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The alternative pathway for LTA 4 metabolism is prominent in cells expressing the enzyme LTC 4 synthase (LTC4S or glutathione- S -transferase), which is found on the nuclear envelope of cells and adds the tripeptide glutathione (glutamyl-cysteinyl glycine) to carbon-6 to yield peptido-leukotriene C 4 (LTC 4 , 5 S ,6 R - S -glutathionyl-7,9,11,14-( E,E,Z,Z )-eicosatetraenoic acid), the first of the 'cysteinyl leukotrienes'

5E, F and Supplementary Fig

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Depending on the individuals medical assessment, it may be considered for selected patients where intravenous micronutrient replenishment is clinically appropriate

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