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Collagen ECM turnover signaling in the heart. Altered mechanical stress (σ) and oxidative stress may stimulate TNF-α, TGF-β, and MMP. TNF-α may stimulate MMP and inhibit TIMP. However, TGF-β may inhibit MMP and stimulate TIMP and myofibroblast. Finally, MMP degrades collagens, but TIMP and myofibroblast inhibit collagen degradation and promote collagen synthesis, which determine collagen ECM remodeling.
