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Liệu pháp Peptide trong Y học Cơ xương khớp

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Injectable and regenerative peptide therapies in orthopaedics and sports medicine — what the evidence shows for tendon, cartilage and bone healing, and where the hype outpaces the data.

Updated Aug 2026
Một chuỗi phân tử peptide bên cạnh một lọ nhỏ.
Các liệu pháp peptide được quảng cáo rộng rãi cho mục đích chữa lành và phục hồi; bằng chứng cho việc sử dụng trong hệ cơ xương khớp còn hạn chế. Kieran Hirpara 4.0

Trang này được dịch bằng máy và chưa được bác sĩ kiểm tra. Bản tiếng Anh là bản chính thức.

Những gì bạn đang cảm thấy

Bạn có thể đang gặp phải tình trạng đau và cứng ở các mô mềm. Sự khó chịu này có thể cảm thấy sâu trong cơ hoặc dọc theo các gân. Tình trạng này thường bùng phát sau khi bạn vận động suốt cả ngày. Bạn có thể nhận thấy nó trầm trọng hơn khi vừa thức dậy vào buổi sáng. Độ cứng có thể giảm nhẹ khi bạn di chuyển, nhưng có thể quay trở lại nếu bạn gắng sức quá mức.

Các hoạt động đơn giản trong sinh hoạt hàng ngày có thể trở nên khó khăn. Bạn có thể gặp khó khăn khi đưa tay ra sau lưng để cài móc áo bra. Việc nhét áo vào quần có thể kéo căng vùng bị đau. Ngủ nghiêng về phía bị ảnh hưởng có thể khiến bạn mất ngủ. Những cử động nhỏ này có thể kích hoạt những cơn đau nhói hoặc cơn đau âm ỉ kéo dài. Bác sĩ phẫu thuật của bạn hiểu rõ những hạn chế này ảnh hưởng đến sinh hoạt thường ngày của bạn như thế nào.

Mặc dù một số phương pháp điều trị cho thấy tiềm năng trong các nghiên cứu trên động vật, bằng chứng về liệu pháp peptide tiêm cho người hiện nay còn thiếu. Không có các thử nghiệm ngẫu nhiên có đối chứng (RCT) nào điều tra việc sử dụng BPC-157 ở đối tượng người. Khoa học hiện chưa đủ mạnh để xác định hiệu quả tổng thể hoặc độ an toàn của nó đối với việc tăng cường thể thao. Vì lý do này, bác sĩ phẫu thuật của bạn không khuyến nghị sử dụng BPC-157 cho hiệu suất thể thao và quá trình hồi phục.

Một số bệnh nhân tìm thấy sự giảm đau với các phương pháp tiếp cận khác. Ví dụ, EGYFIL đã được chứng minh là an toàn để điều trị đau và cứng ở các mô mềm. Nó dường như làm giảm đau và cứng trong ba ngày điều trị. Bạn có thể cảm thấy sự giảm đau này sớm nhất là ba giờ sau lần bôi đầu tiên. Tuy nhiên, kết quả có sự khác biệt, và bác sĩ phẫu thuật của bạn sẽ giúp bạn lựa chọn hướng đi an toàn nhất.

Điều quan trọng là hãy lắng nghe cơ thể của bạn. Nếu một hoạt động gây ra đau nhói, hãy dừng lại và nghỉ ngơi. Chườm đá hoặc chườm nóng theo hướng dẫn của nhóm chăm sóc sức khỏe của bạn. Hãy ghi lại thời điểm cơn đau trầm trọng nhất. Điều này giúp bác sĩ phẫu thuật cá nhân hóa kế hoạch điều trị của bạn. Hãy nhớ rằng, quá trình lành thương cần có thời gian. Hãy kiên nhẫn với tiến độ hồi phục của bạn và giao tiếp cởi mở với nhóm y tế về những gì bạn đang cảm thấy.

Những gì thực sự đang xảy ra

Cơ thể bạn dựa vào một sự cân bằng tinh tế để duy trì chuyển động khớp trơn tru. Sụn khớp đóng vai trò là lớp phủ trơn tru trên các đầu xương, trong khi gân hoạt động như những sợi dây chắc chắn nối cơ với xương. Khi bạn bị tổn thương các cấu trúc này, quá trình sửa chữa tự nhiên thường không đáp ứng đủ nhu cầu. Ví dụ, khi một gân bị rách, điểm nối giữa gân và xương có thể không lành lại với độ bền hoặc cấu trúc cần thiết. Điều này dẫn đến mất ổn định và đau đớn do điểm neo bị suy yếu.

Trong một số trường hợp, bề mặt khớp tự nó bị mòn hoặc phát triển các khuyết tật. Điều này có thể xảy ra sau một chấn thương hoặc do căng thẳng kéo dài. Bề mặt trơn tru trở nên thô ráp, gây ma sát và khó chịu khi bạn vận động. Cơ thể bạn cố gắng khắc phục những vấn đề này bằng cách gửi các tế bào đến khu vực bị tổn thương, nhưng đôi khi mô sửa chữa yếu hoặc không tích hợp tốt với mô khỏe mạnh xung quanh. Đó là lý do tại sao việc nghỉ ngơi đơn thuần hoặc các phương pháp điều trị cơ bản có thể không giải quyết triệt để vấn đề.

Các nhà nghiên cứu đang khám phá những cách mới để hỗ trợ quá trình lành thương này. Một số phương pháp sử dụng các peptide đặc biệt—những khối xây dựng nhỏ của protein—để khuyến khích cơ thể bạn tự sửa chữa hiệu quả hơn. Trong các nghiên cứu trên động vật, một số peptide đã cho thấy tiềm năng trong việc tăng cường kết nối gân-xương và cải thiện quá trình lành sụn khớp. Các phương pháp điều trị khác nhằm mục đích giảm viêm nhanh chóng, giúp bạn cảm thấy ít đau và cứng khớp hơn trong vòng vài giờ hoặc vài ngày. Tuy nhiên, điều quan trọng cần biết là đối với nhiều liệu pháp mới hơn, chẳng hạn như BPC-157, hiện chưa có bằng chứng lâm sàng từ các thử nghiệm trên người để chứng minh hiệu quả hoặc tính an toàn của chúng trong việc phục hồi sau chấn thương thể thao. Bác sĩ phẫu thuật của bạn có thể giúp bạn hiểu rõ những lựa chọn nào có cơ sở khoa học vững chắc và những lựa chọn nào vẫn còn mang tính thử nghiệm.

Những điều cần biết

Bạn nên biết rằng các bằng chứng hiện tại không ủng hộ việc sử dụng lâm sàng thường quy nhiều liệu pháp peptide tiêm trong chỉnh hình và y học thể thao. Đối với hầu hết các phương pháp điều trị này, nền tảng khoa học vẫn còn thiếu hụt. Điều này có nghĩa là chúng tôi chưa thể xác nhận hiệu quả tổng thể, độ an toàn hoặc các cách thức tốt nhất để sử dụng chúng nhằm thúc đẩy quá trình hồi phục.

Một số peptide cụ thể cho thấy tiềm năng trong các nghiên cứu phòng thí nghiệm giai đoạn đầu, nhưng những kết quả này đến từ chuột, ngựa hoặc nuôi cấy tế bào, chứ không phải từ con người. Ví dụ, một số peptide đã giúp chữa lành gân trong các mô hình chuột và sửa sụn trong các mô hình ngựa. Tuy nhiên, không có các thử nghiệm lâm sàng trên người đối với BPC-157. Do khoảng trống dữ liệu ở người này, chúng tôi không khuyến nghị sử dụng BPC-157 để cải thiện thành tích thể thao hoặc quá trình hồi phục. Khoa học hiện tại chưa đủ mạnh để ủng hộ việc sử dụng nó ở vận động viên.

Có một số ngoại lệ nơi đã có dữ liệu từ con người. EGYFIL là một phương pháp điều trị như vậy. Phương pháp này dường như an toàn để giảm đau và cứng khớp ở các mô mềm. Bạn có thể nhận thấy sự giảm triệu chứng sớm nhất là ba giờ sau lần áp dụng đầu tiên. Liệu trình điều trị thường kéo dài ba ngày, trong thời gian đó bạn sẽ cảm thấy ít đau và cứng khớp hơn.

Đối với các tình trạng khác, chẳng hạn như khuyết tật chỏm xương (một loại tổn thương bề mặt khớp), các phương pháp điều trị như peptide tự lắp ráp hoặc vi gãy xương có thể cải thiện triệu chứng so với việc không điều trị. Tuy nhiên, sự cải thiện này xuất phát từ các nguyên nhân khác nhau tùy thuộc vào phương pháp được sử dụng.

Nhìn chung, triển vọng của bạn phụ thuộc vào liệu pháp cụ thể. Nhiều liệu pháp peptide thiếu các lợi ích đã được chứng minh ở người. Những phương pháp khác, như EGYFIL, mang lại sự giảm đau và cứng khớp trong thời gian ngắn. Bác sĩ phẫu thuật của bạn sẽ giúp bạn hiểu rõ những lựa chọn nào có bằng chứng thực sự và những lựa chọn nào thì không. Chúng tôi hướng tới việc đặt ra các kỳ vọng thực tế, chứ không phải những lời hứa. Nếu một phương pháp điều trị thiếu dữ liệu mạnh mẽ từ con người, chúng tôi sẽ trung thực chia sẻ điều đó với bạn.

Reviewed by Kieran Hirpara · 12 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Orthopaedic and sports medicine providers must understand the current lack of evidence to support the clinical use of injectable peptide therapies, despite their potential therapeutic and regenerative benefits [1].
  • Therapeutic strategies for microfracture augmentation, such as those using growth factor–functionalized self-assembling peptide hydrogel scaffolds, can be cost-effective ways to improve cartilage healing outcomes [2].
  • Functionalized self-assembled peptides with hBMP7 biological activity promote the differentiation of adipose-derived stem cells (ADSCs) into nucleus pulposus-like cells [3].
  • Treatment of trochlear defects with only KLD (self-assembling peptide) or only microfracture resulted in an improvement in clinical symptoms compared with no treatment [4].
  • The improvement in clinical symptoms from treating defects with only KLD or only microfracture likely resulted from different causes depending on the treatment [4].
  • The literature on injuries involving artificial turf is suitable for qualitative analysis only due to vast heterogeneity in factors such as level of play, sex, and definition of injury [5].
  • The authors do not recommend the use of BPC-157 for sports performance and recovery because there are no randomized controlled trials investigating its use in human subjects [7].
  • The science is clearly lacking to determine the overall effectiveness, safety profile, and clinical indications for BPC-157 use in sports enhancement in athletes [7].
  • The critical reader uses figures in publications to guide the interpretation of study findings that are described in the text [8].
  • EGYFIL, a topical lotion based on hyaluronic acid and peptides, is safe and seems to reduce pain and stiffness in patients during the 3 days of treatment [9].
  • EGYFIL reduces pain and stiffness in patients already after 3 hours from the first application [9].

How It Works

  • Injectable peptide therapy possesses significant therapeutic and regenerative potential [1].
  • Orthopaedic and sports medicine providers currently lack sufficient evidence to support the clinical use of peptide therapies [1].
  • Self-assembling peptides with hBMP7 biological activity promote the differentiation of adipose-derived stem cells (ADSCs) into nucleus pulposus-like cells [3].
  • Treatment of trochlear defects with only KLD self-assembling peptide or only microfracture results in an improvement in clinical symptoms compared with no treatment [4].
  • The improvement in clinical symptoms from KLD or microfracture treatment likely results from different causes depending on the specific treatment [4].
  • There are no randomized controlled trials investigating the use of BPC-157 in human subjects [7].
  • The science is lacking to determine the overall effectiveness, safety profile, and clinical indications for BPC-157 use in sports enhancement in athletes [7].
  • The authors do not recommend the use of BPC-157 for sports performance and recovery [7].
  • EGYFIL, a topical lotion based on hyaluronic acid and peptides, is safe for the treatment of pain and stiffness in soft tissues [9].
  • EGYFIL reduces pain and stiffness in patients during a 3-day treatment period [9].
  • EGYFIL reduces pain and stiffness already after 3 hours from the first application [9].
  • BMP-7 application significantly enhances the quality of tendon-to-bone healing by promoting structural maturation [10].
  • BMP-7 application significantly enhances the quality of tendon-to-bone healing by promoting functional stability [10].
  • GHRP-2 administration reduced M1 macrophage polarization in a rat rotator cuff tear model [11].
  • GHRP-2 administration enhanced histologic tendon-bone healing properties in a rat rotator cuff tear model [11].
  • GHRP-2 administration enhanced biomechanical tendon-bone healing properties in a rat rotator cuff tear model [11].
  • Axon preservation and minimal inflammation were observed in animals treated with BDNF-incorporated biofunctionalized peptide-based hydrogel [12].
  • Locomotor functional recovery was not observed in animals treated with BDNF-incorporated biofunctionalized peptide-based hydrogel [12].
  • The designed intervention of BDNF-incorporated hydrogel indicates potentiality for further evaluations in developing efficient therapies for severe spinal cord injury [12].

What the Evidence Shows

  • Orthopaedic and sports medicine providers must understand the current lack of evidence to support the clinical use of injectable peptide therapies [1].
  • The improvement in clinical symptoms from KLD or microfracture alone likely resulted from different causes depending on the treatment [4].
  • Injectable therapeutic peptides are not recommended for sports performance and recovery because there are no randomized controlled trials investigating their use in human subjects [7].
  • The science is lacking to determine the overall effectiveness, safety profile, and clinical indications for peptide use in sports enhancement in athletes [7].
  • BMP-7 application significantly enhances the quality of tendon-to-bone healing by promoting structural maturation and functional stability in a rat rotator cuff tear model [10].
  • GHRP-2 administration enhanced histologic and biomechanical tendon-bone healing properties in a rat rotator cuff tear model [11].

Practical Considerations

  • The science is lacking to determine the overall effectiveness, safety profile, and clinical indications for BPC-157 in sports enhancement in athletes [7].
  • The use of BPC-157 for sports performance and recovery is not recommended [7].
  • Functionalized self-assembled peptides promote the differentiation of adipose-derived stem cells (ADSCs) into nucleus pulposus-like cells [3].
  • Treatment of trochlear defects with only KLD (self-assembling peptide) resulted in an improvement in clinical symptoms compared with no treatment [4].
  • Treatment of trochlear defects with only microfracture resulted in an improvement in clinical symptoms compared with no treatment [4].
  • The improvement in clinical symptoms from KLD or microfracture treatment likely resulted from different causes depending on the treatment [4].
  • EGYFIL reduces pain and stiffness in patients during the 3 days of treatment [9].

Key Evidence

  • [L5] While peptide therapy may possess significant therapeutic and regenerative potential, it is critical that orthopaedic and sports medicine providers understand the current lack of evidence to support the clinical use of these peptides. [1] (10.1177/03635465251357593)
  • [L5] Therapeutic strategies for microfracture augmentation, such as those presented in this study, can be cost-effective ways to improve cartilage healing outcomes. [2] (10.1177/03635465211021798)
  • [L5] The functionalized self-assembled peptide promotes the differentiation of ADSCs into nucleus pulposus-like cells. [3] (10.1186/s13018-022-03102-8)
  • [L5] Treatment of defects with only KLD or with only microfracture resulted in an improvement in clinical symptoms compared with no treatment; the improvement likely resulted from different causes depending on the treatment. [4] (10.2106/jbjs.m.01408)
  • [L4] The authors argue that the literature on injuries involving artificial turf is suitable for qualitative analysis only due to vast heterogeneity in factors such as level of play, sex, and definition of injury. [5] (10.1177/03635465231210186)
  • [L5] The authors do not recommend the use of BPC-157 for sports performance and recovery because there are no randomized controlled trials investigating its use in human subjects, and the science is clearly lacking to determine the overall effectiveness, safety profile, and clinical indications for sports enhancement in athletes. [7] (10.1016/j.arthro.2024.09.005)
  • [L5] The critical reader uses figures in publications to guide the interpretation of study findings that are described in the text. [8] (10.1177/03635465241259467)
  • [L4] EGYFIL is safe and seems to reduce pain and stiffness in patients during the 3 days of treatment, already after 3 h from the first application. [9] (10.1186/s12891-023-06903-y)
  • [L5] BMP-7 application significantly enhances the quality of tendon-to-bone healing by promoting structural maturation and functional stability. [10] (10.1016/j.jse.2026.04.003)
  • [L5] GHRP-2 administration reduced M1 macrophage polarization and enhanced histologic and biomechanical tendon-bone healing properties in a rat rotator cuff tear model. [11] (10.1016/j.arthro.2024.11.094)
  • [L5] Although locomotor functional recovery was not observed, axon preservation and minimal inflammation in animals treated with BDNF-incorporated hydrogel indicate the potentiality of the designed intervention for further evaluations in the path of developing efficient therapies for severe spinal cord injury. [12] (10.1016/j.injury.2018.12.027)

References

[1] Injectable Peptide Therapy: A Primer for Orthopaedic and Sports Medicine Physicians. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465251357593

[2] Microfracture Augmentation With Trypsin Pretreatment and Growth Factor–Functionalized Self-assembling Peptide Hydrogel Scaffold in an Equine Model. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211021798

[3] Self-assembling peptides with hBMP7 biological activity promote the differentiation of ADSCs into nucleus pulposus-like cells. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03102-8

[4] Effects of the Combination of Microfracture and Self-Assembling Peptide Filling on the Repair of a Clinically Relevant Trochlear Defect in an Equine Model. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.01408

[5] Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass Playing Surfaces: Response. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465231210186

[7] Injectable Therapeutic Peptides—An Adjunct to Regenerative Medicine and Sports Performance?. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.09.005

[8] The Critical Reader: Visualizing Data. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241259467

[9] A pre-market interventional, single-arm clinical investigation of a new topical lotion based on hyaluronic acid and peptides, EGYFILTM, for the treatment of pain and stiffness in soft tissues. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06903-y

[10] Effects of BMP-7 and Low Molecular Weight Peptide Solution on Healing in a Rotator Cuff Tear Model: A Histopathological and Biomechanical Study in Rats. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.003

[11] Growth Hormone–Releasing Peptide 2 May Be Associated With Decreased M1 Macrophage Production and Increased Histologic and Biomechanical Tendon‐Bone Healing Properties in a Rat Rotator Cuff Tear Model. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.11.094

[12] Biofunctionalized peptide-based hydrogel as an injectable scaffold for BDNF delivery can improve regeneration after spinal cord injury. Injury. 2019. DOI: 10.1016/j.injury.2018.12.027

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a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.