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With sufficient glutathione present, NAPQI is very quickly metabolized into sulfate and cysteine compounds, which are readily excreted through the kidneys.[ref] However, when it isnt neutralized, NAPQI is highly reactive and can cause oxidative stress and damage to the liver cells, hepatocytes, leading to cell death

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Furthermore, the translocation to the plasma membrane of 78-kDa glucose-regulated protein GRP78, which facilitates M2 macrophage polarization of TAMs and tumor growth in lung cancer, was induced by IGF-1R signaling, and concomitant IGF-1 blockade and GRP78 knockdown in TAMs suppressed M2 macrophage-induced maintenance, proliferation, and migration of lung cancer cells (27)