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These released exosomes can then modulate immune response in other cells through a payload of inflammatory cytokines, like TNF-alpha, or through microRNA s that decrease inflammation.[ref] Mast cell release of exosomes has been shown to increase the formation of collagen in fibroblasts, which can lead to fibrosis (including pulmonary fibrosis, IPF)

Other rare issues: Metabolic effects

This trial is detailed in the comprehensive review by Pickart et al

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