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This AOP is constituted the MIE as sterol regulatory element binding transcription factor 2 (SREBF2) gene activation and repressions of glutathione synthetase (GSS) and glutathione S-transferases (GSTA1, GSTA2, GSTA3, GSTA5) genes and the KEs as perturbation of cholesterol, though up regulated unsaturated fatty acid concentration, and glutathione homeostasis leading to oxidative stress, DNA damage and AO as hepatotoxicity (HepG2 cell death)

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Mol Pharmacol (2014) 86:95105

GPs will evaluate: Detailed symptom history Dietary habits and restrictions Medical history, including gastrointestinal conditions Current medications Family history of pernicious anaemia or autoimmune conditions NICE guidance emphasises that treatment should not be delayed whilst awaiting test results if clinical suspicion is high, particularly when neurological symptoms are present