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Clinical and Physiological Characterization of Elevated Plasma Glucagon-Like
Peptide-1 Levels (Hyperglipemia) in a Dipeptidyl Peptidase IV Mutation Carrier
#MMPMID29556215
Zhao D
; Zhao S
; Wang X
; Su M
; Liu W
; Ma Q
; Hong J
; Gu W
; Li J
; Liu R
; Ning G
; Wang J
; Zhang Y
Front Endocrinol (Lausanne)
2018[]; 9
(?): 62
PMID29556215
show ga
The clinical application of dipeptidyl peptidase IV inhibitors (DPP4i) increasing
active glucagon-like peptide-1 (AGLP-1) levels has been linked to pancreatitis,
pancreatic tumors, and cardiovascular events. However, DPP4 mutations in humans
or the long-term outcomes of high glucagon-like peptide-1 (GLP-1) level exposure
have not been reported. A trio family with a proband showing an extremely high
AGLP-1 level [defined here as hyperglipemia (hyper-glucagon-like peptide-1-emia)]
were conducted whole-exome sequencing for potential pathogenic genetic defects.
One novel DPP4 mutation, p.V486M (c.1456 G>A), was identified in the proband and
showed damaged enzymatic activity of DPP4. Ex vivo functional study further
showed that the serum from the proband markedly enhanced insulin production of
primary rat islet cells. Furthermore, V486M variant and another eight DPP4
variants were identified in our in-home database and seven showed decreased
enzymatic activities than wild-type DPP4, consistent with their alterations in
their protein expression levels. Of note, the levels of glucose, lipids, and
tumor markers (especially for CA15-3 and CA125), increased gradually in the
proband during a 4-year follow-up period, although no abnormal physical symptoms
or imaging results were observed at present. The other two old carriers in the
pedigree both had type 2 diabetes, and one of them also had hyperlipidemia and
myocarditis. We first identified hyperglipemia in a female subject harboring a
loss-of-function DPP4 mutation with decreased DPP4 activity. Other sporadic DPP4
mutations verified the low-frequent occurrence of genetic inhibition of DPP4
activity, at least in the Chinese population studied. These results may provide
new evidence for evaluation of the potential long-term effects of DPP4i and GLP-1
analogs.