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While a number of earlier studies suggested that inflammation played a role in hepatocyte necrosis with P2X7 receptor-mediated purinergic signaling thought to promote liver injury through the inflammasome [140,141], the identity of the cytotoxic cell type involved in immune mediated injury is not clear and the effect of P2X7 was shown to be due to inhibition of P450 isoenzymes by the inhibitor of P2X7 and not through inflammasome activation [142]

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The sickest patients suffer from significant compromise in their capacity to detoxify, often complicated by exposure to mold toxins

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