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Model for the production of mTSS. S. aureus bacteria (purple spheres) are located as thin films on the vaginal mucosa. TSST-1 is produced under the conditions listed. TSST-1 binds to CD40 on human vaginal epithelial cells (HVECs). HVECs produce chemokines, which attract the immune system and lead to vaginal barrier disruption. CD4 T cells and macrophages are activated to produce interleukin-1, TNF-α, TNF-β, interferon gamma, and interleukin-2. These cytokines cause mTSS.
