Dipeptidyl-peptidase IV inhibitor (DPP4i) confers increased odds of bullous pemphigoid even years after drug initiation

The timing pattern in which dipeptidyl-peptidase IV inhibitors (DPP4i) confer the risk of bullous pemphigoid (BP) is unknown. To investigate the odds of BP following exposure to DPP4i and to perform a duration-response analysis evaluating the risk of BP in relation to the duration of exposure to the culprit drug. A population-based nested case–control study was performed comparing diabetic patients with BP (n = 1458) with age-, sex- and ethnicity-matched diabetic control subjects (n = 6051) with respect to the prevalence of exposure to DPP4i. Adjusted odds ratios (ORs) were estimated by logistic regression. Overall exposure to DPP4i was associated with an 80% increase in the odds of subsequent BP (OR, 1.81; 95% CI, 1.46–2.08; P < 0.001). In an intraclass analysis, the odds of BP were increased in association with vildagliptin (OR, 3.40; 95% CI, 2.69–4.29; P < 0.001) and sitagliptin (OR, 1.56; 95% CI, 1.33–1.84; P < 0.001). In a duration-response analysis, the highest likelihood of BP was found 1–2 years after commencing the drug (OR, 2.66; 95% CI, 1.97–3.59; P < 0.001). The odds of BP were increased across all time periods and retained its statistical significance even ≥ 6 years after the drug initiation (OR, 1.44; 95% CI, 1.09–1.91; P = 0.011). Relative to other diabetic patients with BP, patients with DPP4i-associated BP were more likely to be admitted to inpatient dermatologic wards (OR, 1.66; 95% CI, 1.30–2.13; P < 0.001) and had higher mean(SD) numbers of outpatient dermatologist visits (14.7[14.8] vs. 12.3[13.2], respectively; P = 0.006). DPP4i should be suspected as a predisposing factor for BP even numerous years after the drug initiation.

Neonatal action of the dipeptidyl peptidase iv inhibitor diprotin A leads to a hyperactive phenotype formation and a prolonged increase in aggressiveness in rats

Введение. Ингибиторы пролинспецифической сериновой протеазы дипептидилпептидазы IV (ДПП-IV, CD26, EC 3.4.14.5), способные модулировать широкий спектр физиологических процессов, находят применение в клинике. В наших работах получены свидетельства влияния ингибиторов ДПП-IV при их введении в раннем постнатальном периоде на эмоционально-мотивационное поведение взрослых крыс. Более сильные изменения в поведении отмечались у крыс при действии ингибитора ДПП-IV дипротина А. Однако не ясно, как долго сохраняются такие изменения. Цель работы - изучение отсроченных эффектов ингибитора ДПП-IV дипротина А на выраженность эмоционально-мотивационных расстройств, индуцированных действием ингибитора в раннем постнатальном периоде, в динамике взросления крыс от 2 до 7 мес. Методика. Дипротин А вводили крысятам ежедневно в 5-18-й постнатальные дни внутрибрюшинно (2 мг/кг), в объеме 0.1 мл на 10 г массы тела. Крысята контрольной группы получали инъекции физиологического раствора. Поведение взрослых крыс оценивали в возрасте 2 и 7 мес в тестах автоматизированного «открытого поля», «Приподнятый крестообразный лабиринт» (ПКЛ), принудительного плавания и социального взаимодействия. Уровень кортикостерона в сыворотке крови определяли методом твердофазного иммуноферментного анализа ELISA. Для статистической обработки результатов использовали двухфакторный дисперсионный анализ Two Way ANOVA и непараметрический U-критерий Манна-Уитни с поправкой на множественность сравнений. Результаты. У крыс опытной группы по сравнению с контрольной группой в возрасте 2 и 7 мес была повышена двигательная активность и скорость перемещения в тесте ПКЛ. В возрасте 7 мес у них также была увеличена вертикальная исследовательская активность. Признаков повышения тревожности не выявлено. У крыс опытной группы выявлены признаки депрессивно-подобного поведения по нарушению биоритмологической структуры плавания, более выраженные в возрасте 7 мес. Неагрессивное социальное взаимодействие у крыс, получавших неонатально дипротин А, было снижено по сравнению с контролем в возрасте 2 мес, а в возрасте 7 мес, напротив, увеличено. У этих животных число и длительность агрессивных социальных контактов были увеличены по сравнению с контролем как в возрасте 2, так и в возрасте 7 мес. Уровень кортикостерона в сыворотке крови у крыс опытной группы в возрасте 7.5 мес был выше, чем в контроле. Заключение. Данные настоящего исследования свидетельствуют о развитии гиперактивного фенотипа и длительных психоэмоциональных нарушений в виде повышенной агрессивности наряду с активацией гипоталамо-гипофизарно-адреналовой оси у взрослых крыс, подвергнутых действию дипротина А в 5-18-й постнатальные дни, и поддерживают представления об участии дипептидилпептидазы-IV в генезе психоэмоциональных расстройств. Background. Inhibitors of the proline-specific serine protease dipeptidyl peptidase IV (DPP-IV, CD26, EC 3.4.14.5) may modulate a wide range of physiological processes and are used in the clinic. In our studies, we obtained evidence for the impact of DPP-IV inhibitors on adult rats’ emotional and motivational behavior when administered in the early postnatal period. Diprotin A exhibited the most significant impact on the animals’ behaviors. However, it is not clear how long the changes persist. Aim. To study the delayed effects of the DPP-IV inhibitor diprotin A on the severity of emotional and motivational disorders induced by the inhibitor action in the early postnatal period, in the dynamics of rats maturation from 2 to 7 months. Methods. Diprotin A was administered to rat pups daily on postnatal days 5-18, intraperitoneally, at a dose of 2 mg/kg, in a volume of 0.1 ml per 10 g of body weight. The rat pups of the control group received saline. The behavior of adult rats was assessed at the age of 2 and 7 months in the automated “open field,” “Elevated Plus Maze” (EPM), forced swimming, and social interaction tests. Serum corticosterone levels were determined by ELISA. The results were statistically processed using Two Way ANOVA and nonparametric Mann-Whitney U-test adjusted for multiple comparisons. Results. Experimental rats increased motor activity and travel speed in the EPM test compared with the control group at 2 and 7 months of age. At the age of 7 months, experimental rats also increased vertical (rearing) activity. There were no signs of increased anxiety. Experimental rats demonstrated depression-like behavior judged by the biorhythmologic structure of swimming, more pronounced at 7 months. Non-aggressive social interaction in rats treated neonatally with diprotin A was reduced compared with controls at the age of 2 months and, on the contrary, increased at the age of 7 months. In these animals, the number and duration of aggressive social contacts were increased compared with controls at the ages of 2 and 7 months. Serum corticosterone levels in experimental rats at the age of 7.5 months were higher than in control. Conclusion. The present study results testify to the development of a hyperactive phenotype and prolonged psychoemotional disorders as increased aggressiveness along with hypothalamic-pituitary-adrenal axis activation in adult rats exposed to the action of diprotin A on postnatal days 5-18. The data support the dipeptidyl peptidase IV involvement in the genesis of psychoemotional disorders.

Application of a Combined Peptidomics and In Silico Approach for the Identification of Novel Dipeptidyl Peptidase-IV-Inhibitory Peptides in In Vitro Digested Pinto Bean Protein Extract

The conventional approach in bioactive peptides discovery, which includes extensive bioassay-guided fractionation and purification processes, is tedious, time-consuming and not always successful. The recently developed bioinformatics-driven in silico approach is rapid and cost-effective; however, it lacks an actual physiological significance. In this study a new integrated peptidomics and in silico method, which combines the advantages of the conventional and in silico approaches by using the pool of peptides identified in a food hydrolysate as the starting point for subsequent application of selected bioinformatics tools, has been developed. Pinto bean protein extract was in vitro digested and peptides were identified by peptidomics. The pool of obtained peptides was screened by in silico analysis and structure–activity relationship modelling. Three peptides (SIPR, SAPI and FVPH) were selected as potential inhibitors of the dipeptidyl-peptidase-IV (DPP-IV) enzyme by this integrated approach. In vitro bioactivity assay showed that all three peptides were able to inhibit DPP-IV with the tetra-peptide SAPI showing the highest activity (IC50 = 57.7 μmol/L). Indeed, a new possible characteristic of peptides (i.e., the presence of an S residue at the N-terminus) able to inhibit DPP-IV was proposed.

Angioedema associated with dipeptidyl peptidase-IV inhibitors

Background Dipeptidyl peptidase-IV (DPP-IV) inhibitors, also known as gliptins, are a class of oral antidiabetic agents. Postmarketing reports have documented the occurrence of angioedema in patients treated with gliptins and it was found that these drugs increased the risk of angioedema in patients concurrently treated with angiotensin-converting enzyme inhibitors (ACEIs). The aim of this manuscript is to provide an overview of the risk of angioedema associated with gliptins. Methods The keywords used for the literature search in the PubMed database included “angioedema” and “dipeptidyl peptidase”, “gliptins”, or the name of each DPP-IV inhibitor. Articles in English published up to December 2020 were taken into consideration. Results The available data appear to rule out a higher risk of angioedema associated with gliptin monotherapy and have revealed an increased susceptibility in patients simultaneously treated with gliptins and ACEIs. However, one single multicenter phase IV trial and case reports, even if very limited in number, have shown that angioedema can also occur during treatment with DPP-IV inhibitors without the concomitant use of ACEIs. The involvement of other drugs and drug interactions has occasionally been suggested. In a few patients, deficiency of enzymes involved in bradykinin catabolism was detected and this finding can constitute a risk factor for angioedema exacerbated by treatment with DPP-IV inhibitors. Conclusions This risk of angioedema associated with the use of gliptins has mostly been related to the concurrent administration of ACEIs, and has been considered rare, but it might be underestimated and underreported. The role of additional risk factors or drug interactions deserves further investigations. Caution should be taken when considering the use of DPP-IV inhibitors in patients treated with ACEIs or presenting with other known risk factors for angioedema.