Glutathione: Difference between revisions

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|overdose====Acute Overdose===
 
====Signs and Symptoms====
 
* Description
 
====Management====
 
* Description


===Chronic Overdose===


There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.


==Overview==
<!--Pharmacology-->
'''Glutathione''' ('''GSH''') is a [[tripeptide]]. It contains an unusual [[peptide]] linkage between the [[amino acid|amine group]] of [[cysteine]] and the [[carboxyl]] group of the [[glutamate]] [[side chain]].  Glutathione, an [[antioxidant]], protects cells from toxins such as [[free radical]]s.<ref>{{cite journal
| author = Strużńka L, Chalimoniuk M, Sulkowski G.
| year = 2005
| month = September
| title = The role of astroglia in Pb-exposed adult rat brain with respect to glutamate toxicity
| journal = Toxicology
| volume = 212
| issue = 2-3
| pages = 185-194
| id = PMID 15955607
| accessdate = 2006-05-05
}}
</ref>


[[Thiol]] groups are kept in a [[redox|reduced]] state at a concentration of approximately ~5 mM in [[animal]] [[cell (biology)|cell]]s. In effect, glutathione reduces any [[disulfide bond]]s formed within [[cytoplasm]]ic [[protein]]s to [[cysteine]]s by acting as an [[electron]] donor.  Glutathione is found almost exclusively in its reduced form, since the enzyme that reverts it from its oxidized form (GSSG), [[glutathione reductase]], is constitutively active and inducible upon [[oxidative stress]].  In fact, the ratio of reduced glutathione to oxidized glutathione within cells is often used scientifically as a measure of cellular toxicity.
<!--Drug box 2-->
|drugBox=<!--Mechanism of Action-->
|mechAction=*


==Biosynthesis==
<!--Structure-->
Glutathione is not an essential nutrient since it can be synthesized from the amino acids [[L-cysteine]], [[L-glutamate]] and [[glycine]].
|structure=*


It is synthesized in two [[adenosine triphosphate]]-dependent steps:
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
*First, gamma-glutamylcysteine is synthesized from L-glutamate and cysteine via the enzyme [[gamma-glutamylcysteine synthetase]] (a.k.a. glutamate cysteine ligase, GCL). This reaction is the rate-limiting step in glutathione synthesis.  
*Second, glycine is added to the C-terminal of gamma-glutamylcysteine via the enzyme [[glutathione synthetase]].


Glutamate cysteine ligase (GCL) is a heterodimeric enzyme composed of a catalytic (GCLC) and modulatory (GCLM) subunit.  GCLC constitutes all the enzymatic activity, whereas GCLM increases the catalytic efficiency of GCLC. Mice lacking GCLC (i.e., all de novo GSH synthesis) die before birth.<ref>{{Citation | last = Dalton | first = TP | last2 = et al. | year = 2000 | journal = Biochem Biophys Res Commun. | volume = 279 | issue = 2 | pages = 324}}</ref> Mice lacking GCLM demonstrate no outward phenotype, but exhibit marked decrease in GSH and increased sensitivity to toxic insults.<ref>Yang Y, et al. (2002) J Biol Chem. 277(51):4944.</ref> <ref>Giordano G, et al. (2007) Toxicol Appl Pharmacol. 219(2-3):181.</ref> <ref>McConnachie LA, et al. (2007) Tox Sci Epub 21 June.</ref>
<!--Pharmacodynamics-->
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.


While all cells in the human body are capable of synthesizing glutathione, liver glutathione synthesis has been shown to be essential.  Following birth, mice with genetically-induced loss of GCLC (i.e., GSH synthesis) only in the liver die within 1 month of birth.<ref>Chen Y, et al. (2007) Hepatology 45:1118.</ref>  
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.


The biosynthesis pathway for glutathione is found in some bacteria, like [[cyanobacteria]] and [[proteobacteria]], but is missing in many other bacteria. Most eukaryotes synthesize glutathione, including humans, but some do not, such as ''Leguminosae'', ''[[Entamoeba]]'', and ''[[Giardia]]''. The only archaea that make glutathione are [[halobacteria]].<ref>{{cite journal | author=| title=Lateral gene transfer and parallel evolution in the history of glutathione biosynthesis genes| journal=Genome biology| year=2002| volume=3| url=http://genomebiology.com/2002/3/5/RESEARCH/0025}}</ref><ref>{{cite book | title=Significance of glutathione in plant adaptation to the environment| url=http://books.google.com/books?hl=sv&lr=&id=aX2eJf1i67IC&oi=fnd&pg=PA13&ots=8feo-QOEPa&sig=XAMjZ0Wan17vmoUKg_FFNRl8g0I#PPP1,M1| author=Grill D, Tausz T, De Kok LJ| date=2001| publisher=Springer| isbn=1402001789}}</ref>
<!--Nonclinical Toxicology-->
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.


==Function==
<!--Clinical Studies-->
Glutathione exists in reduced (GSH) and oxidized (GSSG) states.  In the reduced state, the thiol group of cysteine is able to donate a [[reducing equivalent]] (H<sup>+</sup>+ e<sup>-</sup>) to other unstable molecules, such as reactive oxygen species.  In donating an electron, glutathione itself becomes reactive, but readily reacts with another reactive glutathione to form glutathione disulfide (GSSG).  Such a reaction is possible due to the relatively high concentration of gluathione in cells (up to 5 mM in the liver).  GSH can be regenerated from GSSG by the enzyme glutathione reductase.
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.


In healthy cells and tissue, more than 90% of the total glutathione pool is in the reduced form (GSH) and less than 10% exists in the disulfide form (GSSG). An increased GSSG-to-GSH ratio is considered indicative of oxidative stress.
<!--How Supplied-->
|howSupplied=*
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.


GSH is known as a [[Substrate (biochemistry)|substrate]] in both [[Conjugated system|conjugation]] reactions and [[Redox|reduction]] reactions, catalyzed by [[glutathione S-transferase]] enzymes in [[cytosol]], [[microsome]]s, and [[mitochondria]].  However, it is also capable of participating in non-enzymatic conjugation with some chemicals, as in the case of n-acetyl-''p''-benzoquinone imine ([[NAPQI]]), the reactive [[cytochrome P450 oxidase|cytochrome P450]]-reactive [[metabolite]] formed by [[paracetamol]] (or [[acetaminophen]] as it is known in the US), that becomes toxic when GSH is depleted by an overdose of acetaminophen.  
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


Glutathione in this capacity binds to NAPQI as a [[suicide inhibitor]] and in the process detoxifies it, taking the place of cellular protein thiol groups, which would otherwise be covalently modified; when all GSH has been spent, NAPQI begins to react with the cellular [[protein]]s, killing the cells in the process. The preferred treatment for an overdose of this painkiller is the administration (usually in atomized form) of [[acetylcysteine|N-acetyl-L-cysteine]], which is processed by cells to L-cysteine and used in the de novo synthesis of GSH.
<!--Brand Names-->
|brandNames=* ®<ref>{{Cite web | title =  | url = }}</ref>


Glutathione (GSH) participates in [[leukotriene]] synthesis and is a [[cofactor (biochemistry)|cofactor]] for the [[enzyme]] [[glutathione peroxidase]]. It is also important as a [[hydrophilic]] molecule that is added to [[lipophilic]] toxins and waste in the liver during [[biotransformation]] before they can become part of the [[bile]]. Glutathione is also needed for the detoxification of [[methylglyoxal]], a toxin produced as a by-product of metabolism.  
<!--Look-Alike Drug Names-->
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>


This detoxification reaction is carried out by the [[glyoxalase system]]. Glyoxalase I [http://us.expasy.org/enzyme/4.4.1.5 (EC 4.4.1.5)] catalyzes the conversion of methylglyoxal and reduced glutathione to S-D-Lactoyl-glutathione. Glyoxalase II [http://us.expasy.org/enzyme/3.1.2.6 (EC 3.1.2.6)] catalyzes the hydrolysis of S-D-Lactoyl-glutathione to glutathione and D-lactate.
<!--Drug Shortage Status-->
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== Supplementation ==
Supplementing has been difficult, as research suggests that glutathione taken orally is not well absorbed across the GI tract. In a study of acute oral administration of a very large dose (3 grams) of oral glutathione, ''Witschi and coworkers'' found that "it is not possible to increase circulating glutathione to a clinically beneficial extent by the oral administration of a single dose of 3 g of glutathione."<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=1362956&query_hl=1&itool=pubmed_docsum Witschi A, et. al. The systemic availability of oral glutathione. Eur J Clin Pharmacol. 1992;43(6):667-9]</ref>, <ref>[http://www.aegis.com/aidsline/1993/may/M9350657.html AIDS Line Update]</ref>.
However, tissue and serum glutathione concentrations can be raised by increased intake of the precursor [[cysteine]].  Glutathione precursors rich in cysteine include [[Acetylcysteine]] (NAC),<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?dispmax=50&db=pubmed&pmfilter_EDatLimit=added%20to%20PubMed%20in%20the%20last%200%20i&cmd_current=Limits&orig_db=PubMed&cmd=Search&term=Acetylcysteine+glutathione%20&doptcmdl=DocSum Acetylcysteine and glutathione, PubMed]</ref> [[undenatured]] [[whey protein]] <ref>[http://www.nutritionadvisor.com/glutathione.html Glutathione information for Physicians]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11168457&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Micke et al. Oral supplementation with whey proteins increases plasma glutathione levels of HIV-infected patients. Eur J Clin Invest. 2001 Feb;31(2):171-8.]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16014759&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Moreno et al. Features of whey protein concentrate supplementation in children with rapidly progressive HIV infection. J Trop Pediatr. 2006 Feb;52(1):34-8. Epub 2005 Jul 13.]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15463873&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Lands et al. Improved glutathione status in young adult patients with cystic fibrosis supplemented with whey protein. J Cyst Fibros. 2003 Dec;2(4):195-8.]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11990003&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Micke et al. Effects of long-term supplementation with whey proteins on plasma glutathione levels of HIV-infected patients. Eur J Nutr. 2002 Feb;41(1):12-8.]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8365048&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Bounous et al. Whey proteins as a food supplement in HIV-seropositive individuals. Clin Invest Med. 1993 Jun;16(3):204-9.]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1782728&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Bounous et al. The biological activity of undenatured dietary whey proteins: role of glutathione. Clin Invest Med. 1991 Aug;14(4):296-309]</ref>, <ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Bounous%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus Bounous et al. Multiple references on glutathione enhancement with bioactive whey protein in multiple disease states]</ref>and [[acetylcysteine|N-acetyl-cysteine]] <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8299004&dopt=Citation Biochemical manipulation of intracellular glutathione levels influences cytotoxicity to isolated human lymphocytes by sulfur mustard.]</ref> have been shown to increase glutathione content within the cell. [[N-acetylcysteine]] is a generically available supplement which has been demonstrated to increase intracellular reduced and total glutathione by 92% and 58% respectively. <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&list_uids=8207209&dopt=citation Use of N-acetyl cysteine to increase intracellular glutathione during the induction of antitumor responses by IL-2]</ref> 
All of the published clinical studies using bioactive whey proteins mentioned in the references above used a form of a bioactive whey protein and bonded [[cystine]] dietary supplement derived from [[lactose]]-free [[Organic product|organic]] milk (whey protein) called Immunocal. This whey protein is clinically proven to increase glutathione levels within the [[lymphocytes]] of the immune system by 35.5% while increasing peak power and muscular performance by 13%. <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10517767&query_hl=6&itool=pubmed_DocSum L.C. Lands, V.L. Grey, and A.A. Smountas. Effect of supplementation with cysteine donor on muscular performance. J Appl Ph. 1999 Oct,87(4):138-5.]</ref>


==Pathology==
Excess glutamate at [[synapse]]s, which may be released in conditions such as [[traumatic brain injury]], can prevent the uptake of [[cysteine]], a necessary building block of glutathione.  Without the protection from oxidative injury afforded by glutathione, cells may be damaged or killed.<ref>
{{cite journal
| author = Pereira C.F, de Oliveira C.R.
| year = 2000
| month = July
| title = Oxidative glutamate toxicity involves mitochondrial dysfunction and perturbation of intracellular Ca2+ homeostasis
| journal = Neuroscience Research
| volume = 37
| issue = 3
| pages = 227-236
| doi = doi:10.1016/S0168-0102(00)00124-3
| accessdate = 2006-05-05
}}</ref>


==See also==
<!--Label Display Image-->
*[[Glutathione synthetase deficiency]]


== References ==
{{reflist|2}}


== Related research ==
*The antioxidant glutathione peroxidase family and spermatozoa: A complex story. PMID 16427183
*[http://www.fda.gov/ohrms/dockets/ac/00/slides/3652s1_05/ The Role of Glutathione in Cell Defense.]
* Glutathione metabolism and its implications for health. PMID 14988435
* The changing faces of glutathione, a cellular protagonist. PMID 14555227
*[[Ophthalmic acid]]


{{Antidotes}}
{{Enzyme cofactors}}


[[Category:Thiols]]
[[Category:Peptides]]


[[cs:Glutathion]]
<!--Category-->
[[de:Glutathion]]
[[es:Glutation]]
[[fr:Glutathion]]
[[he:גלוטטיון]]
[[it:Glutatione]]
[[ja:グルタチオン]]
[[no:Glutathion]]
[[pl:Glutation]]
[[pt:Glutationa]]
[[ru:Глутатион]]
[[th:กลูตาไธโอน]]
[[zh:麩氨基硫]]


{{jb1}}
[[Category:Drug]]
{{WH}}
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Revision as of 14:38, 23 January 2015

Glutathione
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

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Black Box Warning

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See full prescribing information for complete Boxed Warning.
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  • Content

Overview

Glutathione is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
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Condition2
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Condition3
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Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Glutathione in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Glutathione in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Glutathione in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Glutathione in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Glutathione in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
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Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Glutathione in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Glutathione in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Glutathione in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Glutathione during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Glutathione with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Glutathione with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Glutathione with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Glutathione with respect to specific gender populations.

Race

There is no FDA guidance on the use of Glutathione with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Glutathione in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Glutathione in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Glutathione in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Glutathione in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Glutathione in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Glutathione in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Glutathione in the drug label.

Pharmacology

There is limited information regarding Glutathione Pharmacology in the drug label.

Mechanism of Action

Structure

File:Glutathione01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Glutathione in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Glutathione in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Glutathione in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Glutathione in the drug label.

How Supplied

Storage

There is limited information regarding Glutathione Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Patient Counseling Information of Glutathione in the drug label.

Precautions with Alcohol

  • Alcohol-Glutathione interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)

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