tumor cell lines is not to detoxify the compounds, but must have another purpose; this hypothesis is also given credence by the common finding of GSTP overexpression in tumor cell lines that are not drug resistant. Clinical significance In addition to their roles in cancer development and chemotherapeutic drug resistance, GSTs are implicated in a variety of diseases by virtue of their involvement with GSH. Although the evidence is minimal for the influence of GST polymorphisms of the alpha, mu, pi, and theta classes on susceptibility to various types of cancer, numerous studies have implicated such genotypic variations in asthma, atherosclerosis, allergies, and other inflammatory diseases. Because diabetes is a disease that involves oxidative damage, and GSH metabolism is dysfunctional in diabetic patients, GSTs may represent a potential target for diabetic drug treatment. In addition, insulin administration is known to result in increased GST gene expression through the PI3K/AKT/mTOR pathway and reduced intracellular oxidative stress, while glucagon decreases such gene expression. Omega-class GST (GSTO) genes, in particular, are associated with neurological diseases such as Alzheimer's, Parkinson's, and amyotrophic lateral sclerosis; again, oxidative stress is believed to be the culprit, with decreased GSTO gene expression resulting in a lowered age of onset for the diseases. Release of GSTs as an indication of organ damage The high intracellular concentrations of GSTs coupled with their cell-specific cellular distribution allows them to function as biomarkers for localising and monitoring injury to defined cell types. For example, hepatocytes contain high levels of alpha GST and serum alpha GST has been found to be an indicator of hepatocyte injury in transplantation, toxicity and viral infections. Similarly, in humans, renal proximal tubular cells contain high concentrations of alpha GST, while distal tubular cells contain pi GST. This specific distribution enables the measurement of urinary GSTs to be used to quantify and localise renal tubular injury in transplantation, nephrotoxicity and ischaemic injury. In rodent pre-clinical studies, urinary and serum alpha GST have been shown to be sensitive and specific indicators of renal proximal tubular and hepatocyte necrosis respectively. GST-tags and the GST pull-down assay GST can be added to a protein of interest to purify it from solution in a process known as a pull-down assay. This is accomplished by inserting the GST DNA coding sequence next to that which codes for the protein of interest. Thus, after transcription and translation, the GST protein and the protein of