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Most of the peptides examined in the studies (especially in the papers where this mechanism is mentioned) contain specific sequences that allow them to cross the lipid membrane, such as the so-called cell-penetrating peptides (CPPs)

doi: 10.1002/biof.1114

2 Pathogenesis of DCM DCM is usually characterized as a contractile dysfunction with later onset of HF without association to dyslipidemia, hypertension or coronary artery disease, but instead caused by metabolic and humoral disruption in connection with hyperglycemia, hyperinsulinemia and insulin resistance ( The two main factors that drive DCM are long-term hyperglycemia and insulin resistance

Increases in circulating levels of endogenous ghrelin, following periods of food restriction, signal an increase in appetite and hunger and are correlated with a general increase in both liking and wanting of food [57,58]

I am so relieved to hear there are some reports that things are getting better

Periodontol 2000 87:204240