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IGF-1 promotes MSC chondrogenic differentiation and chondrocyte proliferation mainly through the activation of IGF-1R

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Concurrently, hyperinsulinemia synergizes with LH at the ovarian level and suppresses hepatic sex hormone-binding globulin (SHBG) production, further exacerbating HA (13)

In a specific embodiment the formulation or composition provides a therapeutically effective amount of at least one otic agent at the site of disease with essentially no systemic exposure

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