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Firstly, long-chain fatty acids are converted to long-chain acyl-CoA catalyzed by acyl-CoA synthetases in the endoplasmic reticulum and outer mitochondrial membrane

However, in addition to their hypoglycemic effect, DPP-4i have also shown potent activities in the cardiovascular system, particularly in the regulation of blood pressure (BP)

While Phase II trials in heart failure and primary mitochondrial myopathy did not meet primary efficacy endpoints, the TAZPOWER trial in Barth syndrome demonstrated significant improvements in muscle strength and sixminute walk distance, leading to FDA accelerated approval in 2025 [3] [10]

There was concern about having to stop the medication that was finally helping reach health goals

Direct regulation of blood pressure by smooth muscle cell mineralocorticoid receptors