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the Met + Pio group ( n = 75) received metformin plus pioglitazone (500 mg, 15 mg, respectively) and placebo (citric acid plus calcium carbonate), twice daily for 12 weeks

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Consistent with GSH regulating serine synthesis via post-translational mechanisms, the pharmacologic inhibition of GSH synthesis using buthionine sulfoximine increased liver serine without altering NRF2 or PHGDH expression (22)