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At clinically relevant concentrations (5 M), metformin accumulates in lysosomes via the proton gradient and binds presenilin enhancer 2 (PEN2), thereby inhibiting vacuolar H + -ATPase (v-ATPase) and triggering AMPK activation independently of mitochondrial perturbation ( in vitro but exceeding typical plasma levels), metformin engages the AXIN-LKB1 scaffold complex to activate AMPK in an LKB1-dependent manner (Woods et al., 2003)

Longer term For recurring injury protocols, review trends every 3-6 months with a clinician

It detects what your body produces when breaking that drug down

Additionally, a new field of epigenetics that has been pursued is epitranscriptomic alterations involving DCM pathologies (139)

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