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2015 ; 116
(8
): 1491-504
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DPP4 in cardiometabolic disease: recent insights from the laboratory and clinical
trials of DPP4 inhibition
#MMPMID25858071
Zhong J
; Maiseyeu A
; Davis SN
; Rajagopalan S
Circ Res
2015[Apr]; 116
(8
): 1491-504
PMID25858071
show ga
The discovery of incretin-based medications represents a major therapeutic
advance in the pharmacological management of type 2 diabetes mellitus (T2DM), as
these agents avoid hypoglycemia, weight gain, and simplify the management of
T2DM. Dipeptidyl peptidase-4 (CD26, DPP4) inhibitors are the most widely used
incretin-based therapy for the treatment of T2DM globally. DPP4 inhibitors are
modestly effective in reducing HbA1c (glycated hemoglobin) (?0.5%) and while
these agents were synthesized with the understanding of the role that DPP4 plays
in prolonging the half-life of incretins such as glucagon-like peptide-1 and
gastric inhibitory peptide, it is now recognized that incretins are only one of
many targets of DPP4. The widespread expression of DPP4 on blood vessels,
myocardium, and myeloid cells and the nonenzymatic function of CD26 as a
signaling and binding protein, across a wide range of species, suggest a
teleological role in cardiovascular regulation and inflammation. Indeed, DPP4 is
upregulated in proinflammatory states including obesity, T2DM, and
atherosclerosis. Consistent with this maladaptive role, the effects of DPP4
inhibition seem to exert a protective role in cardiovascular disease at least in
preclinical animal models. Although 2 large clinical trials suggest a neutral
effect on cardiovascular end points, current limitations of performing trials in
T2DM over a limited time horizon on top of maximal medical therapy must be
acknowledged before rendering judgment on the cardiovascular efficacy of these
agents. This review will critically review the science of DPP4 and the effects of
DPP4 inhibitors on the cardiovascular system.