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Toxic bile salts retention in the liver is accompanied by intracellular metabolic disorders, inflammation and reduced detoxification capacity [176], which may enhance the generation of oxidative stress and the accumulation of ROS and RNS in hepatocytes [177], leading to generalized systemic damage to major organs, starting from the liver and reaching the brain, heart, intestine, and kidney [178,179,180]

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Patients with active cancer should also discuss risks with their provider before starting treatment