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In many cell types, IGF-1 enhances CREB phosphorylation and controls CRE-containing genes, such as c-Fos and B-Cell Leukemia/Lymphoma 2 (Bcl-2) [55]

An invited review in the New England Journal of Medicine stated it plainly: the positive cardiac and renal effects of GLP-1 receptor agonists are more than just improvement in ambient glucose concentrations, pointing to pleiotropic vascular actions as key contributors to the MACE reductions observed across LEADER, SUSTAIN-6, SELECT, and the other landmark trials

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Understanding this distinction is essential because many researchers and patients encounter lyophilized peptides when working with research-grade compounds