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2 Molecular mechanisms of ALD The pathogenesis of ALD is intricate and encompasses diverse pathological processes, including oxidative stress, abnormal lipid metabolism, endoplasmic reticulum stress, autophagy, various modes of cell death (including pyroptosis, necroptosis, and ferroptosis), gut microbiota dysbiosis, hepatic immune response and epigenetic abnormalities

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Although most of the NAPQI is formed in the liver, the kidney also metabolizes acetaminophen to the toxic metabolite and releases the cysteine conjugate into the bile as well as the blood for further elimination in urine