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Activation of this ATP-depleting futile 5-oxoproline cycle (glutamate glutamyl phosphate 5-oxoproline glutamate) requires two triggers: reduced cellular glutathione levels, which activates step 1 of the -glutamyl cysteine synthetase reaction, and reduced cytosol cysteine levels, which blocks step 2 of the reaction sequence and instead causes the accumulating glutamyl phosphate to autocyclize and form 5-oxoproline

Acta Neurol Scand 135:416 Mayo-Smith MF, Beecher LH, Fischer TL et al (2004) Management of alcohol withdrawal delirium