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Under hypoxic conditions, HIF is activated and translocates to the nucleus, where it forms a heterodimer with HIF-β, promoting the expression of genes that favor the conversion of oxidative metabolism to glycolysis, cell proliferation, and survival by regulating signaling pathways such as phosphoinositide 3-kinase (PI3K)/Akt/ mammalian target of rapamycin (mTOR) [51]

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Saline adds a different problem: the sodium chloride can interact with some peptide chemistries and provides no bacteriostatic activity