Dipeptidyl Peptidase IV in Angiotensin-Converting Enzyme Inhibitor–Associated Angioedema
Open accessAbstract
This case-control study tested the hypothesis that dipeptidyl peptidase IV activity and antigen are decreased in sera of patients with a history of angiotensin-converting enzyme inhibitor-associated angioedema. Fifty subjects with a history of angiotensin-converting enzyme inhibitor-associated angioedema and 176 angiotensin-converting enzyme inhibitor-exposed control subjects were ascertained. Sera were assayed for angiotensin-converting enzyme activity, aminopeptidase P activity, aminopeptidase N activity, dipeptidyl peptidase IV activity, and antigen. DPPIV activity and antigen were decreased in patients.
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Claims the paper makes
12 of 36 cited sources checked · 9 supported · 0 flagged · accuracy not yet measured
- Premisecitation
The frequency of decreased APP activity in the population (18%) exceeds the incidence of angioedema in ACEi-exposed patients.
“In addition, the frequency of decreased APP activity in the population (18%) exceeds the incidence of angioedema in ACEi-exposed patients.16”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [16] 16. Cyr M, Lepage Y, Blais C Jr, Gervais N, Cugno M, Rouleau JL, Adam A. Bradykinin and des-Arg (9)-bradykinin metabolic pathways and kinetics of activation of human plasma. Am J Physiol Heart Circ Physiol 2001;281:H275-H283. [PubMed: 11406494] source
The Results (p. 5) report APP activity in 116 healthy individuals, but do not give an 18% frequency of decreased activity. The discussion (p. 8) mentions ACE-inhibitor-associated angioedema without stating its incidence. Searches for the 18% figure and an angioedema incidence did not establish the claimed comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measured
- Premisecitation
DPPIV-deficient Fisher 344 rats demonstrate increased susceptibility to ACEi-induced peritracheal edema through an NK1 receptor-dependent mechanism.
“Likewise, we have observed recently that DPPIV-deficient Fisher 344 rats demonstrate increased susceptibility to ACEi-induced peritracheal edema through an NK 1 receptordependent mechanism.24”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [24] 24. Byrd JB, Shreevatsa A, Putlur P, Foretia D, McAlexander L, Sinha T, Does MD, Brown NJ. Dipeptidyl peptidase IV deficiency increases susceptibility to angiotensin-converting enzyme inhibitor-induced peritracheal edema. J Allergy Clin Immunol 2007;120:403-408. [PubMed: 17531305] source
The Animals and Abstract sections identify DPPIV-deficient Fisher F344 rats and report greater captopril-induced peritracheal edema, attenuated by the neurokinin receptor antagonist spantide. The Discussion describes this as evidence for a neurokinin receptor-dependent mechanism, but the study does not establish that the effect specifically depends on NK1 receptors. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Premisecitation
Substance P contributes to the development of ACEi-associated angioedema in rodent models.
“Although this study does not specifically address the mechanism underlying the association between decreased DPPIV activity and antigen and ACEi-associated angioedema, substance P contributes to the development of ACEi-associated angioedema in rodent models.”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [9] 9. Emanueli C, Grady EF, Madeddu P, Figini M, Bunnett NW, Parisi D, Regoli D, Geppetti P. Acute ACE inhibition causes plasma extravasation in mice that is mediated by bradykinin and substance P. Hypertension 1998;31:1299-1304. [PubMed: 9622145] source
- cites [10] 10. Sulpizio AC, Pullen MA, Edwards RM, Brooks DP. The effect of acute angiotensin-converting enzyme and neutral endopeptidase 24.11 inhibition on plasma extravasation in the rat. J Pharmacol Exp Ther 2004;309:1141-1147. [PubMed: 14769834] source
- cites [24] 24. Byrd JB, Shreevatsa A, Putlur P, Foretia D, McAlexander L, Sinha T, Does MD, Brown NJ. Dipeptidyl peptidase IV deficiency increases susceptibility to angiotensin-converting enzyme inhibitor-induced peritracheal edema. J Allergy Clin Immunol 2007;120:403-408. [PubMed: 17531305] source
- Findingown data
Bradykinin half-life correlates inversely with ACE activity in the absence of ACEi.
“Bradykinin half-life correlated inversely with ACE activity in the sera in the absence of ACEi (r=-0.535;P=0.002) and as well as with ACE activity in sera from subjects taking an ACEi (r=-0.259;P=0.047).”
Quote in the paperNot a substantial claim - Findingown data
Among subjects taking an ACEi, DPPIV activity tends to be higher in diabetic subjects compared with nondiabetic subjects.
“Among subjects taking an ACEi, DPPIV activity was lower in smokers compared with nonsmokers (27.1±8.0 versus 29.8±.6.6 nmol/mL per minute; P=0.04) and tended to be higher in diabetic subjects compared with nondiabetic subjects (30.6±7.1 versus 28.6±6.6 nmol/mL per minute; P=0.07).”
Quote in the paperNot a substantial claim
- Findingown data
DPPIV, ACE, APP, and APN enzyme activities and the degradation half-lives of peptides are similar in men and women.
“DPPIV, ACE, APP, and APN enzyme activities and the degradation half-lives of peptides were similar in men and women.”
Quote in the paperNot a substantial claim - Findingown data
The degradation half-life of substance P correlates inversely with DPPIV antigen during ACE inhibition.
“The degradation half-life of substance P correlated inversely with dipeptidyl peptidase IV antigen during angiotensin-converting enzyme inhibition.”
- Also stated in: § Results · plain
“During ACEi, substance P degradation half-life correlated inversely with DPPIV antigen (r=-0.345;P=0.012; Figure 3) and with APN activity (r=-0.288;P=0.037).”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
DPPIV antigen is decreased in sera from individuals with a history of ACEi-associated angioedema compared with ACEi-exposed control subjects without angioedema, when analyzed without stratification for current ACEi use.
“Overall, dipeptidyl peptidase IV activity (26.6±7.8 versus 29.6±7.3nmol/mL per minute; P=0.026) and antigen (465.8±260.8versus 563.1±208.6 ng/mL; P=0.017) were decreased in sera from individuals with angiotensin-converting enzyme inhibitor-associated angioedema compared with”
- Also stated in: § Results · plain
“When analyzed without stratification for current ACEi use, DPPIV activity (26.6±7.8 versus 29.6±7.3nmol/mL per minute for all case subjects versus all control subjects; P=0.026) and DPPIV antigen (465.8±260.8versus 563.1±208.6 ng/mL for all case subjects versus all control subjects; P=0.017) were significantly decreased in individuals with a history of ACEiassociated angioedema compared with”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
The prevalence of diabetes is significantly lower in case subjects compared with control subjects.
“The prevalence of diabetes was significantly lower in case subjects compared with control subjects.”
- Also stated in: § Discussion · plain
“As reported previously as well, 6 the prevalence of diabetes was decreased among individuals with ACEi-associated angioedema compared with controls.”
Quote in the paperNot a substantial claim - Also stated in: § Discussion · plain
- Findingown data
In the absence of ACEi, the half-life of substance P degradation does not statistically significantly correlate inversely with ACE activity.
“In the absence of ACEi, the half-life of substance P degradation did not statistically significantly correlate inversely with ACE activity (r=-0.293;P=0.098).”
Quote in the paperNot a substantial claim - Findingown data
During ACEi, substance P degradation half-life correlates inversely with APN activity.
“During ACEi, substance P degradation half-life correlated inversely with DPPIV antigen (r=-0.345;P=0.012; Figure 3) and with APN activity (r=-0.288;P=0.037).”
Quote in the paperSubstantial claim - Findingown data
APN activity is lower in ACEi-exposed control subjects than in control subjects not taking an ACEi.
“Similarly, APN activity was lower in ACEi-exposed control subjects than in control subjects not taking an ACEi.”
Quote in the paperNot a substantial claim - Findingown data
During ACE inhibition, DPPIV activity is a significant predictor of case-control status after controlling for smoking and diabetes.
“During ACE inhibition, DPPIV activity was a significant predictor of case-control status after controlling for smoking and diabetes (odds ratio: 0.81; 95% CI: 0.70 to 0.93; P=0.004).”
Quote in the paperSubstantial claim - Findingown data
There is no correlation between ACE activity and DPPIV activity among angioedema patients when analyzed during ACE inhibition or in the absence of ACE inhibition.
“There was no correlation between ACE activity and DPPIV activity among angioedema patients when analyzed during ACE inhibition (P=0.71) or in the absence of ACE inhibition (P=0.11).”
Quote in the paperNot a substantial claim - Findingown data
DPPIV activity is decreased in sera from individuals with a history of ACEi-associated angioedema compared with ACEi-exposed control subjects without angioedema, when analyzed without stratification for current ACEi use.
“Overall, dipeptidyl peptidase IV activity (26.6±7.8 versus 29.6±7.3nmol/mL per minute; P=0.026) and antigen (465.8±260.8versus 563.1±208.6 ng/mL; P=0.017) were decreased in sera from individuals with angiotensin-converting enzyme inhibitor-associated angioedema compared with”
- Also stated in: § Results · plain
“When analyzed without stratification for current ACEi use, DPPIV activity (26.6±7.8 versus 29.6±7.3nmol/mL per minute for all case subjects versus all control subjects; P=0.026) and DPPIV antigen (465.8±260.8versus 563.1±208.6 ng/mL for all case subjects versus all control subjects; P=0.017) were significantly decreased in individuals with a history of ACEiassociated angioedema compared with”
Quote in the paperSubstantial claim - Also stated in: § Results · plain
- Findingown data
During ACEi, des-Arg9-bradykinin half-life correlates with bradykinin half-life.
“Rather, during ACEi, des-Arg 9 -bradykinin half-life correlated with bradykinin half-life (r=0.266;P=0.045).”
Quote in the paperNot a substantial claim - Findingown data
DPPIV antigen and activity are similar in whites and blacks, regardless of ACEi use.
“DPPIV antigen and activity were similar in whites and blacks, regardless of ACEi use.”
Quote in the paperNot a substantial claim - Findingown data
ACEi use does not alter the slope of the relationship between DPPIV activity and antigen.
“Nevertheless, ACEi use did not alter the slope of the relationship between DPPIV activity and antigen (Figure 2).”
Quote in the paperNot a substantial claim - Findingown data
Endogenous bradykinin concentrations are comparable in sera collected from 6 case subjects and 17 ACEi-exposed control subjects.
“Likewise, endogenous bradykinin concentrations were comparable in sera collected from 6 case subjects and 17 ACEi-exposed control subjects (please see the data supplement).”
Quote in the paperNot a substantial claim - Findingown data
In the absence of ACEi, DPPIV antigen accounts for 76% of the variability in DPPIV activity.
“DPPIV antigen accounted for 76% of the variability in DPPIV activity in the absence of ACEi (R 2 =0.758;P<0.001) and 38% of the variability during ACEi (R 2 =0.377;P<0.001).”
Quote in the paperNot a substantial claim - Findingown data
Bradykinin half-life correlates inversely with ACE activity in sera from subjects taking an ACEi.
“Bradykinin half-life correlated inversely with ACE activity in the sera in the absence of ACEi (r=-0.535;P=0.002) and as well as with ACE activity in sera from subjects taking an ACEi (r=-0.259;P=0.047).”
Quote in the paperNot a substantial claim - Findingown data
Among subjects taking an ACEi, DPPIV activity is lower in smokers compared with nonsmokers.
“Among subjects taking an ACEi, DPPIV activity was lower in smokers compared with nonsmokers (27.1±8.0 versus 29.8±.6.6 nmol/mL per minute; P=0.04) and tended to be higher in diabetic subjects compared with nondiabetic subjects (30.6±7.1 versus 28.6±6.6 nmol/mL per minute; P=0.07).”
Quote in the paperNot a substantial claim - Findingown data
The prevalence of smoking is significantly higher in case subjects than in control subjects.
“Conversely, the prevalence of smoking was significantly higher in case subjects than in control subjects.”
- Also stated in: § Discussion · plain
“Smoking has been associated with an increased risk of ACEiassociated angioedema, 30 and we also found an increased prevalence of smoking among case subjects compared with control subjects.”
Quote in the paperNot a substantial claim - Also stated in: § Discussion · plain
- Findingown data
During ACEi, DPPIV antigen accounts for 38% of the variability in DPPIV activity.
“DPPIV antigen accounted for 76% of the variability in DPPIV activity in the absence of ACEi (R 2 =0.758;P<0.001) and 38% of the variability during ACEi (R 2 =0.377;P<0.001).”
Quote in the paperNot a substantial claim - Findingown data
Among subjects not taking an ACEi at the time that their blood was collected, there was a nonsignificant trend toward higher APP activity in the sera of control subjects compared with case subjects.
“For example, in the current study, among subjects not taking an ACEi at the time that their blood was collected, there was a nonsignificant trend toward higher APP activity in the sera of control subjects compared with case subjects.”
Quote in the paperNot a substantial claim - Interpretationown data
Angioedema is associated with a reduction in DPPIV enzyme protein rather than with a decrease in its specific activity.
“Moreover, the serum concentration of soluble DPPIV antigen was similarly decreased during ACEi-associated angioedema, indicating that angioedema is associated with a reduction in DPPIV enzyme protein rather than with a decrease in its specific activity.”
Quote in the paperSubstantial claim - Interpretationreasoning
Environmental or genetic factors that reduce DPPIV activity may predispose individuals to angioedema.
“Environmental or genetic factors that reduce dipeptidyl peptidase IV activity may predispose individuals to angioedema.”
- Also stated in: § Perspectives · hedged
“Genetic or environmental factors that decrease DPPIV activity may predispose individuals to ACEi-associated angioedema.”
Quote in the paperSubstantial claim- Rests on an assumption: The mechanism of ACEi-associated angioedema is unknown.
- Rests on an assumption: Serum DPPIV activity and antigen reflect the relevant tissue DPPIV activity in the pathogenesis of ACEi-associated angioedema.
- Also stated in: § Perspectives · hedged
- Premisecitation
Review of the FDA Adverse Events Reporting System revealed 10 cases of angioedema or angioedema-related symptoms associated with sitagliptin exposure from November 2006 through July 2, 2007.
“Review of the Food and Drug Administration Adverse Events Reporting System revealed 10 cases of angioedema or angioedema-related symptoms associated with sitagliptin exposure from November 2006 through July 2, 2007 (Food and Drug Administration Adverse Event Reporting System Freedom of Information Report, July 2, 2007).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Food and Drug Administration Adverse Event Reporting System Freedom of Information Report, July 2, 2007
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Membrane-bound DPPIV in connective tissue stroma has a 10-fold lower Michaelis constant than does soluble DPPIV.
“Although serum DPPIV activity correlates with the T-cell membrane-bound antigen, 26 membrane-bound DPPIV in connective tissue stroma has a 10-fold lower Michaelis constant than does soluble DPPIV.27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] 27. Pereira DA, Gomes L, El Cheikh MC, Borojevic R. Dipeptidyl peptidase IV (CD26) activity in the hematopoietic system: differences between the membrane-anchored and the released enzyme activity. Braz J Med Biol Res 2003;36:567-578. [PubMed: 12715075] source
- Premisecitation
APP activity has not been found to be decreased in all case subjects with angioedema compared with control subjects.
“However, APP activity has not been found to be decreased in all of the case subjects with angioedema compared with control subjects.12,15”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [12] 12. Blais C Jr, Rouleau JL, Brown NJ, Lepage Y, Spence D, Munoz C, Friborg J, Geadah D, Gervais N, Adam A. Serum metabolism of bradykinin and des-Arg9-bradykinin in patients with angiotensin- converting enzyme inhibitor-associated angioedema. Immunopharmacology 1999;43:293-302. [PubMed: 10596866] source
- cites [15] 15. Lefebvre J, Murphey LJ, Hartert TV, Jiao SR, Simmons WH, Brown NJ. Dipeptidyl peptidase IV activity in patients with ACE-inhibitor-associated angioedema. Hypertension 2002;39:460-464. [PubMed: 11882590] source
- Premisecitation
During ACEi, an increased proportion of bradykinin is degraded to des-Arg9-bradykinin via the kininase I pathway.
“During ACEi, an increased proportion of bradykinin is degraded to des-Arg 9 -bradykinin via the kininase I pathway 12 (Figure 1).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] 12. Blais C Jr, Rouleau JL, Brown NJ, Lepage Y, Spence D, Munoz C, Friborg J, Geadah D, Gervais N, Adam A. Serum metabolism of bradykinin and des-Arg9-bradykinin in patients with angiotensin- converting enzyme inhibitor-associated angioedema. Immunopharmacology 1999;43:293-302. [PubMed: 10596866] source
- Premisecitation
In 1 study, 1 of 175 sitagliptin-treated subjects was hospitalized for angioedema.
“However, studies report an increased incidence of nasopharyngitis in subjects randomly assigned to DPPIV inhibitor 35,38,40 ; in 1 study, 1 of 175 sitagliptin-treated subjects was hospitalized for angioedema.41”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] 41. Rosenstock J, Brazg R, Andryuk PJ, Lu K, Stein P. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing pioglitazone therapy in patients with type 2 diabetes: a 24- week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther 2006;28:1556-1568. [PubMed: 17157112] Table 2 Biochemical Characterization of ACEi-Associated Angioedema Case and Control Subjects ACEi-Associated Angioedema, Mean±SD (n) ACEi-Exposed Control Subjects, Mean±SD (n) Serum Measurement ACEi Off ACEi ACEi Off ACEi ACE activity, nmol/min per mL 6.0±9.5 ( source
- Interpretationown data
The relative contribution of DPPIV to the degradation of substance P is increased in the setting of ACE inhibition.
“These data suggest that the relative contribution of DPPIV to the degradation of substance P is increased in the setting of ACE inhibition.”
Quote in the paperSubstantial claim- Rests on an assumption: Ex vivo degradation half-life of substance P reflects its local in vivo metabolism.
- Premisecitation
During ACE inhibition, DPPIV sequentially degrades substance P to substance P 5-11, which is susceptible to further degradation by APN.
“ACE also degrades substance P; however, in the setting of ACE inhibition, dipeptidyl peptidase IV (DPPIV or CD26; EC 3.4.14.5) sequentially degrades substance P to substance P 5-11, which is susceptible to further degradation by aminopeptidase N (APN or CD13, 3.4.11.2). 20”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] 20. Russell JS, Chi H, Lantry LE, Stephens RE, Ward PE. Substance P and neurokinin A metabolism by cultured human skeletal muscle myocytes and fibroblasts. Peptides 1996;17:1397-1403. [PubMed: 8971937] source
- Interpretationreasoning
Soluble antigen concentrations may reflect not only expression but also cleavage from the cell surface.
“The regulation of DPPIV expression seems to be tissue specific, 28,29 and soluble antigen concentrations may reflect not only expression but also cleavage from the cell surface.”
Quote in the paperNot a substantial claim - Premisecitation
DPPIV degrades the incretins glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (7-36 amide).
“In addition to degrading bradykinin and substance P, DPPIV degrades the incretins glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (7-36 amide).34”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] 34. Mentlein R, Gallwitz B, Schmidt WE. Dipeptidyl-peptidase IV hydrolyses gastric inhibitory polypeptide, glucagon-like peptide-1(7-36)amide, peptide histidine methionine and is responsible for their degradation in human serum. Eur J Biochem 1993;214:829-835. [PubMed: 8100523] source
- Interpretationreasoning
The finding that des-Arg9-bradykinin half-life correlates with bradykinin half-life in sera of ACEi-treated subjects likely reflects continued formation of des-Arg9-bradykinin from exogenous bradykinin under these conditions.
“The finding that the des-Arg 9 -bradykinin half-life correlated with the bradykinin half-life in the sera of ACEitreated subjects likely reflects continued formation of des-Arg 9 -bradykinin from exogenous bradykinin under these conditions.”
Quote in the paperNot a substantial claim - Interpretationown data
Individuals treated with DPPIV inhibitors while concurrently taking an ACEi may be at increased risk for the development of angioedema.
“The data from the present study suggest that individuals treated with this class of drugs, while concurrently taking an ACEi, may be at increased risk for the development of angioedema.”
Quote in the paperSubstantial claim- Rests on an assumption: The mechanism of ACEi-associated angioedema is unknown.
- Rests on an assumption: Serum DPPIV activity and antigen reflect the relevant tissue DPPIV activity in the pathogenesis of ACEi-associated angioedema.
- Premisecitation
Serum DPPIV activity is diminished during acute ACEi-associated angioedema.
“The current study derives from a previous finding of our laboratory that serum DPPIV activity is diminished during acute ACEi-associated angioedema.15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] 15. Lefebvre J, Murphey LJ, Hartert TV, Jiao SR, Simmons WH, Brown NJ. Dipeptidyl peptidase IV activity in patients with ACE-inhibitor-associated angioedema. Hypertension 2002;39:460-464. [PubMed: 11882590] source
- May combine two claims. 17
- Classified as probably not a substantial claim. 13
May combine two claims.
PremisecitationAPP activity and des-Arg9-bradykinin degradation are decreased in the sera of angioedema patients of European origin compared with control subjects.
“Supporting this notion, APP activity and des-Arg 9 -bradykinin degradation are decreased in the sera of angioedema patients of European origin compared with control subjects.13,14”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [13] 13. Adam A, Cugno M, Molinaro G, Perez M, Lepage Y, Agostoni A. Aminopeptidase P in individuals with a history of angio-oedema on ACE inhibitors. Lancet 2002;359:2088-2089. [PubMed: 12086766] source
- cites [14] 14. Molinaro G, Cugno M, Perez M, Lepage Y, Gervais N, Agostoni A, Adam A. Angiotensin-converting enzyme inhibitor-associated angioedema is characterized by a slower degradation of des-arginine (9)-bradykinin. J Pharmacol Exp Ther 2002;303:232-237. [PubMed: 12235256] source
The Discussion reports slower des-Arg9-bradykinin degradation in angioedema patients than controls and cites prior observations of decreased APP activity in the same patients. However, the Blood Samples section says this study tested plasma, not serum, and the Patients section describes participants as white without establishing European origin. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationStudies report an increased incidence of nasopharyngitis in subjects randomly assigned to DPPIV inhibitor.
“However, studies report an increased incidence of nasopharyngitis in subjects randomly assigned to DPPIV inhibitor 35,38,40 ; in 1 study, 1 of 175 sitagliptin-treated subjects was hospitalized for angioedema.41”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [35] 35. Ahren B, Simonsson E, Larsson H, Landin-Olsson M, Torgeirsson H, Jansson PA, Sandqvist M, Bavenholm P, Efendic S, Eriksson JW, Dickinson S, Holmes D. Inhibition of dipeptidyl peptidase IV improves metabolic control over a 4-week study period in type 2 diabetes. Diabetes Care 2002;25:869-875. [PubMed: 11978683] source
- cites [38] 38. Pi-Sunyer FX, Schweizer A, Mills D, Dejager S. Efficacy and tolerability of vildagliptin monotherapy in drug-naive patients with type 2 diabetes. Diabetes Res Clin Pract 2007;76:132-138. [PubMed: 17223217] source
- cites [40] 40. Charbonnel B, Karasik A, Liu J, Wu M, Meininger G. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing metformin therapy in patients with type 2 diabetes inadequately controlled with metformin alone. Diabetes Care 2006;29:2638-2643. [PubMed: 17130197] source
May combine two claims.
PremisecitationPublished trials have either not included subjects taking ACEi or have not commented on the inclusion of subjects exposed to ACEis.
“Published trials have either not included subjects taking ACEi or have not commented on the inclusion of subjects exposed to ACEis.[35][36][37][38][39]”
Quote in the paperSubstantial claim3 of 3 sources checked- cites [35] 35. Ahren B, Simonsson E, Larsson H, Landin-Olsson M, Torgeirsson H, Jansson PA, Sandqvist M, Bavenholm P, Efendic S, Eriksson JW, Dickinson S, Holmes D. Inhibition of dipeptidyl peptidase IV improves metabolic control over a 4-week study period in type 2 diabetes. Diabetes Care 2002;25:869-875. [PubMed: 11978683] source
- cites [36] 36. Ahren B, Gomis R, Standl E, Mills D, Schweizer A. Twelve-and 52-week efficacy of the dipeptidyl peptidase IV inhibitor LAF237 in metformin-treated patients with type 2 diabetes. Diabetes Care 2004;27:2874-2880. [PubMed: 15562200] source
- cites [37] 37. Mari A, Sallas WM, He YL, Watson C, Ligueros-Saylan M, Dunning BE, Deacon CF, Holst JJ, Foley JE. Vildagliptin, a dipeptidyl peptidase-IV inhibitor, improves model-assessed beta-cell function in patients with type 2 diabetes. J Clin Endocrinol Metab 2005;90:4888-4894. [PubMed: 15886245] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationClinical studies of DPPIV inhibitors indicate that this class of drugs improves glycemic control in patients with type 2 diabetes mellitus.
“Clinical studies of DPPIV inhibitors indicate that this class of drugs improves glycemic control in patients with type 2 diabetes mellitus.[35][36][37]”
Quote in the paperNot a substantial claim3 of 3 sources checked- cites [35] 35. Ahren B, Simonsson E, Larsson H, Landin-Olsson M, Torgeirsson H, Jansson PA, Sandqvist M, Bavenholm P, Efendic S, Eriksson JW, Dickinson S, Holmes D. Inhibition of dipeptidyl peptidase IV improves metabolic control over a 4-week study period in type 2 diabetes. Diabetes Care 2002;25:869-875. [PubMed: 11978683] source
- cites [36] 36. Ahren B, Gomis R, Standl E, Mills D, Schweizer A. Twelve-and 52-week efficacy of the dipeptidyl peptidase IV inhibitor LAF237 in metformin-treated patients with type 2 diabetes. Diabetes Care 2004;27:2874-2880. [PubMed: 15562200] source
- cites [37] 37. Mari A, Sallas WM, He YL, Watson C, Ligueros-Saylan M, Dunning BE, Deacon CF, Holst JJ, Foley JE. Vildagliptin, a dipeptidyl peptidase-IV inhibitor, improves model-assessed beta-cell function in patients with type 2 diabetes. J Clin Endocrinol Metab 2005;90:4888-4894. [PubMed: 15886245] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDPPIV activity has been associated with increased glucose concentrations in diabetic subjects.
“Likewise, DPPIV activity has been associated with increased glucose concentrations in diabetic subjects.32”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [32] 32. Mannucci E, Pala L, Ciani S, Bardini G, Pezzatini A, Sposato I, Cremasco F, Ognibene A, Rotella CM. Hyperglycaemia increases dipeptidyl peptidase IV activity in diabetes mellitus. Diabetologia 2005;48:1168-1172. [PubMed: 15864535] source
May combine two claims.
Findingown dataDPPIV antigen is decreased in sera from cases collected during ACE inhibition but not in the absence of ACE inhibition.
“Dipeptidyl peptidase IV activity (21.5±4.9 versus 29.8 ±6.7 nmol/mL per minute; P=0.001) and antigen (354.4±124.7 versus 559.8±163.2ng/mL; P=0.003) were decreased in sera from cases collected during angiotensin-converting enzyme inhibition but not in the absence of angiotensin-converting enzyme inhibition.”
- Also stated in: § Results · plain
“When analyzed separately in subjects currently taking an ACEi and those no longer taking an ACEi, DPPIV activity and antigen were lower in case subjects than in control subjects only among subjects exposed to ACEi at the time of blood collection (Table 2).”
Quote in the paperSubstantial claim- Also stated in: § Results · plain
May combine two claims.
Findingown dataDPPIV activity is decreased in sera from cases collected during ACE inhibition but not in the absence of ACE inhibition.
“Dipeptidyl peptidase IV activity (21.5±4.9 versus 29.8 ±6.7 nmol/mL per minute; P=0.001) and antigen (354.4±124.7 versus 559.8±163.2ng/mL; P=0.003) were decreased in sera from cases collected during angiotensin-converting enzyme inhibition but not in the absence of angiotensin-converting enzyme inhibition.”
- Also stated in: § Results · plain
“When analyzed separately in subjects currently taking an ACEi and those no longer taking an ACEi, DPPIV activity and antigen were lower in case subjects than in control subjects only among subjects exposed to ACEi at the time of blood collection (Table 2).”
Quote in the paperSubstantial claim- Also stated in: § Results · plain
May combine two claims.
Findingown dataDes-Arg9-bradykinin half-life correlates inversely with APP activity in the absence of ACEi but not during ACE inhibition.
“Des-Arg 9 -bradykinin half-life correlated inversely with APP activity (r=-0.445;P=0.01) in the absence of ACEi but not during ACE inhibition.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThere is no difference in ACE activity, APP activity, APN activity, bradykinin degradation half-life, or des-Arg9-bradykinin degradation half-life between case and control subjects either in the presence or absence of ACE inhibition.
“However, there was no difference in ACE activity, APP activity, APN activity, bradykinin degradation half-life, or des-Arg 9 -bradykinin degradation half-life between case and control subjects either in the presence or absence of ACE inhibition.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAmong both case and control subjects, ACE activity is significantly lower, and the half-lives of degradation of bradykinin and des-Arg9-bradykinin are significantly prolonged, in individuals taking an ACEi compared with those not taking an ACEi.
“Among both case and control subjects, ACE activity was significantly lower, and the half-lives of degradation of bradykinin and its active metabolite des-Arg 9 -bradykinin were significantly prolonged in individuals taking an ACEi compared with those not taking an ACEi.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe degradation half-life of substance P correlated with DPPIV antigen only during ACE inhibition; however, the majority of individuals with ACEi-associated angioedema were no longer taking an ACEi at the time that their blood was collected.
“The degradation half-life of substance P correlated with DPPIV antigen only during ACE inhibition; however, the majority of individuals with ACEi-associated angioedema were no longer taking an ACEi at the time that their blood was collected.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataUnexpectedly, there is no difference in APP activity or des-Arg9-bradykinin concentrations between case and control subjects.
“Unexpectedly, we found no difference in APP activity or des-Arg 9 -bradykinin concentrations between case and control subjects.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWe did not detect an effect of either race or gender on enzyme activity or peptide degradation.
“Nevertheless, we did not detect an effect of either race or gender on enzyme activity or peptide degradation.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningAnalyses were performed after stratification for ACEi use at the time of blood collection to account for different proportions of case and control subjects exposed to ACEi.
“To account for the different proportions of case and control subjects exposed to ACEi at the time of blood collection, analyses were performed after stratification for ACEi use at the time of blood collection, except as indicated otherwise in the text.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study was approved by the Vanderbilt University Institutional Review Board, and all subjects provided written informed consent.
“The study was approved by the Vanderbilt University Institutional Review Board, and all of the subjects provided written informed consent.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
InterpretationcitationIt is plausible that either decreased APP activity or decreased DPPIV activity could result in the common phenotype of ACEi-associated angioedema.
“Moreover, given that bradykinin stimulates the release of substance P, 33 it is plausible that either decreased APP activity, leading to decreased inactivation of bradykinin and des-Arg 9 -bradykinin with consequent stimulation of substance P release, or decreased DPPIV activity, leading to decreased inactivation of substance P, could result in the common phenotype of ACEiassociated angioedema.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [33] 33. Kopp UC, Farley DM, Smith LA. Bradykinin-mediated activation of renal sensory neurons due to prostaglandin-dependent release of substance P. Am J Physiol 1997;272:R2009-R2016. [PubMed: 9227622] source
May combine two claims.
PremisecitationBradykinin and substance P, substrates of ACE, increase vascular permeability and cause tissue edema in animals.
“Bradykinin and substance P, substrates of angiotensin-converting enzyme, increase vascular permeability and cause tissue edema in animals.”
- Also stated in: § Abstract · plain
“Bradykinin and substance P are 2 substrates of ACE that produce tracheal edema in animals.9,10”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [9] 9. Emanueli C, Grady EF, Madeddu P, Figini M, Bunnett NW, Parisi D, Regoli D, Geppetti P. Acute ACE inhibition causes plasma extravasation in mice that is mediated by bradykinin and substance P. Hypertension 1998;31:1299-1304. [PubMed: 9622145] source
- cites [10] 10. Sulpizio AC, Pullen MA, Edwards RM, Brooks DP. The effect of acute angiotensin-converting enzyme and neutral endopeptidase 24.11 inhibition on plasma extravasation in the rat. J Pharmacol Exp Ther 2004;309:1141-1147. [PubMed: 14769834] source
- Also stated in: § Abstract · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe regulation of DPPIV expression seems to be tissue specific.
“The regulation of DPPIV expression seems to be tissue specific, 28,29 and soluble antigen concentrations may reflect not only expression but also cleavage from the cell surface.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [28] 28. Abbott CA, Baker E, Sutherland GR, McCaughan GW. Genomic organization, exact localization, and tissue expression of the human CD26 (dipeptidyl peptidase IV) gene. Immunogenetics 1994;40:331-338. [PubMed: 7927537] source
- cites [29] 29. Bohm SK, Gum JR Jr, Erickson RH, Hicks JW, Kim YS. Human dipeptidyl peptidase IV gene promoter: tissue-specific regulation from a TATA-less GC-rich sequence characteristic of a housekeeping gene promoter. Biochem J 1995;311:835-843. [PubMed: 7487939] source
May combine two claims.
Study design and conductreasoningThe study has limitations of small sample size and serum measurements.
“This suggests the need to identify additional mechanisms whereby decreased DPPIV activity and antigen concentrations associate with ACEi-associated angioedema but also highlights the limitations of small sample size and serum measurements.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe ex vivo degradation of substance P may not reflect its local in vivo metabolism.
“Similarly, the ex vivo degradation of substance P may not reflect its local in vivo metabolism.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAt least 1 previous study reported lower DPPIV activity in bronchial alveolar lavage fluid from smokers compared with fluid from non-smokers.
“At least 1 previous study reported lower DPPIV activity in bronchial alveolar lavage fluid from smokers compared with fluid from non-smokers.31”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] 31. Van DV V, Naber BA, Van Hal PT, Overbeek SE, Hoogsteden HC, Versnel MA. Peptidase activities in serum and bronchoalveolar lavage fluid from allergic asthmatics-omparison with healthy non- smokers and smokers and effects of inhaled glucocorticoids. Clin Exp Allergy 1999;29:813-823. [PubMed: 10336599] source
May combine two claims.
PremisecitationBradykinin stimulates the release of substance P from sensory nerves, which causes increased vascular permeability by acting at the NK1 receptor.
“In addition to increasing vascular permeability directly via its B 2 receptor, bradykinin stimulates the release of substance P from sensory nerves, which causes increased vascular permeability by acting at the NK 1 receptor.19”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] 19. Campos MM, Calixto JB. Neurokinin mediation of edema and inflammation. Neuropeptides 2000;34:314-322. [PubMed: 11049735] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationDes-Arg9-bradykinin acts as a proinflammatory agonist at the B1 receptor and is degraded primarily via APP.
“Des-Arg 9 -bradykinin acts as a proinflammatory agonist at the B 1 receptor and is degraded primarily via APP.22”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] 22. Pesquero JB, Jubilut GN, Lindsey CJ, Paiva AC. Bradykinin metabolism pathway in the rat pulmonary circulation. J Hypertens 1992;10:1471-1478. [PubMed: 1363432] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenMedical history, including the history of angioedema, was confirmed by a research nurse or physician using a detailed case report form.
“Medical history, including the history of angioedema, was confirmed by a research nurse or physician using a detailed case report form.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationreasoningThe contrast with data from a largely European population may reflect differences in ethnicity or in concurrent ACEi use.
“This contrasts with data from a largely European population 13 and may reflect differences in ethnicity or in concurrent ACEi use.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] 13. Adam A, Cugno M, Molinaro G, Perez M, Lepage Y, Agostoni A. Aminopeptidase P in individuals with a history of angio-oedema on ACE inhibitors. Lancet 2002;359:2088-2089. [PubMed: 12086766] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSerum DPPIV activity correlates with the T-cell membrane-bound antigen.
“Although serum DPPIV activity correlates with the T-cell membrane-bound antigen, 26 membrane-bound DPPIV in connective tissue stroma has a 10-fold lower Michaelis constant than does soluble DPPIV.27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] 26. Elgun S, Keskinege A, Akan H, Karaca L. Serum dipeptidyl peptidase IV activity correlates with the T-cell CD26 antigen. Clin Chem Lab Med 1999;37:839-840. [PubMed: 10536934] source
The paper relies on this without support.
The mechanism of ACEi-associated angioedema is unknown.
“Although bradykinin has been implicated in the pathogenesis of hereditary forms of angioedema, 4 the mechanism of ACEi-associated angioedema is unknown.”
The paper relies on this without support.
Serum DPPIV activity and antigen reflect the relevant tissue DPPIV activity in the pathogenesis of ACEi-associated angioedema.
“In addition, we measured soluble DPPIV antigen and serum activity, but DPPIV is a cell-surface-associated peptidase.21”
The paper relies on this without support.
Ex vivo degradation half-life of substance P reflects its local in vivo metabolism.
“Similarly, the ex vivo degradation of substance P may not reflect its local in vivo metabolism.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Byrd and colleagues found lower DPPIV antigen and activity in serum from 50 patients with prior ACE inhibitor-associated angioedema than in 176 ACE inhibitor-exposed controls, but they saw no link between case-control status and APP activity.
“Byrd et al. reported decreased DPPIV antigen and activity levels in the sera of 50 patients with a history of ACE inhibitor-associated angioedema as compared to 176 ACE inhibitor-exposed controls, but did not observe a relationship between case-control status and APP activity.[4]”
From Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema (2010) · cites this paper as [4]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredCases had lower serum DPPIV activity than controls.
“Serum DPPIV activity was lower in case subjects as compared to controls, as previously reported for a subset of these subjects.[4]”
From Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema (2010) · cites this paper as [4]
Angioedema linked to ACE inhibitors is more frequent among women and black Americans.
“Angioedema is a rare adverse effect of angiotensin converting enzyme (ACE) inhibitors that occurs more commonly in women and black Americans.”
From Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema (2010) · cites this paper as [4]
Reports on serum APP activity in people who previously had angioedema while on ACE inhibitors have been inconsistent.
“Previous studies have provided conflicting data regarding serum APP activity in patients with a history of ACE inhibitor-associated angioedema.”
From Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema (2010) · cites this paper as [4]
Some patients with ACE inhibitor-associated angioedema have reduced DPPIV activity.
“We have previously reported that DPPIV activity is decreased in some patients with ACE inhibitor-associated angioedema.[4]”
From Sex-dependent and race-dependent association of XPNPEP2 C-2399A polymorphism with angiotensin-converting enzyme inhibitor-associated angioedema (2010) · cites this paper as [4]
Epidemiological studies have reported that patients with diabetes were less likely to be affected by ACEi-AE.
“Epidemiological studies have reported a higher risk for ACEi-AE in smokers 13 as well as in patients with concomitant hay fever/ allergic rhinitis 10,12 or coronary artery disease, 1 whereas patients with diabetes were less likely to be affected.1,12,14”
From Meta-analysis of ACE inhibitor-induced angioedema identifies novel risk locus. (2024) · cites this paper as [14]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Diabetic count in the serum subset exceeds the full-group count
MinorThe table lists 110 diabetic controls in the serum-available subset, but only 64 diabetic controls in the full group. The serum-available controls are a subset of the full group, so their diabetic count cannot be larger.
“Nondiabetic:diabetic:unknown, n 40:9:1 112:64:0 0.02 32:6 60:110 0.02”
“Sera were available for measurement of DPPIV activity or antigen from 38 subjects with angioedema and 170 of the control subjects.”
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“Reduced DPP-4 enzyme activity and DPP-4 enzyme deficiency have been associated with an increase in ACE inhibitor-induced angioedema in rats and humans [46,47], and it was hypothesized that concomitant use of DPP-4 inhibitors and ACE inhibitors could increase the risk of angioedema-related adverse events.”
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“Researchers have suggested that reduced DPP-4 enzyme activity and DPP-4 enzyme deficiency increase ACE inhibitor-induced angioedema in rats and potentially humans [29,38].”
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BackgroundNeprilysin inhibition in chronic kidney disease
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“Substance P is a potent pro-inflammatory peptide released during sensory nerve activation, which causes edema and pain and may be involved in the pathogenesis of angioedema [91].”
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“Angioedema is thought to be mediated by increases in bradykinin, des-Arg9-bradykinin and possibly substance P, potent vasoactive peptides that cause vasodilation and enhance vascular permeability [30].”
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Diabetes mellitus and the skin
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“Other authors also reported a decrease of the activity of APP and dipeptidyl peptidase IV (DPPIV or CD26) in the substance P degradation pathways [27].”
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“However, there have been several studies and case reports describing the association between DPP4-inhibitors (or DPP4 deficiency) and non-cardiac pulmonary edema 43 , pitting edema 44 , angioedema 45 , and peritracheal edema 46 .”
DPP4 inhibitors for diabetes—What next?
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ResultSelf-citationPathophysiology of Hereditary Angioedema
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“Moreover, NEP converts angiotensin-I to angiotensin 1–7 [31] which conveys vasodilating, antiproliferative, and natriuretic effects through the activation of the Mas receptor [34].”
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BackgroundInfluentialCardiovascular and Diabetic Medications That Cause Bradykinin-Mediated Angioedema
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“The process of bradykinin degradation involves more than just ACEi.”
BackgroundInfluentialPotential Effect of DPP-4 Inhibitors Towards Hepatic Diseases and Associated Glucose Intolerance
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“Among the described risk factors we find, in addition to C1 inhibitor deficiency and a history of AE whether hereditary or not, the African origin, female gender, trauma, smoking, age over 65 years, a history of other allergies, and various drugs use such as mTOR (mammalian target of rapamycin) inhibitors (sirolimus,…”
BackgroundDPP-4 inhibitors and angioedema: a cause for concern?
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“128 Recently, serum endothelial-selectin and angiopoietin-2 have shown to be increased in BK-induced angioedema compared to his-tamine-mediated angioedema, showing the role of endothelial dysfunction and serine proteases in this angioedema subtype.”
BackgroundAngiotensin receptor-neprilysin inhibitors: clinical potential in heart failure and beyond
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Assessment of 105 Patients with Angiotensin Converting Enzyme-Inhibitor Induced Angioedema
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“Seemingly, ACEi induced angioedema is related to polygenetic and demographic as well as environmental factors such as age, race, gender, comorbidity, and smoking, but most available studies are describing heterogeneous and relatively small sample sizes [1, 8].”
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“59,60 Other publications, like a study of Ohyama et al., support the hypothesis, that DPP4-4 inhibitors may induce angioedema in prone patients, even in the absence of a concomitant ACE inhibitor intake.”
BackgroundDrug-induced angioedema: experience of Italian emergency departments
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“However, ex vivo studies demonstrate that the half-life of SP in serum correlates inversely with DPPIV concentration under ACE inhibition (Byrd et al., 2008) indicating that both enzymes can coordinate their proteolytic action.”
BackgroundResultInfluentialBradykinin-Mediated Angioedema Induced by Drugs
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“Previous history of drug-induced AE, whether from ACEIs or DPP-IV inhibitors, may potentially predict an increased risk of recurrence [111,119,120,122].”
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“Moreover, a polymorphism of the B2R, termed BET 1, has recently been associated with changes in bradykinin-dependent vasodilatation during ACEI treatment (Byrd et al., 2008).”
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“Bei einer Hemmung von ACE erfolgt die Degradierung primär durch DPP-IV [25, 34, 35].”
BackgroundInfluentialContact System Activation and Bradykinin Generation in Angioedema
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Okeahialam, B. N. (2017) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098617705625 · Cited by 8 · see citing works
- Authors
- Byrd, J. B., Touzin, K., Sile, S., Gainer, J. V., Yu, C., Nadeau, J., Adam, A., & Brown, N. J.
- Affiliations
- United States Department of Veterans Affairs (US)
- Venue
- Hypertension
- Published
- 2008-01
- Volume
- 51
- Issue
- 1
- Pages
- 141-147
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2749928
- OpenAlex
- W2065408836
- Cited by
- 147
- References
- 43
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 11 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 6 · 2017: 11 · 2016: 11 · 2015: 8 · 2014: 13 · 2013: 8 · 2012: 10
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- University of Michigan Library
- Funders
- National Institutes of Health (5r01hl065193-12)
- National Heart, Lung, and Blood Institute (T32HL076133, R01-HL076133, R01HL079184, R01-HL065193)
- National Institute of General Medical Sciences (T32GM007569)
- National Center for Research Resources (M01RR000095)
- Topics
- Health Sciences › Medicine › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Oncology › Peptidase Inhibition and Analysis
- Keywords
- dipeptidyl peptidase IV, bradykinin degradation, aminopeptidase P, CD13, bradykinin B2 receptor, bradykinin B1 receptor
- MeSH terms
- Adult, Aged, Angioedema, Angiotensin-Converting Enzyme Inhibitors, Antigens, Bradykinin, Female, Humans, Hypertension, Peptidyl-Dipeptidase A, Male, Middle Aged, Substance P, Case-Control Studies, Dipeptidyl Peptidase 4, Genetic Predisposition to Disease
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.
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