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Investigations propose that the peptide may engage signaling pathways involved in lipid metabolism, thermogenesis, and tissue remodeling, though exact mechanisms remain under study

Horsthuis DJ, Molholm S, Foxe JJ, Francisco AA (2023) Event-related potential (ERP) evidence for visual processing differences in children and adults with cystinosis (CTNS gene mutations)

& Rudolph, K

however, when recombinant IGF-1 is co-administrated with recombinant GH, circulating leptin levels are unexpectedly elevated, likely due to GH stimulatory effects on insulin production.87 Moreover, treatment with recombinant GH increases IGF-1 levels in patients undergoing hemodialysis with low protein intake, resulting in a positive nitrogen balance and suggesting an anabolic response, which may also contribute to increase the leptin levels.88 Of note, among the multiple factors, circulating IGF-1 concentration is strongly associated with loss of appetite in dialysis patients, a condition linked to poor clinical outcomes.89 However, very low IGF-1 levels have been associated with a higher mortality in CKD patients with poor muscle strength, whereas those with higher muscle strength showed improved survival despite of the reduced IGF-1 concentration.90 This suggests that muscle effects, potentially influenced by physical exercise habits or muscle-derived cytokines (myokines), may play a role in these outcomes