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However, excessive NFE2L2 activation may also promote intracellular cysteine accumulation, which can react with sugars to form adducts that impair cell proliferation 163

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These adverse effects, including peripheral neuropathy and hearing loss, can have a profound impact on patient quality of life and require careful monitoring throughout treatment [44, 45]

589 DN and DPN share a reciprocal relationship, both arising from prolonged hyperglycemia and common pathophysiological mechanisms, such as oxidative stress, inflammation, and endothelial dysfunction