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BM, bone marrow

This synergy operates through multiple mechanisms: Complementary signaling : Sermorelin activates cAMP/PKA while ipamorelin activates PLC/PKC, and both pathways converge on calcium mobilization for GH exocytosis Somatostatin suppression : Ipamorelin (via GHS-R1a) suppresses hypothalamic somatostatin release, while sermorelin's effects are regulated by somatostatin -- reducing this brake enhances sermorelin's action GH synthesis plus release : Sermorelin increases GH gene transcription and pituitary reserve, while ipamorelin triggers release of the accumulated GH stores The combined GHRH + GHRP approach is a well-documented strategy in growth hormone secretagogue research, and the ipamorelin-sermorelin combination specifically has gained attention due to ipamorelin's clean hormonal profile (no cortisol or prolactin stimulation) paired with sermorelin's established clinical track record