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39 In addition, the reactive aldehydes such as acrolein and 4-hydroxy-2-nonenal (4-HNE) formed from lipid peroxidation cause damage to the epithelial cells, acrolein is unstable and toxic, whereas 4-HNE in high concentrations is capable of inducing caspase (a major promoter of cell apoptosis)

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Alterations in key metabolic pathways such as glycolysis and oxidative phosphorylation profoundly affect the activation, differentiation and function of B and T cells, monocytes, neutrophils and other immune cells, driving inflammation and tissue injury