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144 This can pose challenges in achieving therapeutic serum concentrations of agents such as anti-TNF therapies 17 and thioguanine metabolites

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Secondly, although the main signal pathways activated by insulin and IGF-1 are the same, PI3K-AKT and MAPK-ERK signal pathways, insulin and IGF-1 have been reported to alter different gene expressions in cellular metabolism (Entingh-Pearsall and Kahn, 2004)