Fig. 2

Pathobiology perspective: a multiple mechanism model. # Image courtesy of Keefe and Sonis. NB: The upregulation and message generation phase involves the activation of a number of signalling pathways and transcription factors, most importantly NFκB, which in turn mediates gene expression and synthesis of various inflammatory molecules including proinflammatory cytokines. Signal amplification is the third phase of mucositis development where the inflammation signal is further amplified as a consequence of proinflammatory cytokines, with subsequent further tissue damage as a result of increased apoptosis