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Like at AMYRs, these features require the expansion of extracellular TM bundle of CTR through outward movements of TM1, ECL1/TM3, TM4/ECL2 and a small shift in the positioning of the mid-region of the peptide at the start of the N-terminal helix, relative to rAmy when bound to the CTR in the bypass conformation (Fig

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Combined with GLP-1 effects on gastric emptying, this creates a more intense gastrointestinal experience than the GIP/GLP-1 combination in tirzepatide