CCN2 and systemic sclerosis: It is thought that these T cell–associated chemokines and cytokines then stimulate fibroblasts and endothelial cells to produce TGF-β and connective tissue growth factor (CTGF) to stimulate tissue fibrosis (via increased collagen production) and endothelial cell damage (via influence of adhesion molecules ICAM-1 (intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule-1), with elevation of these adhesion molecules demonstrated in the peripheral blood of SSc patients (74–78).