In fibroblasts and macrophages, IL-1/-2/-6 and TNF-⍺ can all induce MMP2 and MMP9 expression via MAPK.62 Many of the DEGs in our model were also linked to MAPK signaling, which has well-known roles in regulating tumor differentiation and tissue invasion.63 Taken together, our results provide several mechanistic insights into how MMP9 activity could mediate adherent VS development. Here, TNF is linked to neoplasm.