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While enhanced alcohol metabolism may seem protective, elevated CYP2E1 accelerates ethanol oxidation, resulting in higher acetaldehyde production and excessive reactive oxygen species (ROS) generation, including hydroxyethyl radicals, superoxide anions, and hydroxyl radicals [27, 28]

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In the brain, hyperglycaemia activates microglia, and microglia activation and polarisation can mediate central inflammatory responses, neuronal apoptosis and exacerbate central neuropathy leading to dementia (28)

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