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Final practical checklist Use this checklist if you notice a fishy smell after starting L-carnitine 1

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The IGF-1/IGF-1R axis can also induce phosphorylation of ER through ribosomal S6 kinase 1 (S6K1), downstream of the PI3K/AKT/mTOR pathway which results in the upregulation of IGF-1, IGF-1R and other ER target genes (Kim et al., 2007)

doi:10.1007/s00405-019-05694-0 Buki B, Ecker M, Junger H, Lundberg YW