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Published preclinical and in vitro research has examined its interaction with extracellular matrix remodelling, broad gene-expression modulation, antioxidant and anti-inflammatory pathways, and copper-coordination chemistry in cultured fibroblasts and animal wound models

However, TCAs are generally recommended as second-line treatments due to their higher risk of adverse effects, including orthostatic hypotension, dry mouth, constipation, urinary retention, memory impairment, hallucinations, and confusion [157]

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