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R Amino acid conjugation: The two-step reaction involves: (1) mitochondrial medium-chain acyl-CoA ligase (HXM-A and HXM-B) activating the carboxylic acid substrate with CoA in an ATP-dependent reaction to form an acyl-CoA thioester, and (2) GLYAT (glycine N-acyltransferase) transferring the acyl group from CoA to the alpha-amino group of glycine via a ping-pong mechanism

The reduction in glucose flux toward the TCA cycle favors rewiring to lactate production

The Three Inputs Onto The Somatotroph GH secretion from the anterior pituitary is governed by three principal signals: (1) GHRH, which stimulates GH synthesis and release via a cyclic-AMPdependent pathway

Published clinical data supports accelerated initial response with the combination approach