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Researchers propose that the peptide's brief presence is sufficient to trigger a cascade of gene expression changesincluding activation of transcription factors c-Fos, c-Jun, and Egr-1that initiate self-sustaining healing processes well beyond the peptide's physical presence

Another group independently also concluded that disability progression and brain atrophy occur earlier than in the classical secondary progressive stage, with many relapsing patients exhibiting insidious progression without clinical or radiographic evidence of inflammatory disease activity, coining the term silent progression (Cree et al., 2019)

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