Cellular Necrosis Activation of Resident M acrophages Recruitment and Activation of More M acrophages Chronic Toxicant E xposure Cytokines, chemokines , Eicosanoids ( TNF a , IL1 b , PGE2) Decreased ATP, increased Ca2+, increased oxidative stress Fibroblast proliferation, differentiation Intracellular contents (e.g. ATP, dsDNA ) Growth factors (e.g. TGF b , IGF1, PDGF, ROS) Cell proliferation TGF b Epithelial-to- mesenchymal transition (EMT) Leakier basement membrane Infiltration of more immune cells into damaged tissues TGF b , IGF1, PDGF, TNF a Excessive formation of hardened extracellular matrix (ECM) TNF a , ROS Tissue Cells And Macrophage Cellular Necrosis fibrosis angiogenesis Growth factors (e.g. TGF b , IGF1, PDGF, ROS) Genetic instability Mutations Cell proliferation Cellular transformation VEGF Malignant progression of cancer cells Growth factors (e.g. TGF b , IGF1, PDGF, ROS) Cytokines, chemokines , Eicosanoids ( TNF a , IL1 b , PGE2) TGF b Recruitment and Activation of More M acrophages Epithelial-to- mesenchymal transition (EMT) EMT and breakdown of ECM proteases Proteases, TGF b breakdown of ECM (invasion) Cancer cells extravagate with macrophages and blood supply into circulation metastasis Tissue dysfunction, tissue damage, degeneration, organ failure