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Large amounts of hepatocyte necrosis during liver failure can lead to the release of HMGB1 from hepatocytes, as HMGB1 has a similar effect to endotoxin, HMGB1 is also involved in the pathogenesis of ALF (46)

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Genetic variants in pathways controlling tyrosinase activity and melanocyte function may explain why some people report subtle changes while others see none

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