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MMP-13 (matrix metalloproteinase-13) is involved in cartilage degradation;331 ADAMTS5 is closely related to cartilage damage and inflammation.332,333,334 The NO produced by iNOS, as a free radical, can regulate intracellular signal transduction and modulate the inflammatory response.335,336 The expression of iNOS is primarily activated by the NF-B pathway, which is activated and translocated to the nucleus upon inflammatory stimulation (such as bacterial endotoxins or pro-inflammatory cytokines), thus increasing the transcription and expression of iNOS.337,338,339 GLP-1 can exert its anti-inflammatory effects by activating its receptor, GLP-1R.339 When GLP-1 binds to GLP-1R, it activates the cAMP signaling pathway, leading to increased cAMP levels.1,340 The rise in cAMP further activates PKA, which can inhibit the NF-B signaling pathway, reducing the production of inflammatory factors such as iNOS and other inflammation-related proteins.12,340,341 The expression of MMP-13 is regulated by IL-1 and TNF-
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