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In the early adhesion phase, immune defenses are active: neutrophils and M1 macrophages target bacteria via phagocytosis, oxidative bursts, increased antimicrobial peptides (AMPs), reactive oxygen species (ROS), and pro-inflammatory cytokines (IL-1, IL-6, TNF-) and chemokines

Effects may be less dramatic than the first course if the initial burden was substantially reduced Maintenance: Some community protocols transition to once-yearly courses for ongoing senescent cell management There is no research to validate this approach