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To replenish intracellular GSH, cells synthesize GSH in a two-step metabolic pathway centred on the rate-limiting enzyme glutamate cysteine ligase (GCL), which is composed of a catalytic (GCLC) and a regulatory or modifier (GCLM) subunit, and the GSH synthetase (GS) 22

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In a clinical trial of seven patients with acute-on-chronic liver failure, three fully recovered, one survived and later underwent OLT, and three died within 2.512 months post-transplantation (Wang et al., 2014)