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The primary mechanism by which plasma proteins, such as thrombin and fibrinogen, activate astrocytes is through the interaction of protease-activated receptors (PARs), specifically PAR-1, PAR-3, and PAR-4, with astrocyte surface receptors, triggering activation and proliferation (52)

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The mechanisms promoting endothelial dysfunction in the systemic and/or pulmonary circulation of COPD patients are different and include systemic inflammation, alteration of adhesion and pro-inflammatory molecules, oxidative stress, cellular senescence, and apoptosis