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MSTN: A KEY REGULATOR OF MUSCLE AND FAT MSTN, also known as growth/differentiation factor-8 (GDF-8), is a member of the transforming growth factor-β (TGF-β) superfamily that negatively regulates skeletal muscle mass.[12] Its regulatory role in muscle was first discovered through the observation of a doubled muscle phenotype in homozygous Mstn knockout ( Mstn −/− ) mice, with the increased muscle mass resulting from both hyperplasia and hypertrophy of muscle cells.[12,13] This phenotype is thought to arise because MSTN represses myoblast proliferation and differentiation.[12,14,15] Such a role of MSTN in muscle is well conserved across species, as a doubled muscle phenotype has been observed not only in Mstn −/− mice, but also in humans,[16] dogs,[17] sheep,[18] and cattle,[19] with naturally occurring mutations in the MSTN gene
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Higher costs for Part D plans under the BALANCE model would have translated to higher federal spending and increased Part D premiums for enrollees, always a tough sell but especially so when the cost of health care, including prescription drugs, ranks as a top concern for many Americans
