RESEARCHING AGE-RELATED WEIGHT GAIN A PEPT ID E SCI ENCE S EDU C ATIONAL INS IGH T CONT E N TS 01 WHAT IS SOMATOPAUSE?............ 5 02 THE ROLE OF PEPTIDES IN WEIGHT GAIN........ 9 WHAT ARE PEPTIDES?..................... 10 GROWTH HORMONE RESEARCH AND ENERGY BALANCE.....................................11 MITOCHONDRIAL RESEARCH AND METABOLISM................................ 16 HORMONE RESEARCH AND HUNGER............ 18 03 CONCLUSION............ 23 04 RESOURCES............ 25 ALL ARTICLES AND PRODUCT INFORMATION PROVIDED ON THIS WEBSITE ARE FOR INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY. THE PRODUCTS WE OFFER ARE NOT INTENDED FOR HUMAN USE DIRECTLY. THEY ARE INTENDED FOR IN-VITRO AND PRE-CLINICAL RESEARCH PURPOSES ONLY. THESE PRODUCTS ARE NOT MEDICINES OR DRUGS AND HAVE NOT BEEN APPROVED BY THE FDA TO PREVENT, TREAT OR CURE ANY MEDICAL CONDITION, AILMENT OR DISEASE. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 2 INTRO RESEARCHING AGE-RELATED WEIGHT GAIN Hormones control almost everything in our bodies, from growth to metabolism to how fast our hair grows. As we age, levels of hormones change, altering the way our bodies work. Most everyone has heard of menopause, the decline in estrogen that occurs in women as they age. Many people have also heard of low T (andropause), which is the decline of testosterone in men with age. There is another hormone change that many people have not heard of, however, called somatopause. Scientists are paying a lot of attention to somatopause because research shows that it has dramatic effects on weight gain, fat mass, muscle mass, bone strength, heart health, mood, and more. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 3 01 WHAT IS SOMATOPAUSE? 01 WHAT IS SOMATOPAUSE? Just like testosterone and estrogen, growth hormone (GH) levels decline with age. Lower levels of GH make it harder to build muscle and burn fat. This decline in growth hormone with age is known as somatopause. Research indicates that somatopause is one reason why we get fatter as we age. It is also why exercise becomes less effective and contributes to a decline in physical function declines Pattern of GH changes with age. Levels peak at age 20 and then begin to steadily decline around age 30. as we age as well. It can Source: National Library of Medicine fat accumulation, increased lead to frailty, abdominal triglyceride and cholesterol levels, increased risk of heart disease, and even deterioration of mental function. Animal studies show that growth hormone levels decline by about 15%, per decade, starting at Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 5 level changes, is the major reason that we all gain cha pt er o ne the age of 30. This, combined with other hormone 1-2 pounds every year from age twenty to about age sixty[1]. Unfortunately, most of that weight gain is in the form of fat. Age-Related Weight Gain and Body Composition Somatopause is a major factor contributing to agerelated changes in “body composition” or the ratio of lean body mass (i.e. muscle and bone) to fat. However, it isn’t the only factor that affects body composition. Changes in mitochondrial function and the hormones that control hunger contribute as well. Less energetic mitochondria burn less energy at rest, lowering baseline metabolism. At the same time, changes in certain gut and brain chemicals can affect our appetite and even the types of food we crave. Fighting against these changes is difficult because it means fighting an uphill battle against our very biology. Lower levels of GH make us less responsive to exercise and decrease our energy levels. Changes in mitochondria mean we burn fewer calories at rest. Alterations in neurotransmitters mean we seek out Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 6 cha pt er t w o “RESEAR C H HAS S HO W N T H A T PEPTI D ES C AN HEL P R EV E R SE A GE-RELA TED W EIGHT GAIN A N D M AYBE EV EN EX T END L I F E ” foods that are less healthy and more fattening. Simply put, we have to work harder than ever before to maintain a healthy body weight as we age. Unfortunately, this often means we fall into a vicious cycle of ever-increasing weight gain. It isn’t all bad news though. The Good News About Age-Related Weight Gain Science is uncovering new ways to combat age-related weight gain by restoring growth hormone to more youthful levels, regulating fat burning in mitochondria, and altering feelings of hunger and fullness (satiety). Research in animals has shown that peptides can help reverse age-related weight gain and maybe even extend life by resetting metabolism to more youthful level. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 7 02 THE ROLE OF PEPTIDES IN WEIGHT GAIN 02 THE ROLE OF PEPTIDES IN WEIGHT GAIN Peptides are not new. Scientists have been investigating their properties since the mid-1800s. Research in the area was hampered, however, by the difficulty of obtaining peptides. Until recently, most peptides were either harvested from animals or collected from cadavers. With the development of modern synthetic biology, however, peptides can be produced quickly, reliably, and affordably in a laboratory. The result has been an explosion in peptide research in the last fifty years. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 9 M O D E R N SY N T H E T I C BI OL O G Y , cha pt er t w o “W I T H T H E D E V E L O P M E N T O F H OW E V E R , P E P T I D E S C A N BE P R OD U C E D Q U I C K L Y , R E L I A B LY , A N D A F F OR D A BL Y I N A L A BO R A T O R Y . " What Are Peptides? Peptides are short proteins made up of tiny parts called amino acids. Peptides are remarkable for their ability to manifest ever more complex structures from these simple building blocks. This gives peptides and proteins an almost limitless set of properties, which explains why they are critical in many aspects of biology. One fundamental role of peptides is as signaling molecules to help the body coordinate activities like growth, immune function, energy balance, and more. As we will see, this means that peptides, acting as hormones, play fundamental roles in regulating metabolism, weight, hunger, growth, sleep, and more. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 10 " IF WE TAKE IN MO R E ENE R G Y Energy balance refers to TH AN WE USE, O U R B O D IES S T O R E how our body deals with IT AS F AT AND GL YC O GE N. " cha pt er t w o Growth Hormone Research and Energy Balance differences between the energy we take in and the energy we use in a given day. If we take in more energy than we use, our bodies store it as fat and glycogen. When we take in less energy than we need, our bodies tap into those energy stores to meet demand. Peptides regulate this energy balancing act and can tip the scales toward or away from storage. Growth hormone is a primary energy balance hormone. High levels of GH favor muscle and bone growth while preventing fat storage. As we age, GH levels fall and the balance shift. We start to gain fat and lose muscle While it is possible to supplement directly with GH, research shows that this approach has too many serious side effects to be useful. Animal research suggests that the better approach is to stimulate the body to make more GH naturally. Some peptides, like sermorelin, GHRP-6, CJC-1295, and others do just that. These peptides are derived from the molecules that control GH production in the pituitary gland. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 11 cha pt er t w o The Growth Hormone Cycle Author: OpenStax College Source: Anatomy & Physiology, Connexions Web site. Compounds that Show Promise Before we examine a few of the more exciting compounds involving metabolism, let’s think forward to the exciting breakthroughs on the horizon. Peptides can provide the stimulus necessary to keep cells producing energy, dividing, replicating themselves efficiently, as well as efficiently disposing of degraded cellular matter. As we better understand the ways peptides can be harnessed Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 12 cha pt er t w o to optimize cellular function, we are also improving our ability to synthesize these powerful compounds. The original forms of commercially available insulin and growth hormone were extracted from cadavers! With modern technology these peptides are now synthesized and we are getting better at it quickly. The likelihood is, the future of peptides is one where they will be increasingly used to treat all forms of metabolic disorder. Anything that interferes with highly energetic and vibrant life is put on notice. Things like cancer treatments, the maintenance of healthy organs, muscles, and bones will be at the top of that list. This will be a general extension of youthful appearance and cellular health. Imagine a world where 60 and 70 year olds still have the hair, skin, and bodies they did in their 30s. This is not even an extreme example of what is achievable the more we learn how to positively influence cellular health with these compounds. More important are the things that will be addressed both directly and by second order preventative action. Yes healthy cells resist anomaly, but peptides are also showing massive success directly effecting the signaling pathways that may allow us to enhance our immune and regenerative properties far beyond anything we are capable of today. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 13 cha pt er t w o Research with Growth Hormone Secretagogues (Growth Hormone Mimics) Most of the research into growth hormone has studied the class of peptides known as growth hormone secretagogues. These peptides boost levels of GH secretion from the anterior pituitary gland by simulating the effects of growth hormone releasing hormone (GHRH). The benefits of this approach are that it allows the body to maintain normal patterns of GH secretion as well as normal feedback control of GH production. Together, these reduce the risks of side effects and overdose while making administration simpler. The growth hormone secretagogues can be broadly divided into two categories. The first are growth hormone releasing hormone analogues like sermorelin and CJC-1295. These peptides cause a physiologic but enhanced release of GH and have few if any side effects. The second category are growth hormone secretagogue receptor agonists that mimic the natural peptide ghrelin. Peptides like GHRP-2, GHPR-6, hexarelin, and Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 14 represent some of the earliest peptides for weight loss cha pt er t w o ipamorelin fall into this category. These peptides ever developed and tested. The ghrelin mimetics are well known for their ability to cause dramatic increases in GH levels. Fragment 176-191 (Growth Hormone Analogue) Fragment 176-191 is a small piece of the larger GH protein. It works by mimicking the effects of GH in the body and by increasing the density of the beta-3 adrenergic receptor that controls how fast we burn fat. Fragment 176-191 appears to only affect fat tissue. Research LEARN MORE >> in mice shows that only obese mice lose weight while using this peptide. Normal weight mice simply maintain their body weight[2]. AOD9604 (Growth Hormone Analogue) AOD9604 is derived from growth hormone and specifically developed to maintain the lipolytic (fat Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 15 cha pt er t w o burning) features of growth hormone without retaining any LEAo R Nf << MORE growth hormone’s other effects. AOD9604 increases weight loss 3-fold compared to placebo. It especially affects beta-3- adrenergic receptor density on white fat to increase rates of fat breakdown. AOD9604 has been shown to be one of the most effective peptides for weight loss, with animal studies showing as much as a 50% reduction in weight gain over just three-weeks of administration[2]. Ipamorelin (Ghrelin Mimetic) Ipamorelin simulates the effects of ghrelin and causes a natural GH release from the anterior oL E fA R N pituitary. It is interesting for its weight loss properties and its ability MORE >> t o to stimulate bone growth. Ipamorelin is undergoing research as a potential treatment for osteoporosis and other bone-loss conditions[3]–[5]. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 16 cha pt er t w o Mitochondrial Research and Metabolism Another place in which peptides have shown promise is in the regulation of metabolic rate. Simply defined as the rate at which we burn energy, metabolism is the fundamental process that sustains life in an organism. Disruptions of metabolism can lead to everything from obesity to extreme weight loss, cancer, disorders of “ MET AB O L IS M IS T H E FUN D EMENT AL P R O C ES S T H A T the immune system, and can even accelerate the process of aging itself. SUS TAINS LI F E IN AN O R GANI SM ” Most of the energy our bodies use is produced in tiny compartments inside of cells. These compartments, called mitochondria, are where food energy is converted into energy that our body can use. The faster mitochondria work, the higher our metabolism is and the faster we “burn” calories. Research shows that peptides can regulate the rate at which mitochondria work, turning them up or down. This can be used to fine-tune energy balance. Increasing metabolism this way can especially help to burn fateven without exercising! Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 17 Ipamorelin is a highly selective growth hormone (GH) cha pt er t w o CJC-1295 + Ipamorelin secretagogue[1]. By acting on the ghrelin/growth hormone secretagogue receptor, ipamorelin improves bone health, boosts muscle repair and development, stimulates insulin release, and improves bowel motility and gastric function[3] [5] [19]–[21]. LEARN MORE >> CJC-1295 (without DAC aka Modified GRF) causes GH release by stimulating the growth hormone positive hormone receptor. benefits on It releasing is bone has demonstrated health, lean body mass, insulin resistance, and muscle growth and development[22]–[24] Combining the two peptides may produce enhanced effects by stimulating the growth hormone axis via two different receptors. CJC-1295 will be produce both higher peaks and higher troughs while preserving normal growth hormone pulsatile secretion. Ipamorelin will further augment those peaks. Together, the peptides could lead to a higher set point for the normal ebb and flow of natural GH release, resulting in improved lean body mass, better muscle development, and overall better metabolic function. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 18 Research Formula cha pt er t w o Longevity, Performance & Obesity 5-amino-1MQ is a small molecule that blocks the activity of nicotinamide N-methyltransferase (NNMT). Blocking NNMT increases NAD+ levels, improves metabolic rate, and activates sirtuin-1 (SIRT1). SIRT1 is known as the "longevity gene" because of its role in reducing the risks of multiple diseases[10] [25]–[26]. NMN (Nicotinamide mononucleotide) is a unique form of vitamin B3 that gets converted into Nicotinamide Adenine Dinucleotide (NAD+). NAD+ declines with age and is an essential coenzyme for energy production, cellular repair, and the regulation of aging (via sirtuins). NMN supports the synthesis of NAD+ and may therefore decrease age-associated body weight gain, improve energy metabolism and glucose homeostasis, alter plasma lipid profiles, enhance eye function, and improve insulin control[27]–[30]. LEARN << MORE Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 19 cha pt er t w o JBSNF-000088 inhibits NNMT activity, reduces MNA levels, and drives insulin sensitization, glucose modulation, and body weight reduction in animal models of metabolic disease. In mice with high fat diet (HFD)-induced obesity, JBSNF-000088 caused a reduction in body weight and normalized glucose tolerance to the level of lean control mice. These three compounds primarily affect levels of NAD (both directly and via decreased NNMT activity) and increase the expression of GLUT-4 receptors. Together, these effects improve cellular metabolism, enhance weight loss, and improve glucose control. Additionally, increased levels of NAD help stem cells to survive and thrive, providing a pool of healthy cells that can readily take the place of those that are worn or damaged. This leads to improved tissue function and decreased effects of aging. Activating sirtuin-1 (SIRT1), the "longevity gene," can reduce the risks of diabetes, obesity, metabolic syndrome, cardiovascular disease, kidney disease, liver disease, and neurodegeneration. By combining these three research compounds, it might be possible to drastically alter energy metabolism for the better while simultaneously boosting anti-aging, anti-inflammatory, and anti-apoptosis activity in cells. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 20 MOTS-c is a very short peptide, even among peptides for cha pt er t w o MOTS-c (Mitochondrial/Nuclear Gene Regulator) weight loss, which allows it get into mitochondria and affect metabolism at the most basic level. Research with MOTS-c has been shown to promote the burning of fat and sugar in mitochondria by activating the AMPK pathway[6], [7]. This is similar to what happens in ketogenic diets like the Atkin’s diet, but without the need to radically alter what LEARN MORE >> you eat. 5-Amino-1MQ (NNMT Inhibitor) 5-Amino-1MQ (5-amino-1-methylquinolinium) inhibits an enzyme known as NNMT. NNMT regulates the futile cycle, which our bodies use when we are cold to convert energy to heat. The futile cycle is highly effective at burning fat, but NNMT turns this cycle off. Reasearch shows that 5-Amino-1MQ blocks NNMT and increases the rate of the futile cycle. It also shows that 5-Amino-1MQ causes dramatic weight loss in mouse LEARN << MORE models – as much as 35% fat loss in just 11 days[8]–[10]. As an added bonus, 5-Amino-1MQ lowers total cholesterol levels significantly[10]. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 21 cha pt er t w o Hormone Research and Hunger We tend to think of hunger as our bodies telling us we need energy, but that isn’t quite true. Hunger is controlled by a complex array of hormones and neurotransmitters in our brains that evaluate everything from the time of day to the mood we are in. The signals our stomach sends to our brain to tell us we are hungry are also susceptible to dysregulation by a number of factors including age, insulin sensitivity, hormone levels, and more. The drive to eat can be triggered not just by a low energy state, but by various sights, sounds, smells, and even emotions. Controlling hunger is no simple task, especially when it becomes dysregulated. Research shows that a number of peptides and neurotransmitters play a role in hunger and food cravings. They can prompt us to eat less and can even affect the kinds of food we prefer, leading us to choose more nutritious foods over fatty foods. Common targets for suppressing hunger in animal studies include the GLP1 receptor, the GIP receptor, and the dopamine receptor in the brain. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 22 cha pt er t w o Semaglutide (GLP-1 Receptor Agonist) Semaglutide is an agonist of the GLP1 receptor and works in two different ways. First, Semaglutide can delay gastric emptying and slow intestinal motility (movement) to increase LEARN MORE >> feelings of fullness and decrease the rate of rise of blood sugar. Second, Semaglutide can act as a neurotransmitter to reduce the drive to eat in the brain. Research has shown it to produce a 5% weight loss over 6 months and average weight loss of 15% at one year[11]. Tirzepatide (GLP-1 and GIP Receptor Agonist) Tirzepatide is a peptide that interacts with both the GLP-1 receptor and the GIP receptor (i.e. twincretin). It is similar to Liraglutide and Semaglutide, but with additional properties. Compared to strict GLP-1 LEARN MORE >> receptor agonists, Tirzepatide has been show to be nearly 33 times more likely to produce weight loss of 15% or Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 23 more. Tirzepatide acts on the GLP- HAS S HOW N T O B E 3 3 % 1 receptor in the central nervous TI MES MOR E L IKEL Y T O P ROD UCE TO W EIGHT L O S S OF 15% O R MO R E.” cha pt er t w o “TI RZEPA TID E R ES EAR C H system to curb appetite and on the GIP receptor in the gut to boost insulin release and inhibit gastrin release. Tirzepatide research has shown to promote an average weight loss of 11 kg (25 lbs) over 12 months[13], [14]. It also lowers triglycerides and other factors that are associated with heart disease[12]. Tesofensine Tesofensine is a dopamine- serotonin-norepinephrine (triple) reuptake inhibitor. Originally being studied for Parkinson’s Disease, LEARN MORE >> Tesofensine was quickly identified as a potential weight loss product when its most common “side effect” turned out to be weight loss. Research in mice shows that Tesofensine regulates appetite and food cravings to decrease energy intake. Tesofensine research has been shown to promote a 10.6% weight loss over 24 weeks[15], [16]. It is thought that Tesofensine suppresses appetite by increasing dopamine levels in the brain[17]. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 24 03 CONCLUSION 03 CONCLUSION Gaining weight as we age is an all-too-common problem that is associated with changes in exercise capacity, decreased energy levels, impaired heart health, and waning cognitive function. We once blamed all of these changes on the ravages of aging, but have discovered that they may have more to do with declining hormone levels. In fact, animal research has started to reveal that these “inevitable” consequences of aging may actually be preventable or even reversible. Peptide research is untangling the mystery of how we regulate weight. It is leading to discoveries that may make it possible for us live longer, healthier lives. Animal studies have demonstrated that we can regulate energy balance, improve cardiac health, boost fat burning, and build more muscle through the scientific application of peptides. Ongoing research with peptides is helping us to understand what causes our bodies deteriorate as we age. This research may eventually usher in a new era of wellness by not only increasing life span, but by increasing health span as well. Peptide research is unlocking the science to living long, healthy, fulfilling lives. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 26 04 RESOURCES 04 RESOURCES [1] “Middle-Age Weight Gain Study.” https://www2.lbl.gov/Science-Articles/Archive/spare-tire.html (accessed Apr. 21, 2022). [2] M. Heffernan et al., “The effects of human GH and its lipolytic fragment (AOD9604) on lipid metabolism following chronic treatment in obese mice and beta(3)-AR knock-out mice,” Endocrinology, vol. 142, no. 12, Art. no. 12, Dec. 2001, doi: 10.1210/endo.142.12.8522. [3] N. B. Andersen, K. Malmlöf, P. B. Johansen, T. T. Andreassen, G. Ørtoft, and H. Oxlund, “The growth hormone secretagogue ipamorelin counteracts glucocorticoid-induced decrease in bone formation of adult rats,” Growth Horm. IGF Res., vol. 11, no. 5, Art. no. 5, Oct. 2001, doi: 10.1054/ghir.2001.0239. [4] J. V. Gobburu, H. Agersø, W. J. Jusko, and L. Ynddal, “Pharmacokinetic-pharmacodynamic modeling of ipamorelin, a growth hormone releasing peptide, in human volunteers,” Pharm. Res., vol. 16, no. 9, Art. no. 9, Sep. 1999, doi: 10.1023/a:1018955126402. [5] J. Svensson et al., “The GH secretagogues ipamorelin and GH-releasing peptide-6 increase bone mineral content in adult female rats,” J. 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Neelakantan et al., “Selective and membrane-permeable small molecule inhibitors of nicotinamide N-methyltransferase reverse high fat diet-induced obesity in mice,” Biochem. Pharmacol., vol. 147, pp. 141– 152, Jan. 2018, doi: 10.1016/j.bcp.2017.11.007. [11] D. H. Ryan, “Drugs for Treating Obesity,” Handb. Exp. Pharmacol., Nov. 2021, doi: 10.1007/164_2021_560. [12] S. Urva et al., “The novel dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide transiently delays gastric emptying similarly to selective long-acting GLP-1 receptor agonists,” Diabetes Obes. Metab., vol. 22, no. 10, pp. 1886–1891, Oct. 2020, doi: 10.1111/dom.14110. Copyr igh t © 2023 | P EP T I D E SC I EN C ES. A ll r ig h t s r e s e r v e d . 28 04 RESOURCES [13] B. Ludvik et al., “Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial,” Lancet Lond. Engl., vol. 398, no. 10300, pp. 583–598, Aug. 2021, doi: 10.1016/ S0140-6736(21)01443-4. [14] M. K. Thomas et al., “Dual GIP and GLP-1 Receptor Agonist Tirzepatide Improves Beta-cell Function and Insulin Sensitivity in Type 2 Diabetes,” J. Clin. Endocrinol. Metab., vol. 106, no. 2, pp. 388–396, Nov. 2020, doi: 10.1210/clinem/dgaa863. [15] A. Astrup, S. Madsbad, L. Breum, T. J. Jensen, J. P. Kroustrup, and T. M. Larsen, “Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial,” Lancet Lond. Engl., vol. 372, no. 9653, Art. no. 9653, 29 2008, doi: 10.1016/S01406736(08)61525-1. [16] A. Astrup, D. H. Meier, B. O. Mikkelsen, J. S. Villumsen, and T. M. Larsen, “Weight loss produced by tesofensine in patients with Parkinson’s or Alzheimer’s disease,” Obes. Silver Spring Md, vol. 16, no. 6, Art. no. 6, Jun. 2008, doi: 10.1038/oby.2008.56. [17] A. M. D. Axel, J. D. Mikkelsen, and H. H. Hansen, “Tesofensine, a novel triple monoamine reuptake inhibitor, induces appetite suppression by indirect stimulation of alpha1 adrenoceptor and dopamine D1 receptor pathways in the diet-induced obese rat,” Neuropsychopharmacol. Off. Publ. Am. Coll. Neuropsychopharmacol., vol. 35, no. 7, Art. no. 7, Jun. 2010, doi: 10.1038/npp.2010.16. [18] K. Raun et al., “Ipamorelin, the first selective growth hormone secretagogue,” Eur. J. Endocrinol., vol. 139, no. 5, Art. no. 5, Nov. 1998, doi: 10.1530/eje.0.1390552. [19] N. K. Aagaard et al., “Growth hormone and growth hormone secretagogue effects on nitrogen balance and urea synthesis in steroid treated rats,” Growth Horm. IGF Res., vol. 19, no. 5, Art. no. 5, Oct. 2009, doi: 10.1016/j.ghir.2009.01.001. [20] E. 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