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doi: 10.1016/j.biomaterials.2014.03.055

Clinical examination of these patients revealed the presence of wasting of the muscles of the scapular region, in particular the supraspinatus and infraspinatus muscles in 12 people, wasting of the infraspinatus muscle in 39 people

Its levels decline naturally with age, and this decline is accelerated by chronic conditions including HIV/AIDS, cancer, type 2 diabetes, Parkinson's disease, and hepatitis

PMID 6653901)

This can be a sign of intramuscular injection