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It is also possible that there is a relay of some kind, where the exerkine can bind to a surface receptor on a neighboring cell that initiates an intracellular signaling cascade which elicits ROS production

Noguchi, T

The livers ability to transform bilirubin into a nontoxic, excretable form is essential for maintaining metabolic homeostasis and preventing the toxic accumulation of bilirubin in the body [24, 25]