic differences in the prevalence of the
31828. homozygous deleted genotype of glutathione S-transferase theta. Car-
[35] Casagrande S, Bonetto V, Fratelli M, Gianazza E, Eberini I, Massig- cinogenesis 1995;16:12435.
nan T, et al. Glutathionylation of human thioredoxin: a possible [56] Strange RC, Fryer AA. The glutathione S-transferases: influence of
crosstalk between the glutathione and thioredoxin systems. Proc Natl polymorphism on cancer susceptibility. IARC Sci Publ 1999:23149
Acad Sci USA 2002;99:97459. [Chapter 19].
[36] Shen H, Tsuchida S, Tamai K, Sato K. Identification of cysteine [57] Chenevix-Trench G, Young J, Coggan M, Board P. Glutathione
residues involved in disulfide formation in the inactivation of glu- S-transferase M1 and T1 polymorphisms: susceptibility to colon can-
tathione transferase P-form by hydrogen peroxide. Arch Biochem cer and age of onset. Carcinogenesis 1995;16:16557.
Biophys 1993;300:13741. [58] Pearson WR, Vorachek WR, Xu SJ, Berger R, Hart I, Vannais D, et al.
[37] Walsh AC, Rosen DR, Lawrence DA. Genetic mapping of GLCLC, Identification of class-mu glutathione transferase genes GSTM1-
the human gene encoding the catalytic subunit of y-glutamylcysteine GSTM5 on human chromosome 1p13. Am J Hum Genet 1993;53:
synthetase, to chromosome band 6pl 12 and characterisation of a 22033.
polymorphic trinucleotide repeat within its 5'-untranslated region. [59] DeJong JL, Mohandas T, Tu CP. The human Hb (mu) class glutathione
Cytogenet Cell Genet 1996;75:1146. S-transferases are encoded by a dispersed gene family. Biochem
[38] Shi ZZ, Kala G, Kala SV, Barrios RJ, Habib GM, Lukin DJ, et al. Biophys Res Commun 1991;180:1522.
Glutathione synthesis is essential for mouse development but not for [60] Baez S, Segura-Aguilar J, Widersten M, Johansson AS, Mannervik B.
cell growth in culture. Proc Natl Acad Sci USA 2000;97:51016. Glutathione transferases catalyse the detoxication of oxidized
[39] Beutler EGT, Kondo T, Matsunaga AT. The molecular basis of a case metabolites (o-quinones) of catecholamines and may serve as an
of y-glutamylcysteine synthetase deficiency. Blood 1999;94:28904. antioxidant system preventing degenerative cellular processes. Bio-
[40] Rozet JM, Perrault I, et al. Structure and refinement of the physical chem J 1997;324(Pt 1):258.
mapping of the y-glutamylcysteine ligase regulatory subunit [61] Cowell IG, Dixon KH, Pemble SE, Ketterer B, Taylor JB. The struc-
(GLCLR) gene to chromosome 1p22.1 within the critically deleted ture of the human glutathione S-transferase pi gene. Biochem J 1988;
region of human malignant mesothelioma. Cytogenet Cell Genet 255:7983.
1998;82:914. [62] Lo HW, Ali-Osman F. Structure of the human allelic glutathione
[41] Jakobsson PJ, Thoren S, Morgenstern R, Samuelsson B. Identification S-transferase-pi gene variant, hGSTP1 C, cloned from a glioblastoma
of human prostaglandin E synthase: a microsomal, glutathione- multiforme cell line. Chem Biol Interact 1998;1112:91102.
dependent, inducible enzyme, constituting a potential novel drug [63] Goto S, Iida T, Cho S, Oka M, Kohno S, Kondo T. Overexpression of
target. Proc Natl Acad Sci USA 1999;96:72205. glutathione S-transferase pi enhances the adduct formation of cispl-
[42] Mannervik B. The isoenzymes of glutathione transferase. Adv Enzy- atin with glutathione in human cancer cells. Free Radical Res 1999;
mol Relat Areas Mol Biol 1985;57:357417. 31:54958.
D.M. Townsend et al. / Biomedicine & Pharmacotherapy 57 (2003) 145155 155
[64] Watson MA, Stewart RK, Smith GB, Massey TE, Bell DA. Human [84] Fernandez-Checa JC, Colell A, Garcia-Ruiz C. S-adenosyl-L-
glutathione S-transferase P1 polymorphisms: relationship to lung methionine and mitochondrial reduced glutathione depletion in alco-
tissue enzyme activity and population frequency distribution. Car- holic liver disease. Alcohol 2002;27(3):17983.
cinogenesis 1998;19:27580. [85] Fernandez-Checa JC, Kaplowitz N, Garcia-Ruiz C, Colell A. Mito-
[65] Stoehlmacher J, Park DJ, Zhang W, Groshen S, Tsao-Wei DD, chondrial glutathione: importance and transport. Semin Liver Dis
Yu MC, et al. Association between glutathione S-transferase P1, T1, 1998;18(4):389401.
and M1 genetic polymorphism and survival of patients with metastatic [86] Barbaro G, DiLorenzo G, Soldini M, Parrotto S, Bellomo G, Bel-
colorectal cancer. J Natl Cancer Inst 2002;94:93642. loni G, et al. Hepatic glutathione deficiency in chronic hepatitis C:
[66] Ristoff E, Larsson A. Patients with genetic defects in the gamma- quantitative evaluation in patients who are HIV positive and HIV
glutamyl cycle. Chem Biol Interact 1998;1112:11321. negative and correlations with plasmatic and lymphocytic concentra-
[67] Shi ZZ, Habib GM, Rhead WJ, Gahl WA, He X, Sazer S, et al. tions and with the activity of the liver disease. Am J Gastroenterol
Mutations in the glutathione synthetase gene cause 5-oxoprolinuria. 1996;91(12):256973.
Nat Genet 1996;14:3615. [87] Hudson V. Rethinking cystic fibrosis pathology: the critical role of
[68] Dringen RGJ, Hirlinger J. Glutathione metabolism in the brain. Eur J abnormal reduced glutathione (GSH) transport caused by CFTR
Biochem 2000;267:49126. mutation. Free Radical Biol Med 2001;30:144061.
[69] Halliwell B, Gutteridge JM. Oxygen free radicals and iron in relation
[88] Roum JH, Buhl R, McElvaney NG, Borok Z, Crystal RG. Systemic
to biology and medicine: some problems and concepts. Arch Biochem
deficiency of glutathione in cystic fibrosis. J Appl Physiol 1993;75:
Biophys 1986;246:50114.
241924.
[70] Youdim MB. Understanding Parkinsons disease. Sci Am 1997;276:
[89] Brown RK, ScBurney A, Lunec J, Kelly FJ. Oxidative damage to
529.
DNA in patients with cystic fibrosis. Free Radical Biol Med 1995;234:
[71] Forno LS. Neuropathology of Parkinsons disease. J Neuropathol Exp
13746.
Neurol 1996;55:25972.
[72] Sofic ELK, Jellinger K, Riederer P. Reduced and oxidized glutathione [90] Brown RK, Wyatt H, Price JF, Kelly FJ. Pulmonary dysfunction in
in the substantial nigra of patients with Parkinsons disease. Neurosci cystic fibrosis is associated with oxidative stress. Eur Respir J 1996;
Lett 1992;142:12830. 9:3349.
[73] Adams Jr JD, Klaidman LK. Parkinsons diseaseredox mecha- [91] Hull J, Thomson AH. Contribution of genetic factors other than CFTR
nisms. Curr Med Chem 2001;8:80914. to disease severity in cystic fibrosis. Thorax 1998;53:101821.
[74] Andersen JK, Hom DG, Lee FY, Harnish P, Hamill RW, McNeil TH. [92] Buhl R, Vogelmeier C, Critenden M, Hubbard RC, Hoyt Jr RF,
Effect of buthionine sulfoximine, a synthesis inhibitor of the antioxi- Wilson EM, et al. Augmentation of glutathione in the fluid lining the
dant glutathione, on the murine nigrostriatal neurons. J Neurochem epithelium of the lower respiratory tract by directly administering
1996;67:216471. glutathione aerosol. Proc Natl Acad Sci USA 1990;87:40637.
[75] Sechi GDM, Bua G, Satta WM, Deiana GA, Pes GM, Rosati G. [93] Roum JH, Borok Z, McElvaney NG, Grimes GJ, Bokser AD,
Reduced intravenous glutathione in the treatment of early Parkinsons Buhl R, et al. Glutathione aerosol suppresses lung epithelial surface
disease. Prog Neuropsychopharmacol Biol Psychiatry 1996;20: inflammatory cell-derived oxidants in cystic fibrosis. J Appl Physiol
115970. 1999;87:43843.
[76] Buhl R, Jaffe HA, Holroyd KJ, Wells FB, Mastrangeli A, Sal- [94] Flint DH, Tuminello JF, Emptage MH. The inactivation of FeS
tini C, et al. Systemic glutathione deficiency in symptom-free HIV- cluster containing hydro-lyases by superoxide. J Biol Chem 1993;
seropositive individuals. Lancet 1989;2:12948. 268:2236976.
[77] Staal F, Roederer M, Herzenberg LA, Herzenberg LA. Intracellular [95] Gardner PR, Fridovich I. Superoxide sensitivity of the Escherichia
thiols regulate activation of nuclear factor kB and transcription of coli aconitase. J Biol Chem 1991;266:1932833.
human immunodeficiency virus. Proc Natl Acad Sci USA 1990;87: [96] Mallis RJ, Hamann MJ, Zhao W, Zhang T, Hendrich S, Thomas JA.
99437. Irreversible thiol oxidation in carbonic anhydrase III: protection by
[78] Duh E, Maury WJ, Folks TM, Fauci AS, Rabson AB. Tumor necrosis S-glutathiolation and detection in aging rats. Biol Chem 2002;383:
factor alpha activates human immunodeficiency virus type 1 through 64962.
induction of nuclear factor binding to the NF-kappa B sites in the long
[97] Koster JF, Sluiter W. Is increased tissue ferritin a risk factor for
terminal repeat. Proc Natl Acad Sci USA 1989;86:56748.
atherosclerosis and ischaemic heart disease? Br Heart 1995;73:2089.
[79] Suthanthiran M, Anderson ME, Sharma VK, Meister A. Glutathione
[98] Toba G, Aigaki T. Disruption of the microsomal glutathione
regulates activation-dependent DNA synthesis in highly purified nor-
S-transferase-like gene reduces life span of Drosophila melanogaster.
mal human T lymphocytes stimulated via the CD2 and CD3 antigens.
Gene 2000;8:17987.
Proc Natl Acad Sci USA 1990;87:33437.
[80] Gil L, Martinez G, Gonzalez I, Tarinas A, Alvarez A, Giuliani A, et al. [99] Jones DP, Mody Jr VC, Carlson JL, Lynn MJ, Sternberg Jr P. Redox
Contribution to characterization of oxidative stress in HIV/AIDS analysis of human plasma allows separation of pro-oxidant events of
patients. Pharmacol Res 2003;47:21724. aging from decline in antioxidant defenses. Free Radical Biol Med
[81] Nakamura HMH, Yodoi J. Redox imbalance and its control in HIV 2002;33:1290300.
infection. Antioxid Redox Signal 2002;4:45564. [100] Liu RM. Down-regulation of gamma-glutamylcysteine synthetase
[82] DeRosa SC, Zaretsky MD, Dubs JG, Roederer M, Anderson M, regulatory subunit gene expression in rat brain tissue during aging. J
Green A, et al. N-acetylcysteine replenishes glutathione in HIV infec- Neurosci Res 2002;68:34451.
tion. Eur J Clin Invest 2000;30(10):91529. [101] Knight JA. The biochemistry of aging. Adv Clin Chem 2000;35:162.
[83] Micke PBK, Schlaak JF, Buhl R. Oral supplementation with whey [102] Murata Y, Amao M, Yoneda J, Hamuro J. Intracellular thiol redox
proteins increases plasma glutathione levels of HIV-infected patients. status of macrophages directs the Th1 skewing in thioredoxin trans-
Eur J Clin Invest 2001;31:1718. genic mice during aging. Mol Immunol 2002;38:74757.