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These observations suggest that the actions of DSIP on substance P, beta-endorphin, and corticosterone are indicative of a wider array of biochemical modifications, proposing that DSIP may trigger a cascade of molecular events that may facilitate its stress-modulatory functions

Cartilage destruction is considered a hallmark of OA and is a result of increased production of catabolic effectors 32,33,34,35 and reduced matrix biosynthesis by chondrocytes 36

Nitric oxide and macrophage function

Because they enter systemic circulation, they can alter hormone levels, increase IGF-1 (which may raise cancer risk in certain cases), and cause unwanted metabolic effects