RAPGEF3 and keloid: Epac1 inhibition with ESI-09 suppresses keloid fibroblast proliferation, migration, collagen synthesis, and fibrosis-related marker expression by reducing Akt phosphorylation, while concurrently promoting apoptosis, highlighting Epac1/Akt signaling as a potential therapeutic target in keloid fibrosis (Lv et al., 2021a).