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The extracellular matrix, the structural scaffold beneath the skins surface, needs to be actively rebuilt rather than left to passively contract
In atrophying muscles, there is activation of the Forkhead box O transcription factor family (FOXO), as well as NF-B, which can be activated by TNF-, soluble TNF-like weak inducer of apoptosis (TWEAK), or IL-1 [15, 16]
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