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Enhanced expression of GSH metabolism enzymes including glutathione peroxidases, gamma-glutamyl cysteinyl synthetase (gamma-GCS), glutathione S-transferases (GST), and ABC-family membrane transport proteins including the multidrug resistance-associated protein (MRP) were all documented to play prominent roles in cellular resistance to oxidative stress

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In the reported cases, the clinical presentation consisted of recurrent episodes of Reye-like encephalopathy, hypoketotic hypoglycemia, and/or cardiomyopathy

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