GO:0006750 glutathione biosynthetic process: Antioxidant Defense Pathway, Genes, Functions and Research Methods
Research-grade guide for scientists and biopharma professionals
Key Takeaways
• GO:0006750 (glutathione biosynthetic process) describes the two-step enzymatic pathway that builds the tripeptide glutathione (gamma-glutamylcysteinylglycine), the most abundant non-protein thiol antioxidant in mammalian cells.
• The pathway is classically catalyzed by glutamate-cysteine ligase (GCL/GCLC-GCLM) and glutathione synthetase (GSS), using cysteine, glutamate, and glycine as substrates.
• Glutathione exists in reduced (GSH) and oxidized (GSSG) forms, and the GSH/GSSG ratio is a key cellular redox indicator.
• Glutathione is compartmentalized across cytosol, mitochondria, nucleus, and endoplasmic reticulum, with distinct biosynthetic and transport requirements.
• Defective or dysregulated glutathione biosynthesis is linked to oxidative stress-related pathologies including lens cataract, cisplatin nephrotoxicity, and inflammatory coagulopathy.
• CRISPR knockout, point-mutation, knock-in, and overexpression models enable causal dissection of GCLC, GCLM, GSS, and related genes in glutathione biology.
Description
Glutathione is a ubiquitous tripeptide that serves as a coenzyme and as a major antioxidant protecting sulfhydryl groups in enzymes and other proteins. The Gene Ontology term GO:0006750, glutathione biosynthetic process, captures the chemical reactions and pathways that result in glutathione formation, also known as glutathione synthesis, biosynthesis, or anabolism. Because glutathione is central to redox homeostasis, xenobiotic detoxification, and cellular signaling, understanding its biosynthetic route is fundamental to cell biology and medicine. The pathway has been studied for decades, with early biochemical work establishing the enzymatic steps and the role of glutathione in sulfhydryl protection. More recent research has refined the subcellular distribution of glutathione and its membrane transport, revealing that biosynthesis and compartmentalization are tightly coordinated. Glutathione also serves as a substrate for conjugation reactions, and export pumps for glutathione S-conjugates highlight its role in detoxification and drug disposition. In the lens, redox regulation by glutathione is critical for maintaining transparency, and perturbed glutathione status is associated with cataract formation. In sepsis, glutathione S-transferase omega 1 can promote macrophage inflammation-associated coagulopathy by S-glutathionylating ANXA5, illustrating how glutathione-dependent chemistry influences inflammation and coagulation. In cancer therapy, cisplatin-induced renal injury is modulated by glutathione metabolism, underscoring the clinical relevance of this pathway. Finally, cysteinyl-containing immunoresolvents are linked to biosynthetic metabolomes that intersect with glutathione-related pathways, expanding the biological scope of this term. For researchers, GO:0006750 provides a precise framework to annotate genes, interpret omics data, and design experiments that test causal roles of glutathione biosynthetic enzymes in health and disease.
glutathione biosynthetic process At A Glance
| GO ID | GO:0006750 |
|---|---|
| GO term | glutathione biosynthetic process |
| Ontology | biological_process |
| Synonym | glutathione anabolism; glutathione biosynthesis; glutathione formation; glutathione synthesis |
| Major function | Formation of the tripeptide glutathione (glutamylcysteinylglycine), a coenzyme and antioxidant protecting protein sulfhydryl groups |
| Key substrates | Glutamate, cysteine, and glycine |
| Key enzymes | Glutamate-cysteine ligase (GCL/GCLC-GCLM) and glutathione synthetase (GSS) |
| Subcellular context | Cytosol, mitochondria, nucleus, and endoplasmic reticulum, with distinct transport and distribution |
| Related processes | Glutathione conjugation and export of glutathione S-conjugates |
What Is GO:0006750?
GO:0006750 glutathione biosynthetic process is defined as the chemical reactions and pathways resulting in the formation of glutathione, the tripeptide glutamylcysteinylglycine, which acts as a coenzyme for some enzymes and as an antioxidant in the protection of sulfhydryl groups in enzymes and other proteins. In practice, this term covers the enzymatic assembly of glutathione from its constituent amino acids, including the canonical two-step pathway and any alternative or organism-specific routes that produce glutathione. The term is a biological_process in the Gene Ontology and is synonymous with glutathione anabolism, glutathione biosynthesis, glutathione formation, and glutathione synthesis.
Why Is glutathione biosynthetic process Important in Cell Biology?
Glutathione biosynthetic process is essential because glutathione is the principal non-protein thiol antioxidant in cells, maintaining redox balance and protecting enzymes and other proteins from oxidative damage. Its biosynthesis supports coenzyme functions, detoxification of xenobiotics via conjugation, and regulation of cellular responses to stress. Dysregulation of glutathione synthesis is implicated in diverse pathologies, including lens cataract, cisplatin nephrotoxicity, and inflammation-associated coagulopathy, making this pathway a high-value target for mechanistic and translational research.
• Maintains cellular redox homeostasis by supplying reduced glutathione (GSH) to counter oxidative stress.
• Protects sulfhydryl groups in enzymes and other proteins, preserving their function.
• Supports coenzyme roles for certain enzymes, linking glutathione to diverse metabolic reactions.
• Enables detoxification through glutathione S-conjugation and export of conjugates.
• Is critical for lens transparency, with redox regulation by glutathione preventing cataract.
• Modulates cisplatin-induced renal injury, a major dose-limiting toxicity in cancer therapy.
• Contributes to inflammation-associated coagulopathy via S-glutathionylation of ANXA5 in sepsis.
• Intersects with immunoresolvent biosynthetic metabolomes containing cysteinyl residues.
• Provides a biochemical basis for subcellular glutathione distribution and membrane transport.
• Offers a tractable pathway for CRISPR-based causal gene studies in oxidative stress biology.
What Happens During glutathione biosynthetic process?
Substrate availability and cysteine supply
In simple terms: The cell must first gather the three building blocks of glutathione, with cysteine being the limiting one.
Glutathione biosynthesis requires glutamate, cysteine, and glycine as substrates. Cysteine availability is often rate-limiting, and its supply influences the overall flux through the pathway. The biosynthetic metabolomes of cysteinyl-containing immunoresolvents further highlight the importance of cysteine pools in related pathways. In cells, cysteine can be obtained from extracellular uptake or from methionine via the transsulfuration pathway, and these sources feed into glutathione production.
First step: gamma-glutamylcysteine formation by glutamate-cysteine ligase
In simple terms: The first enzyme glues glutamate and cysteine together to form a dipeptide intermediate.
The first and rate-limiting step of glutathione biosynthesis is catalyzed by glutamate-cysteine ligase (GCL), also known as gamma-glutamylcysteine synthetase, which forms gamma-glutamylcysteine from glutamate and cysteine. GCL is a heterodimer composed of a catalytic subunit (GCLC) and a modifier subunit (GCLM), and its activity is regulated by feedback inhibition by glutathione and by the availability of cysteine. This step consumes ATP and is considered the committed step of the pathway.
Second step: glutathione synthetase adds glycine
In simple terms: The second enzyme adds glycine to the dipeptide to complete the glutathione molecule.
Glutathione synthetase (GSS) catalyzes the second step, adding glycine to gamma-glutamylcysteine to form the tripeptide glutathione (gamma-glutamylcysteinylglycine). This step also requires ATP and is essential for the final product. Deficiencies or inhibition of GSS lead to accumulation of gamma-glutamylcysteine and reduced glutathione levels, underscoring its role in the pathway.
Subcellular distribution and compartmentalization
In simple terms: Glutathione is made and stored in different parts of the cell, and it must be moved around as needed.
Glutathione is distributed across subcellular compartments including the cytosol, mitochondria, nucleus, and endoplasmic reticulum, and its biosynthesis and transport are compartment-specific. Mitochondrial glutathione is particularly important for protecting against oxidative stress generated by respiration. Membrane transport systems move glutathione and its precursors between compartments and across the plasma membrane, influencing overall cellular glutathione status. Export pumps for glutathione S-conjugates further illustrate the dynamic movement of glutathione-related species.
Redox cycling and GSH/GSSG balance
In simple terms: Glutathione can switch between a reduced and an oxidized form, and the balance between them tells the cell about its oxidative state.
Glutathione exists predominantly as reduced glutathione (GSH), which can be oxidized to glutathione disulfide (GSSG) during antioxidant reactions. The GSH/GSSG ratio is a widely used indicator of cellular redox status, and its maintenance depends on biosynthesis as well as recycling by glutathione reductase. In the lens, redox regulation by glutathione is critical for maintaining transparency, and an altered GSH/GSSG balance is associated with cataract. Similar redox-sensitive mechanisms operate in other tissues, linking glutathione biosynthesis to protection against oxidative damage.
Key Genes Involved in GO:0006750 glutathione biosynthetic process
The following genes and proteins are central to glutathione biosynthetic process and related glutathione biology, as supported by the cited literature.
| Gene | Major Role | Research Relevance |
|---|---|---|
| GCLC | Catalytic subunit of glutamate-cysteine ligase, catalyzing the first and rate-limiting step of glutathione biosynthesis | Target for knockout and point-mutation studies of pathway flux and oxidative stress sensitivity |
| GCLM | Modifier subunit of glutamate-cysteine ligase, regulating enzyme activity and stability | Knockout and overexpression models to test modulation of glutathione synthesis capacity |
| GSS | Glutathione synthetase, catalyzing the second step that adds glycine to gamma-glutamylcysteine | Loss-of-function models to study glutathione depletion and gamma-glutamylcysteine accumulation |
| GSTO1 | Glutathione S-transferase omega 1, involved in S-glutathionylation of target proteins such as ANXA5 | Knockout and point-mutation models to dissect inflammation-associated coagulopathy in sepsis |
| ANXA5 | Target of S-glutathionylation by GSTO1, affecting its ubiquitination and function | Knock-in and point-mutation models to map glutathionylation sites and downstream effects |
| GGT | Gamma-glutamyl transpeptidase, involved in glutathione breakdown and recycling | Models to study glutathione turnover and subcellular distribution |
| SLC7A11 | Cystine/glutamate antiporter supplying cysteine for glutathione synthesis | Knockout and overexpression models to test cysteine availability as a rate-limiting factor |
| SLC3A2 | Partner subunit of cystine/glutamate antiporter, supporting cysteine uptake | Models to study transporter-dependent glutathione biosynthesis |
| G6PD | Generates NADPH for glutathione recycling and redox homeostasis | Knockout models to test NADPH-dependent redox balance |
| GSR | Glutathione reductase, recycles GSSG to GSH | Models to study GSH/GSSG balance and oxidative stress |
| GPX | Glutathione peroxidase, uses GSH to reduce peroxides | Models to test antioxidant defense and lipid peroxidation |
| Nrf2 (NFE2L2) | Transcription factor regulating antioxidant response genes including glutathione pathway enzymes | Knockout and overexpression models to study transcriptional control of glutathione synthesis |
| MRP/ABCC | Export pumps for glutathione S-conjugates | Models to study detoxification and drug resistance |
| CBS | Transsulfuration enzyme contributing cysteine for glutathione synthesis | Models to test cysteine supply pathways |
| MTHFR | One-carbon metabolism enzyme influencing cysteine and glutathione precursor pools | Models to study metabolic control of glutathione biosynthesis |
| GCLM/GCLC regulatory kinases | Signaling components that modulate GCL activity and glutathione synthesis | Models to dissect post-translational regulation |
| GSTO1-ANXA5 axis | Glutathionylation-dependent regulation of inflammation and coagulation | Models to study sepsis-associated coagulopathy |
How Is glutathione biosynthetic process Regulated?
Glutathione biosynthetic process is regulated at multiple levels. The first step catalyzed by glutamate-cysteine ligase is rate-limiting and subject to feedback inhibition by glutathione, ensuring that the pathway slows when product levels are sufficient. Cysteine availability is a key determinant of flux, and transporters such as the cystine/glutamate antiporter influence substrate supply. Transcriptional regulation via antioxidant response elements, including Nrf2-mediated control, adjusts expression of glutathione pathway enzymes in response to oxidative stress. Subcellular compartmentalization and membrane transport further modulate glutathione distribution and availability. In pathological contexts, such as sepsis, glutathione-dependent S-glutathionylation of ANXA5 by GSTO1 can regulate protein function and downstream coagulation. These layers of regulation allow cells to match glutathione production to redox demand and metabolic state.
glutathione biosynthetic process and Human Disease
| Gene | Disease / Biology | Potential Experimental Model |
|---|---|---|
| GCLC | Oxidative stress sensitivity and cisplatin nephrotoxicity | Knockout and point-mutation cell models to test glutathione depletion |
| GSS | Glutathione synthetase deficiency and redox imbalance | Loss-of-function knockout models to study gamma-glutamylcysteine accumulation |
| GSTO1 | Sepsis-associated inflammation and coagulopathy | Knockout and point-mutation models to dissect ANXA5 glutathionylation |
| ANXA5 | Inflammation-associated coagulopathy | Knock-in of glutathionylation-site mutations to test ubiquitination |
| GSR | Redox imbalance and cataract | Overexpression and knockout models to study GSH/GSSG balance |
Glutathione biosynthesis and cancer therapy toxicity
Cisplatin is a widely used chemotherapeutic agent, but its clinical use is limited by nephrotoxicity. Glutathione metabolism modulates cisplatin-induced renal injury, and alterations in glutathione biosynthesis can influence susceptibility to kidney damage. Because glutathione detoxifies reactive species and conjugates drugs, the pathway is directly relevant to chemotherapy toxicity and resistance. Experimental models that manipulate GCLC, GCLM, or GSS can help define causal roles in cisplatin nephrotoxicity.
Redox regulation in the lens and cataract
The lens relies on glutathione for redox regulation and protection against oxidative damage, and impaired glutathione status is associated with cataract formation. Glutathione biosynthesis supports the high GSH levels needed to maintain lens transparency. Studying this pathway in lens models can reveal how redox imbalance contributes to protein aggregation and opacification. The GSH/GSSG ratio is a key readout in such studies.
Inflammation-associated coagulopathy in sepsis
In sepsis, glutathione S-transferase omega 1 promotes macrophage inflammation-associated coagulopathy by S-glutathionylating ANXA5, enhancing its ubiquitination. This illustrates how glutathione-dependent post-translational modification can drive disease pathology. Targeting GSTO1 or the glutathionylation site on ANXA5 may offer experimental strategies to dissect this mechanism. The findings connect glutathione chemistry to coagulation and inflammation.
Subcellular glutathione distribution and transport in disease
Glutathione is distributed across subcellular compartments, and membrane transport systems regulate its availability. Export pumps for glutathione S-conjugates contribute to detoxification and drug disposition, with implications for disease and therapy. Disruption of glutathione transport or compartmentalization can impair antioxidant defense and contribute to pathology. Research models that track glutathione distribution can clarify these mechanisms.
From glutathione biosynthetic process-Related Genes to Experimental Models
| Research Question | Suitable Model |
|---|---|
| Does loss of GCLC reduce glutathione biosynthesis and increase oxidative stress? | GCLC knockout cell model |
| Does a point mutation in GSS alter enzyme activity and glutathione levels? | GSS point-mutation knock-in cell model |
| Does S-glutathionylation of ANXA5 require GSTO1? | GSTO1 knockout and ANXA5 knock-in models |
| Does overexpression of GCLM enhance glutathione synthesis capacity? | GCLM overexpression cell model |
| How does cysteine availability limit glutathione biosynthesis? | SLC7A11 knockout or overexpression models |
| Does Nrf2 regulate glutathione pathway genes? | Nrf2 knockout and overexpression models |
How to Study the glutathione biosynthetic process Process
| Method | What It Measures | Typical Application |
|---|---|---|
| Glutathione recycling assay | Total glutathione and GSH/GSSG ratio | Validating knockout or overexpression effects on glutathione levels |
| RNA-seq | Expression of glutathione pathway genes | Profiling transcriptional responses to oxidative stress |
| Proteomics | Protein abundance and S-glutathionylation | Identifying glutathionylated targets and modifications |
| Subcellular fractionation | Compartment-specific glutathione distribution | Studying mitochondrial and nuclear glutathione pools |
| Fluorescent imaging | Live-cell glutathione dynamics | Visualizing redox changes in real time |
| CRISPR knockout | Loss-of-function phenotypes | Testing causal roles of GCLC, GCLM, GSS |
| CRISPR knock-in | Precise mutation or tag introduction | Mapping glutathionylation sites in ANXA5 |
| Metabolomics | Cysteinyl-containing metabolites and biosynthetic intermediates | Profiling immunoresolvent and glutathione-related metabolomes |
Biochemical assays for glutathione levels
Total glutathione and GSH/GSSG ratios can be measured using enzymatic recycling assays, HPLC, or mass spectrometry-based methods. These assays quantify the product of glutathione biosynthetic process and are essential for validating genetic models. In lens research, such measurements link glutathione status to transparency and oxidative damage.
Transcriptomics and proteomics of glutathione pathway genes
RNA-seq can profile expression of GCLC, GCLM, GSS, and related genes under oxidative stress or genetic perturbation. Proteomics can assess protein abundance and post-translational modifications such as S-glutathionylation. These approaches help identify regulatory nodes and downstream effects of altered glutathione biosynthesis.
Subcellular fractionation and imaging
Subcellular fractionation followed by glutathione quantification reveals compartment-specific distribution. Fluorescent probes and imaging can visualize glutathione dynamics in live cells. These methods are useful for studying mitochondrial and nuclear glutathione pools.
Genetic perturbation with CRISPR
CRISPR knockout, point mutation, knock-in, and overexpression models enable causal testing of glutathione pathway genes. Such models can be combined with biochemical and omics readouts to define gene function. They are particularly valuable for dissecting rate-limiting steps and regulatory mechanisms.
How CRISPR Can Be Used to Study GO:0006750 glutathione biosynthetic process
Knockout
CRISPR knockout of GCLC, GCLM, or GSS can abolish or reduce glutathione biosynthesis, enabling studies of oxidative stress sensitivity and compensatory pathways. Knockout models are useful for validating rate-limiting steps and for testing synthetic lethality with oxidative insults. They also help define the contribution of glutathione to drug detoxification.
Point Mutation
Point mutations in catalytic residues of GCLC or GSS can dissect enzyme mechanism and regulation without fully eliminating protein expression. Such models are valuable for separating catalytic activity from scaffolding or regulatory functions. They can also be used to test feedback inhibition and substrate binding.
Knock-in
Knock-in of tags or disease-relevant mutations allows tracking of glutathione pathway proteins and their modifications. For example, knock-in of glutathionylation-site mutations in ANXA5 can test the importance of S-glutathionylation for ubiquitination. Knock-in models also support precise reporter systems for pathway activity.
Overexpression
Overexpression of GCLM or GCLC can increase glutathione synthesis capacity and protect against oxidative stress. Overexpression models are useful for testing sufficiency of pathway components in redox protection. They can also reveal feedback and toxicity thresholds associated with excess glutathione.
How EDITGENE Supports glutathione biosynthetic process Research
Researchers studying glutathione biosynthetic process-related genes often need to determine whether a candidate gene is causally involved in glutathione production, redox regulation, or disease phenotypes. EDITGENE provides CRISPR-based cell model services that enable precise genetic perturbations to answer these questions.
Contact EDITGENE today to design your custom CRISPR model for glutathione biosynthetic process research.
Related Products
| Product name | Cat.No. | Species | Gene ID | |
|---|---|---|---|---|
| GCLM Knockout HEK293 Cell Line | EDJ-KQ1587 | Human | 2730 | Details Get a Quote |
| SLC1A2 Knockout HEK293 Cell Line | EDJ-KQ2658 | Human | 6506 | Details Get a Quote |
| GSS Knockout HEK293 Cell Line | EDJ-KQ2781 | Human | 2937 | Details Get a Quote |
| GGT5 Knockout HEK293 Cell Line | EDJ-KQ3265 | Human | 2687 | Details Get a Quote |
| HAGH Knockout HEK293 Cell Line | EDJ-KQ3338 | Human | 3029 | Details Get a Quote |
| GCLC Knockout HEK293 Cell Line | EDJ-KQ3948 | Human | 2729 | Details Get a Quote |
| GGT7 Knockout HEK293 Cell Line | EDJ-KQ4705 | Human | 2686 | Details Get a Quote |
| GGT1 Knockout HEK293 Cell Line | EDJ-KQ4706 | Human | 2678 | Details Get a Quote |
| MGST2 Knockout HEK293 Cell Line | EDJ-KQ5210 | Human | 4258 | Details Get a Quote |
| SLC1A1 Knockout HEK293 Cell Line | EDJ-KQ5760 | Human | 6505 | Details Get a Quote |
| HAGH Knockout A-549 Cell Line | EDJ-KQ24980 | Human | 3029 | Details Get a Quote |
| HAGH Knockout HeLa Cell Line | EDJ-KQ24981 | Human | 3029 | Details Get a Quote |
| GGT1 Knockout HCT 116 Cell Line | EDJ-KQ26184 | Human | 2678 | Details Get a Quote |
| MGST2 Knockout A-549 Cell Line | EDJ-KQ28214 | Human | 4258 | Details Get a Quote |
| MGST2 Knockout HCT 116 Cell Line | EDJ-KQ28215 | Human | 4258 | Details Get a Quote |
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Frequently Asked Questions About glutathione biosynthetic process
What is glutathione biosynthetic process?
Glutathione biosynthetic process (GO:0006750) is the set of chemical reactions and pathways that produce glutathione, the tripeptide glutamylcysteinylglycine, which acts as a coenzyme and antioxidant protecting protein sulfhydryl groups.
What genes are involved in glutathione biosynthetic process?
Key genes include GCLC and GCLM, which form glutamate-cysteine ligase, and GSS, which encodes glutathione synthetase. Other genes such as SLC7A11 and GSR support substrate supply and redox recycling.
What enzymes catalyze glutathione biosynthesis?
Glutamate-cysteine ligase (GCL) catalyzes the first and rate-limiting step, and glutathione synthetase (GSS) catalyzes the second step.
Where does glutathione biosynthesis occur in the cell?
Glutathione is distributed across the cytosol, mitochondria, nucleus, and endoplasmic reticulum, with compartment-specific biosynthesis and transport.
Why is glutathione important for cells?
Glutathione protects sulfhydryl groups in enzymes and other proteins, serves as a coenzyme, and acts as a major antioxidant.
How is glutathione biosynthesis regulated?
It is regulated by feedback inhibition by glutathione, cysteine availability, transcriptional control via Nrf2, and subcellular transport.
What diseases are linked to glutathione biosynthesis?
Dysregulation is linked to cisplatin nephrotoxicity, lens cataract, and sepsis-associated coagulopathy, among other oxidative stress-related conditions.
How can I study glutathione biosynthetic process with CRISPR?
CRISPR knockout, point mutation, knock-in, and overexpression models can be used to test causal roles of GCLC, GCLM, GSS, and related genes.
What methods measure glutathione levels?
Enzymatic recycling assays, HPLC, mass spectrometry, and fluorescent probes can quantify glutathione and GSH/GSSG ratios.
What is the GSH/GSSG ratio?
It is the ratio of reduced glutathione to glutathione disulfide and is a key indicator of cellular redox status.
Conclusion
GO:0006750 glutathione biosynthetic process defines the enzymatic route that produces glutathione, a tripeptide essential for redox homeostasis, coenzyme function, and protection of protein sulfhydryl groups. The pathway is governed by GCLC, GCLM, and GSS, with regulation by substrate availability, feedback inhibition, and transcriptional programs. Its dysfunction is implicated in cancer therapy toxicity, lens cataract, and inflammatory coagulopathy, making it a compelling target for mechanistic and translational studies. CRISPR-based cell models provide powerful tools to dissect causal roles of glutathione pathway genes and to identify new therapeutic opportunities.
References
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- 2. Zhang J et al.. 2021. Cisplatin chemotherapy and renal function.. Adv Cancer Res 152:305-327 PMID: 34353441
- 3. Oestreicher J et al.. 2019. Glutathione: subcellular distribution and membrane transport (1).. Biochem Cell Biol 97(3):270-289 PMID: 30427707
- 4. Keppler D. 1999. Export pumps for glutathione S-conjugates.. Free Radic Biol Med 27(9-10):985-91 PMID: 10569630
- 5. Lou MF. 2003. Redox regulation in the lens.. Prog Retin Eye Res 22(5):657-82 PMID: 12892645
- 6. Peng J et al.. 2026. Glutathione S-Transferase Omega 1 Promotes Macrophage Inflammation-Associated Coagulopathy in Sepsis by S-Glutathionylating ANXA5 to Enhance Its Ubiquitination.. FASEB J 40(17):e72243 PMID: 42663978
- 7. Benöhr HC et al.. 1975. [Glutathione (author's transl)].. Klin Wochenschr 53(17):789-802 PMID: 543
- 8. Jouvene CC et al.. 2019. Biosynthetic metabolomes of cysteinyl-containing immunoresolvents.. FASEB J 33(12):13794-13807 PMID: 31589826