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To date, these conclusions have mostly been drawn from retrospective studies and meta-analyses, and prospective studies are warranted to validate these findings

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As an antioxidant, glutathione enables precise direct or indirect control of ROS (such as singlet oxygen, superoxide anions, hydrogen peroxide, etc.), which often accumulate/produce at high levels during biotic stress, thereby reducing damage to the cells (Zechmann, 2020)

However, in pathological states associated with tinnitus and neurodegeneration, this translocation is impaired or the binding affinity of Nrf2 to ARE is diminished, resulting in insufficient upregulation of antioxidant enzymes (Scuto et al., 2020

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Persistent smokers may, in that case, inhale more ROS than can be scavenged by the residual antioxidants, resulting in increased vulnerability to oxidative stress