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The appetite suppression, slowed gastric emptying, and central nervous system effects combine to reduce caloric intake by 20% to 40% in many patients

An in vitro study using GnRH neurons of adult male mice demonstrated that both GLP-1 and Ex4 might excite GnRH neurons, either directly or indirectly by modulating the nitric oxide (NO) and endocannabinoid pathways that control the presynaptic excitatory GABA-ergic inputs to GnRH neurons [36]