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Through oligomerization, ninjurin-1 causes the plasma membrane to rupture completely, resulting in the efflux of large damage-associated molecular patterns (161, 162)
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These activated Smads form a complex with Smad4, which translocates to the nucleus and promotes the expression of pro-fibrotic genes [24], such as Type I Collagen alpha 1 (COL1A1) and Fibronectin and Connective Tissue Growth Factor (CTGF)
Since the net charge of CAND is -0.2, resulting in an overall neutral charge, it is difficult for CAND to be effectively transported to the cell nucleus on its own