Furthermore, MMP-9 is elevated in the skin and plasma of patients with common vitiligo, being produced in keratinocytes by the stimulation of TNF and IFN and associated with E-cadherin cleavage.44 The DKK1 protein, which reduces melanogenesis and certain somatic functions of melanocytes, is overexpressed by lesional fibroblasts in vitiligo.45 Similarly, there is a greater expression of fibronectin, a key protein in intercellular communication by binding to integrins, in the dermis of patients with vitiligo compared with healthy controls.43 Additionally, elastin is reduced in lesional dermis, but collagen fibers show no difference when compared to unaffected skin.46 Oxidative changes Cutaneous melanocytes, located in the organ with the greatest interface with the external environment and, consequently, the most exposed to ultraviolet radiation and pollutants, are particularly vulnerable to excessive production of reactive oxygen species (ROS)

Thyroid, 2020;30(10), 1440-1450.7 Kubiak M, Wiatr K, Kowalczyk A, Grecki R, Gajewska D, Sobieska M
Front Nutr 10:1094081
Compared to conventional IGF-1, this enhances its bioavailability and permits longer, more sustained activation of cellular receptors, hence enhancing its anabolic effects (3)
This interaction increases cell surface ATP levels, which then activates P2X4 purinergic receptors