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Acknowledgement The author wishes to thank Daniel Soares Freire, MD, PhD for providing medical writing and editorial assistance on behalf of Springer Healthcare

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274,275 This, in turn, diminishes additional downstream effects, including oxidative stress, the secretion of pro-degradative substances, modifications to cell phenotype (hypertrophy, M1/M2 macrophage phenotype, fibrosis), and damage or deterioration of joint cells (apoptosis, senescence)

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