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While GTs initiate extracellular GSH breakdown, the primary intracellular degradation pathway is now thought to be mediated by the cationic transport regulator homolog (ChaC)-like family of -glutamylcyclotransferases (GCT) ( ChaC-like family proteins are remarkably conserved, being found across all phyla from bacteria to humans, where they catalyze intracellular GSH degradation and yield 5-oxoproline and cysteinylglycine (Figure 2)

Delevoye et al

This low-grade systemic inflammation: Impairs insulin receptor signalling, directly worsening insulin resistance Damages ovarian granulosa cells, impairing egg development and ovarian function Disrupts gut barrier integrity, contributing to what some researchers call a "leaky gut" pattern associated with systemic inflammation Amplifies HPA axis dysregulation, raising cortisol and further disrupting sex hormone balance Chronic inflammation is both a consequence of PMOS and a driver that perpetuates it

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