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This Polyol (Sorbitol) pathway is activated only if the concentration of glucose in cells is high because the enzyme Aldose reductase has a relatively low affinity for glucose (and conversely high Michaelis Menten constant K m )

Activation of this pathway disturbs lipid synthesis and breakdown, causing abnormal lipid accumulation and metabolic dysfunction in hepatocytes ( CHB is also characterized by T-cell exhaustion, which is worsened by alcohol and includes up-regulation of PD-1, CTLA-4, and TIM-3 ( Paradoxically, controlled low-dose alcohol exposure enhances dendritic cell (DC) maturation and exosome-driven T-cell activation in CHB, countering typical immunosuppression

10.1007/s10072-009-0128-5 [DOI] [PubMed] [Google Scholar] 20.Lahrouchi N, Lodder E, Mansouri M, Tadros R, Zniber L, Adadi N, et al