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Produced by the liver in response to GH, it activates the IGF-1R receptor in muscle cells, triggering the PI3K/Akt/mTOR pathway, which stimulates protein synthesis, inhibits proteolysis, and promotes the proliferation of satellite cells (muscle precursors)

their capillaries and veins (including mastoid emissary veins to the sigmoid sinus) can carry drug into the venous and arterial circulation around the inner ear

Furthermore, the increased expression of HO-1 in individuals suffering from heart failure serves to mitigate the adverse effects of pathological left ventricular remodeling, diminish myocardial hypertrophy, minimize oxidative stress, and abate inflammatory activation [96]

Some individuals report transient flushing, headache, or water retention during initial titration