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Macrophages regulate epithelial and stromal cell function by secreting enzymes and inflammatory factors that act directly and indirectly on airway structural cells, such as IL-1, TNF-, IL-8, monocyte chemoattractant protein-1(MCP-1), reactive oxygen species (ROS) and MMPs, directly involved in the process of airway remodelling 60,61

The same symptoms have shown up in 53 patients in Illinois, where the majority have been otherwise healthy, relatively young men

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