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serious effects are uncommon when treatment is supervised and doses are tailored

If the myostatin pathway is not inhibited, the active myostatin dimer binds to ActRIIB, which recruits and activates the type I receptor (ALK4 or ALK5) by transphosphorylation initiating a cascade through Smad 2, Smad 3, and Smad 4 that enters the nucleus to activate target gene transcription suppressing muscle growth