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This structural modification significantly reduces its affinity for IGF binding proteins (IGFBPs), increases the free concentration, and enhances its biological activity by more than three times compared to natural IGF-1

(PubMed) da Costa KA, Niculescu MD, Craciunescu CN, Fischer LM, Zeisel SH

Proc Natl Acad Sci U S A (2000) 97(12):68749.10.1073/pnas.120069197 69 BroxmeyerHEHoggattJOLearyHAMantelCChittetiBRCooperSet alDipeptidylpeptidase 4 negatively regulates colony-stimulating factor activity and stress hematopoiesis

This is perhaps the most psychologically challenging aspect of the washout period

, Steinert, R