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doi: 10.1093/advances/nmy007 66

134,135,136,137 UBE2K attaches ubiquitin to the Lys48 position of Lys63-linked polyubiquitin chains to form branched polyubiquitin chains, which potentially serve as more efficient signals to transport substrates to the 26S proteasome

Even that lower dose showed a pretty profound impact. The reason, Skelley explains, is that tirzepatide isnt just a GLP-1 drugit also activates another receptor, called the glucose-dependent insulinotropic polypeptide receptor