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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.

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.

Định nghĩa

Liệu pháp peptide tiêm sử dụng các đoạn protein nhỏ để hỗ trợ cơ thể bạn chữa lành các mô bị tổn thương. Các peptide này được thiết kế để tương tác với các tế bào của bạn nhằm thúc đẩy quá trình sửa chữa. Hiện nay, chúng đang được nghiên cứu ứng dụng trong các tình trạng chấn thương chỉnh hình và y học thể thao. Bao gồm các vấn đề như rách gân, tổn thương sụn và đau mô mềm.

Khoa học về lĩnh vực này vẫn đang trong giai đoạn phát triển. Hiện chưa có đủ bằng chứng để hỗ trợ việc sử dụng chúng một cách thường quy trong lâm sàng các chuyên ngành này. Ví dụ, mặc dù một số nghiên cứu trên động vật cho thấy tiềm năng trong việc chữa lành gân hoặc sụn, nhưng chưa có các thử nghiệm ngẫu nhiên có đối chứng (RCT) trên người đối với một số peptide nhất định như BPC-157. Do thiếu hụt dữ liệu trên người, các chuyên gia không khuyến cáo sử dụng BPC-157 để nâng cao thành tích thể thao hoặc phục hồi chức năng. Tính an toàn và hiệu quả tổng thể đối với việc tăng cường thể lực nói chung vẫn chưa rõ ràng.

Tuy nhiên, một số liệu pháp cụ thể đã cho thấy những dấu hiệu ban đầu về lợi ích. Một liệu pháp gọi là EGYFIL được đánh giá là an toàn để điều trị đau và cứng khớp ở mô mềm. Bệnh nhân thường cảm thấy giảm đau và cứng khớp chỉ sau 3 giờ từ lần áp dụng đầu tiên. Sự giảm đau này tiếp tục duy trì trong suốt giai đoạn điều trị tiêu chuẩn kéo dài 3 ngày. Các phương pháp khác, chẳng hạn như sử dụng các giá đỡ peptide tự lắp ráp, đang được nghiên cứu nhằm cải thiện quá trình chữa lành sau các thủ thuật như vi gãy xương (microfracture). Những phương pháp này nhằm mục đích tạo ra một môi trường hỗ trợ cho các quá trình sửa chữa tự nhiên của cơ thể bạn. Bác sĩ của bạn có thể thảo luận xem các lựa chọn mới nổi này có phù hợp với tình trạng cụ thể của bạn hay không.

Liệu nó có hiệu quả?

Câu trả lời ngắn gọn là chúng ta hiện chưa có đủ các thử nghiệm lâm sàng chất lượng cao trên người để khẳng định các phương pháp điều trị này hiệu quả đối với hầu hết các tình trạng bệnh. Phần lớn bằng chứng hiện tại đến từ các nghiên cứu trên động vật hoặc các thử nghiệm nhỏ trong phòng thí nghiệm. Điều này có nghĩa là bác sĩ của bạn không thể cam kết kết quả cụ thể đối với các liệu pháp peptide tiêm. Không có các thử nghiệm có đối chứng ngẫu nhiên (RCT) trên người đối với BPC-157. Cơ sở khoa học hiện chưa đủ mạnh để xác định tính an toàn hoặc hiệu quả của nó đối với quá trình phục hồi sau vận động thể thao. Vì lý do này, chúng tôi không khuyến nghị sử dụng BPC-157 để tăng cường thành tích thể thao hoặc đẩy nhanh quá trình chữa lành.

Một số phương pháp điều trị cụ thể cho thấy nhiều triển vọng trong nghiên cứu giai đoạn đầu. Ví dụ, một loại kem bôi chứa axit hyaluronic và peptide đã được thử nghiệm cho các cơn đau mô mềm. Sản phẩm này có vẻ an toàn và có thể giảm đau và cứng khớp. Bạn có thể nhận thấy sự giảm đau chỉ sau ba giờ kể từ lần bôi đầu tiên. Các lợi ích này tiếp tục duy trì trong suốt ba ngày điều trị. Các thí nghiệm khác trên động vật cho thấy một số peptide nhất định có thể giúp gân chữa lành chắc chắn hơn hoặc bảo vệ các sợi thần kinh. Tuy nhiên, những kết quả này vẫn chưa được chứng minh là có hiệu quả tương tự ở người.

Điều quan trọng là cần có cái nhìn thực tế về những gì các liệu pháp này có thể làm được trong hiện tại. Trong khi một số nghiên cứu trên động vật cho thấy quá trình chữa lành được cải thiện hoặc giảm viêm, thì các nghiên cứu khác lại không cho thấy bất kỳ sự phục hồi chức năng nào. Chúng ta phải phân biệt giữa thành công trong phòng thí nghiệm và lợi ích lâm sàng. Cho đến khi các nghiên cứu trên người quy mô lớn và nghiêm ngặt hơn được hoàn tất, các lựa chọn này vẫn còn mang tính chất thử nghiệm đối với nhiều tình trạng chỉnh hình. Bác sĩ của bạn sẽ thảo luận xem liệu pháp peptide cụ thể nào có phù hợp với trường hợp độc đáo của bạn hay không, nhưng xin vui lòng hiểu rằng cơ sở bằng chứng vẫn đang được phát triển và chưa đủ dứt khoát để sử dụng rộng rãi.

Liệu nó có phù hợp với bạn?

Liệu pháp peptide hiện chưa phải là phương pháp điều trị tiêu chuẩn cho hầu hết các chấn thương chỉnh hình hoặc thể thao. Bằng chứng hiện tại không ủng hộ việc sử dụng lâm sàng thường quy. Hầu hết các kết quả nghiên cứu đều đến từ các thí nghiệm trên động vật, chẳng hạn như chuột hoặc ngựa, hơn là trên người. Ví dụ, trong khi một số peptide cải thiện quá trình lành vết thương ở gân chuột hoặc sụn ngựa, chưa có các thử nghiệm ngẫu nhiên có đối chứng (RCT) nào đánh giá BPC-157 ở người. Các nhà khoa học hiện chưa thể xác nhận liệu nó có an toàn hay hiệu quả để tăng cường hiệu suất thể thao hay không. Bác sĩ của bạn không khuyến nghị sử dụng BPC-157 cho mục đích nâng cao hiệu suất hoặc phục hồi.

Tuy nhiên, một số lựa chọn cụ thể cho thấy tiềm năng trong việc giảm nhẹ triệu chứng. Ví dụ, EGYFIL an toàn để điều trị đau và cứng ở các mô mềm. Nó có thể làm giảm sự khó chịu của bạn nhanh chóng chỉ sau ba giờ sau lần bôi đầu tiên. Sự giảm đau này tiếp tục duy trì trong suốt ba ngày điều trị. Các phương pháp khác, như hydrogel peptide tự lắp ráp, đang được nghiên cứu để hỗ trợ sụn lành lại sau phẫu thuật vi gãy xương. Những phương pháp này có thể cải thiện các triệu chứng ở các khuyết tật khớp, mặc dù lý do chính xác cho sự cải thiện này có thể khác nhau.

Bạn nên xem đây là một quyết định chung với bác sĩ của bạn. Hãy hỏi bác sĩ về sự thiếu hụt dữ liệu dài hạn ở người. Hãy lưu ý rằng một số phương pháp điều trị thử nghiệm có thể không mang lại sự phục hồi chức năng, ngay cả khi chúng bảo tồn các cấu trúc thần kinh trong môi trường phòng thí nghiệm. Chi phí và khả năng tiếp cận thay đổi rất nhiều vì các liệu pháp này thường chưa được thiết lập hoàn toàn. Hãy đảm bảo bạn hiểu rõ những gì đã được chứng minh và những gì vẫn còn mang tính thử nghiệm trước khi tiến hành.

Kết luận chung

Các liệu pháp peptide tiêm hiện thiếu bằng chứng mạnh mẽ từ con người để hỗ trợ việc sử dụng chúng trong chỉnh hình. Mặc dù một số loại kem bôi như EGYFIL có thể giảm đau và cứng khớp trong vòng 3 giờ, nhưng hầu hết các kết quả hứa hẹn đều đến từ các nghiên cứu trên động vật, chưa được chuyển đổi sang chăm sóc lâm sàng ở người. Bạn không nên kỳ vọng những phương pháp điều trị này cải thiện đáng kể hiệu suất thể thao hoặc quá trình hồi phục. Bác sĩ của bạn sẽ dựa vào các phương pháp đã được chứng minh thay vì các peptide tiêm chưa được kiểm chứng để hỗ trợ quá trình lành bệnh của 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

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].
  • 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].
  • 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].
  • 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 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].
  • 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 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 and functional stability in a rat rotator cuff tear model [10].
  • GHRP-2 administration reduced M1 macrophage polarization in a rat rotator cuff tear model [11].
  • GHRP-2 administration enhanced histologic and 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].

Practical Considerations

  • Orthopaedic and sports medicine providers must understand the current lack of evidence to support the clinical use of injectable peptide therapies [1].
  • 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 in sports enhancement in athletes [7].
  • The use of BPC-157 for sports performance and recovery is not recommended [7].
  • 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 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, 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 the 3 days of treatment [9].
  • EGYFIL reduces pain and stiffness in patients 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].

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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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

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.