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Mechanistically, Esm1 has been shown to bind to fibronectin and displace fibronectin-bound VEGF-A, thereby increasing the bioavailability and signaling capacity of the growth factor 31

These include modulation of inflammatory mediators (chemical messengers that drive swelling and pain), support of angiogenesis (formation of new small blood vessels that deliver oxygen and nutrients), and interactions with nitric oxide signaling (a pathway involved in blood flow and cellular communication)