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Gamma-glutamyltransferase 1 (GGT1), a key enzyme in glutathione homeostasis, is significantly down-regulated in chRCC compared with normal kidneys, while overexpression of GGT1 can inhibit the chRCC cells proliferation, and inhibit the cystine uptake and GSH levels (125)

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Dysbiosis of the hindgut microbiota, characterized by the depletion of acetate-producing genera (e.g., Faecousia ) and the expansion of acetate-consuming methanogens (e.g., Methanosphaera ), leads to a deficiency in intestinal acetate

Phylum-level analyses indicate predominant Firmicutes with relative Bacteroidetes reduction in some studies (264, 265), while others report increased Actinobacteria , Verrucomicrobia , or pro-inflammatory Proteobacteria , alongside potential reduction of beneficial Bacteroidetes and Actinobacteria ( 262, 266)