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Interestingly, tamoxifen acting mostly as an anti-estrogen compound has potential for causing cognitive side effects (Novick et al., 2020), given the neuroprotective property of central estrogen, but the true effects of tamoxifen as an estrogen antagonist or agonist appear to depend on the background concentration of endogenous ligand (partial agonist at low estrogen concentration, for example,) (Paige et al., 1999)

Figure 2 More recently, a multiple hits theory has been proposed, with the addition of other pathogenic factors in NAFLD development: low-grade chronic inflammation, genetic and epigenetic mutations, and intestinal microbiota

doi: 10.2337/db09-1401 58 TiedgeMLortzSDrinkgernJLenzenS

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