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Depending on dose, a fraction of APAP is converted into a highly reactive toxic intermediate, N-acetyl-p-benzoquinone imine (NAPQI) by several P450 cytochromes[4]
C.DuncanM
The GSH-toxin complex becomes water-soluble, allowing elimination via urine or bile
10.1016/j.semcancer.2017.10.007 39 Entingh-PearsallA.KahnC
However, during oxidative stress, specific cysteine residues on Keap1 undergo chemical modification, impairing its ability to bind Nrf2 effectively
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