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The current evidence base points to several overlapping molecular pathways operating in parallel: VEGFR2/Akt/eNOS — Angiogenic Signalling A primary mechanistic axis involves upregulation of vascular endothelial growth factor receptor 2 (VEGFR2), leading to activation of the Akt/eNOS (endothelial nitric oxide synthase) downstream pathway

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However, Sermorelin offered theoretical advantages including preservation of pulsatile GH patterns, potential for improved safety, and possible enhancement of endogenous pituitary function rather than suppression

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