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E1 is a TPP-dependent -ketoacid dehydrogenase, E2 is a dihydrolipoamide transacetylase that binds one or two lipoyl groups via covalent amide linkages to lysine residues, and E3 is an FAD-containing dihydrolipoamide dehydrogenase that re-oxidizes dihydrolipoamide using NAD +

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The machinery it drives inside the cell maxes out long before the receptor itself fills, so the effect can run flat-out while occupancy is still tiny (the spare-receptor effect). Retatrutide runs on this

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Cardiovascular outcomes (Ozempic for heart attack and stroke reduction