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The absence of those cytokines promotes the production of reactive oxygen species (ROS) and causes oxidative damage on fibroblasts

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Both ligands had similar cAMP potency but the exendin-4-C16 showed 2.5-fold bias towards G protein recruitment and a 60% reduction in -arrestin-2 recruitment efficacy compared to exendin-4, as well as reduced GLP-1R endocytosis and preferential targeting towards recycling pathways

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These nutritional supplements could help offset some of the downsides.