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In the nuclear pathway, E2 binds either estrogen receptor (ER) or ER in the cytoplasm, forming heterodimers and homodimers that translocate to the nucleus, bind DNA at estrogen response elements (ERE), and activate the expression of ERE-dependent genes

Physical examination checks range of motion, muscle tenderness, and nerve function

At the same time, the field acknowledges real limitations heterogeneous trial designs, industry-funded studies, and copper's inherent toxicity at higher concentrations that responsible researchers should factor into any study design

Acts as a biological repair signal through copper binding and gene regulation