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Lipid peroxidation products, such as 4-HNE and MDA, activate the p53 pathway, inhibit Bcl-2 (an anti-apoptotic protein), activate Bax (a pro-apoptotic protein), increase mitochondrial membrane permeability, release cytochrome c, and initiate the caspase cascade, ultimately leading to cell death ( Moreover, lipid peroxidation is closely associated with necrotic cell death

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