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This is one practical reason why higher concentrations (10 mg/ml and 20 mg/ml) are more popular for tirzepatide
They also remain outside the scope of the FDAs interim enforcement discretion policy, which currently extends only to substances in Category 1
"Nicotinamide N-methyltransferase regulates hepatic nutrient metabolism through Sirt1 protein stabilization." Nature Medicine
Much of the foundational research also comes from a single research group, which limits the breadth of independent validation