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Several biological factors have been found to contribute to this association, including altered estrogen metabolism, insulin resistance, and the promotion of inflammation, fibrosis, and angiogenesis [46,47,48,49]

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At the same time, there is evidence of T cell exhaustion and reduced natural killer cell function, suggesting the immune system is simultaneously overactivated in some pathways and depleted in others

Crucially, this stasis exacerbates a process called enterohepatic recirculation

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