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678,679,680 High methylation of downstream genes of ER leads to reduced expression, further leading to ER dysfunction and inducing tamoxifen resistance, such as NAT1, ELOVL2 and PRA

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Furthermore, to confirm mitochondrial abnormalities, the expression level of genes related to mitochondrial functionoptic atrophy 1 ( OPA1 ), pyruvate dehydrogenase kinase 1 ( PDK1 ), BCL2-interacting killer ( BIK