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Patients with glutathione synthetase deficiency should avoid drugs known to precipitate hemolytic crises in patients with glucose-6-phosphate dehydrogenase deficiency

This compromised barrier facilitates the systemic translocation of immunostimulatory microbial derivativesparticularly endotoxin (LPS) and pro-fibrotic oxidized trimethylamine N-oxide (TMAO)which drive cardiac fibroblast activation, collagen deposition, and adverse myocardial remodeling