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Proposed Mechanism of cAMP Anti-Fibrotic Effects. Anti-fibrotic effects of cAMP are proposed to involve 1) increased PKA and p-CREB, 2) down-regulation of p-Smad2/3 binding to CBP, 3) concomitant reduced activation of p-Smads and the Smad-induced genes, Collagen I, Fn and α-SMA in induced fibroblasts, and 4) a resultant inhibition of myofibroblast differentiation
