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The vascular endothelium modulates muscle perfusion through NOmediated vasodilation, whereas skeletal muscle subsequently secretes myokines such as interleukin-6 (IL-6), irisin, and vascular endothelial growth factor (VEGF), which influence endothelial cell activity, angiogenesis, and vascular remodeling (16, 17)

This pathway does not depend on the FDA drug shortage list in the same way as 503B

Tissue Hypoxia: Adipose tissue is poorly vascularised particularly in the deep fat layers of morbidly obese patients

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