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Arylpropionylpiperazines as antagonists of the human melanocortin-4 receptor

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Other considerations include lumbar spine pathology (such as a herniated disc compressing the L2 or L3 nerve roots), which may be a more likely structural cause than post-operative haematoma or scar tissue formation both of which are uncommon after laparoscopic sleeve gastrectomy and should be considered rare

The D-alanine substitution at position 2 is specifically directed at blocking the primary DPP-4 cleavage site, while the remaining substitutions prevent additional enzymatic attack at susceptible positions and reduce oxidative degradation during storage and in vivo

Apr 2010;15(1):76-83