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Recombinant PRELP protein is a therapeutic candidate being investigated for the treatment of pulmonary fibrosis, including idiopathic pulmonary fibrosis (IPF). PRELP (proline/arginine-rich end leucine-rich repeat protein), also known as prolargin, is a small leucine-rich proteoglycan (SLRP) that is normally present in the lung extracellular matrix but is reduced in the alveolar regions of IPF patients. The recombinant protein acts by reinforcing alveolar epithelial cell function, suppressing the acquisition of mesenchymal traits (epithelial-mesenchymal transition), and inhibiting the migration of fibroblasts. Mechanistically, it modulates multiple fibrotic pathways, including the suppression of TGF-β signaling (reducing SMAD2/3 phosphorylation and CTGF expression) and the inhibition of the RAGE/DIAPH1/YAP signaling axis. Preclinical studies involving trans-airway administration in bleomycin-induced mouse models have demonstrated significant reduction in lung fibrosis.
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