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High levels of pro-inflammatory agents and a hypoxic condition, pathogens' invasion, and immune cells' activity injure the epithelial-endothelial integrity causing permeability in the vascular wall and extravasation of exudative fluids (31)

In addition, sulforaphane normalizes gut microbiota dysbiosis and increases the expression of TJ proteins, contributing to intestinal homeostasis (He et al., 2018)

Pathogenesis of chronic obstructive pulmonary disease: understanding the contributions of gene-environment interactions across the lifespan

Research is currently in progress to address some of these issues and, as mentioned, NICE guidelines for the diagnosis and management of vitamin B12 deficiency are in development