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The Journals of Gerontology: Series A, 78, 7589.

The imbalance of mitochondrial fusion/fission drives high-glucose-induced vascular injury

This pathway is considered the most genotoxic as the 4-OH estrogen metabolites can become reactive quinones that have the potential to bind to DNA and form damaging (unstable) depurating adducts, that may increase risk for cancer, such as breast and prostate cancer