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Conversely, we define “Treg exhaustion” more specifically as a state induced by chronic inflammation, characterized by persistent expression of inhibitory receptors (e.g., PD-1/TIGIT), metabolic insufficiency, epigenetic and lineage instability (such as FOXP3 destabilization), and a decline in suppressive capacity, particularly in the context of continuous antigenic and cytokine stimulation

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45 Obvious similarities exist between the described traumatic avulsion of the ring apophysis in adolescents and the annulus endplate junction failure in adults (Fig