Fibroblasts proliferate, may differentiate into myofibroblasts and adipocytes, accumulate and secrete hyaluronic acid (HA), synthesize and secrete chemoattractants (interleukin-16, RANTES, CXCL10) and a number of cytokines (interleukin-1, interleukin-6, interferon-g, tumor necrosis factor-a, interleukin-8, interleukin-10, platelet-derived growth factor, transforming growth factor-b), which concur to auto-maintain the inflammatory process (47)
Proliferation of orbital fibroblasts and adipocytes, both in the retroocular space and in the perimysial space, is also associated with an increased production of glycosaminoglycans, which are the ultimate responsible for edematous changes both in the connective tissue and the muscles, owing to their hydrophilic nature
Orbital tissues, including muscles, are infiltrated by inflammatory cells, including lymphocytes, mast cells, and macrophages
After recognition of one or more antigens (shared with the thyroid) on fibroblast surface, facilitated by HLA class II antigen expression on antigen-presenting cells (B cells, macrophages)
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