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The 2019 Cell and Tissue Research paper provided independent replication of BPC-157 musculoskeletal soft-tissue findings outside the originating Croatian laboratory (PMID 30915550)

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Within the cytosol the accumulating fumarate, similar to the effect of accumulating succinate, results in the inhibition of 2-oxoglutarate and Fe 2+ -dependent dioxygenases that are responsible for the hydroxylation of the -subunit (HIF1) of the HIF-1 complex