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Nevertheless, the insulin resistance and abdominal adiposity seems to be essential in the pathophysiological process, and for this reason, based on the information available, we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome due to its implications in the metabolism of carbohydrates and lipids

Tumor necrosis factor increases hepatocellular glutathione by transcriptional regulation of the heavy subunit chain of -glutamylcysteine synthetase

The manipulation included disrupting the precursor degradation pathways ( tnaA and sdaA ), eliminating l-glutathione degradation ( ggt and pepT ), and manipulating the intracellular ATP level (disruption of glgB )

This step establishes clarity and sets realistic expectations before medication begins

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