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Wnt/catenin is a major pathway linked to osteoblast differentiation [48,49,50,51,52] and it has been shown that in the presence of Wnt signaling, catenin accumulates in the cytoplasm and translocate to the nucleus, where it associates with Tcf/Lef transcription factors to regulate target gene expression [53,54,55,56,57,58]

It usually occurs during the first 6 months of VPA therapy and is commonly but not always preceded by minor elevations in transaminases

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