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doi: 10.1136/ard-2022-223626 89 HoruluogluBHKayrakliogluNTrossDKlinmanD

Mechanism Comparison Factor CJC-1295 + Ipamorelin HGH (Somatropin) Approach Stimulates endogenous GH production Replaces GH with exogenous protein Pituitary involvement Required pituitary manufactures and releases GH Bypassed GH delivered directly Feedback loop Preserved somatostatin still regulates GH levels Suppressed exogenous GH downregulates natural production GH release pattern Pulsatile, mimics natural circadian rhythm Spike-and-decline, non-physiological Receptor targets GHRH-R (CJC-1295) + GHS-R1a (Ipamorelin) GH receptor directly (no pituitary signaling) Molecular size CJC-1295: 29 AA (~3,368 Da) / Ipamorelin: 5 AA (~712 Da) 191 amino acids (~22,124 Da) The Pituitary Feedback Question This is arguably the most important mechanistic difference for researchers to understand

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