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After consideration of public comments on this proposed provision, we are finalizing our proposal as proposed at 427.302(d)

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The primary role of RBP4 is to transport retinol (vitamin A) from the liver to peripheral tissues, where it is metabolized into retinoic acid ( Initially, research primarily linked RBP4 to obesity, insulin resistance (IR), and type 2 diabetes mellitus (T2DM) ( 2 RBP4 structure and function 2.1 RBP4 structural characteristics RBP4 is a single-polypeptide protein composed of 201 amino acid residues, with a molecular weight of approximately 21 kDa ( in vivo and link it closely to metabolic regulation and disease pathophysiology

Possible signs include jawline prominence, enlarged hands/feet, coarse facial features, and organ enlargement (rare and associated with long-term abuse)