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Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (which can be caused by ingestion of corrosives, extensive tumors, and conditions associated with gastric atrophy, such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy) Structural lesions leading to vitamin B 12 deficiency, including regional ileitis, ileal reactions, and malignancies Competition for vitamin B 12 by intestinal parasites or bacteria
Moreover, amino acid metabolism regulates the redox balance through the generation of nicotinamide adenine dinucleotide phosphate (NADPH) and reduced glutathione (GSH), which are essential for cellular defense against oxidative stressa key driver in IPF progression [7, 19]
While this association is not solely attributable to BDNF, the neurotrophin pathway is a leading mechanistic candidate
Rational drug combinations Strategies to combat MDR include direct inhibition of transporter proteins, regulation of SLC function and expression pathways, development of nanocarrier systems, and combination with emerging targeted therapies
