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2.3 Dysregulation and failure of endogenous antioxidant defense mechanisms Under physiological conditions, the myocardium maintains redox homeostasis through a robust endogenous antioxidant defense system, comprising enzymatic components like SOD, Catalase (CAT), and Glutathione Peroxidases (GPxs), as well as non-enzymatic antioxidants such as glutathione (GSH) and thioredoxin (Kumar et al., 2022)

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Materials and methods Study approval and registration The investigator-initiated GSH-MAP study (ClinicalTrials.gov Identifier: NCT 03596125) was conducted in the Department of Obstetrics (2018-2021), funded by the University-Hospital of Nantes, and approved by the medical ethical committee ( CPP-EST I , N2017/65), besides the National Agency for the Safety of Medicines and Health Products (N EudraCT 2017-003999-31)

Acknowledgments The authors thank the staff of Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases

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