The literature is not uniform. It divides into distinct lines of research that are frequently presented as if they were one.
Musculoskeletal tissue. The largest line. A 2025 systematic review identified 544 papers from 1993 to 2024 and included 36 after screening. In preclinical models it recorded improvements in functional, structural and biomechanical measures across muscle, tendon, ligament and bone, alongside increased growth hormone receptor expression and reduced inflammatory cytokines.
The vascular mechanism — why everything converges here. Activation of the VEGFR2 receptor and nitric oxide synthesis via the Akt–eNOS axis, with ERK1/2 signalling. The described result is angiogenesis, fibroblast activity and neuromuscular stabilisation, particularly in poorly vascularised tissue such as tendons and myotendinous junctions. This explains why one molecule appears across such different fields: the common denominator is the blood vessel.
Digestive tract. A separate line, with a history predating the sports medicine interest. In preclinical models and cell cultures, it examined stabilisation of intestinal epithelial permeability and cytoprotection against damage from non-steroidal anti-inflammatory drugs.
Nervous system. The newest and least mature line, in preclinical models, emphasising the relationship with the nitric oxide system.
Stability of the molecule. It remains intact for more than 24 hours in human gastric juice, where most peptides degrade rapidly in an acidic environment.
The technical detail
Vasireddi et al., HSS Journal, 2025 (doi 10.1177/15563316251355551); McGuire et al., Curr Rev Musculoskelet Med, 2025 (doi 10.1007/s12178-025-09990-7); Park et al., Curr Pharm Des, 2020 (doi 10.2174/1381612826666200523180301); Vukojević et al., Neural Regen Res, 2022 (doi 10.4103/1673-5374.320969); Sikirić et al., World J Gastroenterol, 2022 (doi 10.3748/wjg.v28.i1.23). Data from PubMed, verified 30/08/2026.