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Current laboratory investigations further evaluate intracellular signaling involving TGF- , MAPK/ERK , PI3K/Akt , NF-B , matrix metalloproteinases (MMPs) , tissue inhibitors of metalloproteinases (TIMPs) , copper-dependent enzymes, and additional molecular pathways associated with extracellular matrix regulation and cellular remodeling

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In western Syria, his identity transformed to align with the regions agricultural cycles

Diagnosis can be challenging due to the broad range of symptoms, lack of traditional clinical presentation, and majority of knowledge based on small number of patients presented as case reports in the literature

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