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FGF21D2D3 is an engineered recombinant protein analog of fibroblast growth factor 21 (FGF21) designed to overcome the weak signaling activation of the wild-type protein. It was developed by substituting the R96-V106 region of FGF21—the site responsible for binding the D2-D3 domain of the fibroblast growth factor receptor 1c (FGFR1c)—with the corresponding sequence from FGF1. This structural modification significantly enhances its binding affinity for FGFR1c. Mechanistically, FGF21D2D3 activates the FGFR1-AMPK signaling pathway, which inhibits oxidative stress and improves lipid metabolism. Preclinical studies in type 2 diabetes mouse models have demonstrated that FGF21D2D3 is more effective than wild-type FGF21 in treating hyperlipidemia and diabetic cardiomyopathy (DCM).
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