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The peptide activates extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation in a dose-dependent manner, leading to nuclear translocation and activation of transcription factors including c-Fos, c-Jun, and early growth response-1 (Egr-1) that drive expression of genes involved in cell growth, migration, and angiogenesis

Mid-portion tendinopathy typically responds faster than insertional problems due to easier injection access and slightly better baseline vascularity

M.et al (2008)