Figure 1. Generic adverse outcome pathway from chemical insult to cell death.

The first step or the MIE involves initial cell injury, whereby the parent chemical and/or its metabolites cause narcosis, directly impair mitochondrial function or induce decompartmentalization. In the second step, which is a KE, a MPT process takes place as a consequence of the primary insult. This ultimately leads to cell death by apoptosis or necrosis in the third step, being the actual AO.