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CHAC1 further exacerbates cellular stress by degrading GSH, intensifying oxidative damage and ultimately driving ferroptotic cell death (Figure 5) ( FIGURE 5 While the eIF2K3/PERK-eIF2-ATF4 cascade, another branch of the ISR, can modulate ferroptosis in the context of ER stress, cysteine deprivation selectively activates GCN2 rather than PERK, highlighting distinct regulatory mechanisms ( Cysteine starvation triggers mitochondrial fragmentation, impairs mitochondrial function and leads to the accumulation of ROS ( CHAC1 is upregulated through the ATF4-dependent ISR pathway, where it degrades GSH to liberate cysteine needed for the synthesis of Fe-S cluster proteins (Ward et al., 2024)

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Clinical outcomes in patients are presenting with a systemic oxidative burden, which results in persistent fatigue, delayed recovery from physical exertion, and early dermatological signs of premature aging