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Finally, the protonated glutamate residue donates a hydrogen to the amine of the -linked peptide, releasing an amino acid with a free amino group (Figure 3) ( FIGURE 3 The ChaC-like family proteins, including CHAC1, preferentially degrade reduced glutathione but can also break down other -glutamyl amino acids ( Although CHAC2 enzymes in Leishmania major were shown to degrade only reduced and not oxidized glutathione, this specificity has yet to be confirmed for CHAC1 ( CHAC2 is both evolutionarily older and structurally distinct from CHAC1

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Thus, the GST-catalyzed GSH conjugation is protective of these biomolecules inside the cell and therefore is considered as a detoxification process (Figure 2) [9,36]

Considering that elevated CNS-derived biomarkers provide evidence of direct CNS injury in delirium, and that the neuroprotective effects of ketones include reducing neuroinflammation, we hypothesize that exogenous ketone administration will lead to a reduction in the injury signal, as evidenced by lower NfL and GFAP levels in the treatment group