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It is required for over 500 enzymatic reactions and plays key roles in the regulation of almost all major biological processes (Ansari and Raghava, 2010)
In the model proposed by Lee, homocysteine is shunted away from the methionine synthesis pathway and toward the GSH synthesis pathway, creating a relative deficiency of methyl donors in order to keep up with increased demand for the glutathione needed for POP conjugation ( Fig 3 )
When glutathione availability declines, GPX4 activity falters, permitting unchecked lipid peroxidation, cardiomyocyte loss, and progression toward heart failure (19)
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