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FOXO4-DRI acts as a competitive inhibitor of this interaction binding directly to the transactivation domain 2 (TAD2) of p53, displacing FOXO4, and allowing phosphorylated p53 to be exported from the nucleus and directed to mitochondria, where it activates BAX, triggers caspase-3 cleavage (via the p53/BCL-2/Caspase-3 signalling pathway), and drives cell-intrinsic apoptosis

These injuries occur during explosive movements like sprinting, kicking, or rapid hip flexion