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The Nrf2 protein, encoded by the NFE2L2 gene, regulates around 250 genes that play a role in maintaining cellular balance, including antioxidant proteins, detoxifying enzymes, drug transporters, and various cytoprotective proteins [43]

check IGF-1 at 6 weeks | | Clonidine | Alpha-2 suppression of SRIH | Potentiates GH response | Check IGF-1 at 6 weeks | | Levothyroxine (hypothyroid replacement) | Restores permissive thyroid tone | Normalises somatotroph response | Achieve euthyroid first | | GLP-1 agonists | Weight/fat reduction lowers SRIH tone | May potentiate GH response | Re-evaluate dose at 12 weeks | Special Populations and Interaction Considerations Paediatric GHD Walker et al

Mechanistically, BL-mediated protection involves downregulation of IFN- production, attenuation of cytotoxic microglial activation and CD4 + T cell responses, expansion of Treg populations, and suppression of Th17 cell differentiation

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-Butyrobetaine is a proatherogenic intermediate in gut microbial metabolism of L-carnitine to TMAO