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[1] That acyl modification is not incidental chemistry: it is installed by a dedicated enzyme (ghrelin O-acyltransferase) and is required for the peptide to bind and activate GHSR1a

doi: 10.1093/jn/136.1.21 8

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Studies of the few surviving KO mice (less than 5%), however, show continually retarded bone growth (27,28), suggesting that IGF-I signaling is also essential for skeletal development during post-natal growth