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Aldehyde dehydrogenase then oxidizes - N -trimethylaminobutyraldehyde to - N -trimethylaminobutyrate with NAD + as a cofactor

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Consistent with this prediction, inhibition of glutamate-cysteine ligase (GCL, formerly known as -glutamylcysteine synthetase), the rate-limiting first enzyme in the two-step synthesis of GSH, using buthionine-( S , R )-sulfoximine (BSO [41]), can induce cell death that is suppressed by -tocopherol and DFO, but not by the caspase inhibitor zVAD-fmk or the necroptosis inhibitor Nec-1 [9, 39]