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This leads to increased expression of adhesion molecules and enhanced leukocyte and platelet adhesion to the endothelium, as well as increased permeability, and plasminogen activator inhibitor-1 (PAI-1), predisposing to thrombosis and disease progression [7]

10.1080/03630269.2021.1941081 69 SakuraiM.IshitsukaK.ItoR.WilkinsonA

The dual mechanism genuinely adds something new, and for many patients, its the change that restarts meaningful progress

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This suggests that reactivation may be triggered by impaired immune function, which occurs with advancing age