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In the case of alcohol the mechanism is well described: ethanol metabolism involving the CYP2E1 enzyme releases free radicals, and these reduce the level of reduced glutathione in the liver (Lieber, Drug Metabolism Reviews 2004, PMID 15554233)

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It can lead to other secondary afflictions such as nerve damage, blindness, heart disease, stroke, and kidney disease

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The ADC-antigen complex then undergoes endocytosis, termed internalization (step 3)