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Other aspects of the physiology of thymic epithelial cells can also be modulated by hormones and neuropeptides, particularly cytokeratin expression, cell growth and production of extracellular matrix proteins, thus characterizing the pleiotrophic action of these molecules on the thymic epithelium

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Thus, the transition from "physiological" to "pathological" fibrosis is driven by impaired apoptosis of myofibroblasts, as well as excessive ECM deposition and accumulation, resembling a persistent wound-healing response

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