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A specific etiology is only found in 29% of patients, however when identified it can have significant impact on treatment and counseling

Oxidative stress to the TM can cause much damage, such as reduce TM mitochondrial respiratory activity, leading to growth arrest (49), affect ECM structure (50) and lead to ECM accumulation (51), damage TM cellular DNA (52), alter membrane permeability (53), cause the rearrangement of TM cell cytoskeletal structures, cause the loss of cell-matrix adhesion (54), affect cell cycle progression (55), cause inflammatory cytokine release (56,57), and trigger apoptosis (58,59), as well as many forms of cell death (60)

Levin 2012

References : ARS Pharma (2014)

vitamins act as catalysts, and proteins and calories provide the substrate for them to work on