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After a decade of human genetics studies focusing on disease risk, emerging results from genetic studies of disease progression suggest a multi-hit paradigm in which disease initiation and disease progression are not necessarily driven by the same mechanisms (Figure 3)

Clinical Chemistry Contributed by Simmi Patel, MD and Octavia Peck-Palmer, PhD CASE PRESENTATION A male in his early twenties was found to have elevated Gamma Glutamyl Transferase (GGT) incidentally during his work up for medical clearance for the US armed forces