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Mechanism with Numbers: How These Peptides Signal Muscle The GH axis pathway relevant here is: GHRH or ghrelin receptor agonism at the pituitary triggers GH pulse, GH signals the liver to produce IGF-1, IGF-1 binds IGF-1R on muscle cells and activates the PI3K/Akt/mTOR pathway, which drives protein synthesis and inhibits protein degradation