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H 2 O 2 also mediates redox signaling through Nrf2, AMPK/PGC-1, and MAPK/ERK pathways, modulating antioxidant defense, metabolism, and cell survival ( To neutralize ROS, mitochondria use enzymatic systems including glutathione peroxidases (GPX1/4), which reduce H 2 O 2 and lipid peroxides using glutathione (GSH)

Distribution of constituents and metabolites of maritime pine bark extract (Pycnogenol( )) into serum, blood cells, and synovial fluid of patients with severe osteoarthritis: A randomized controlled trial