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Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2025; 17(12): 113443
Published online Dec 26, 2025. doi: 10.4330/wjc.v17.i12.113443
Reimagining risk stratification: Dipeptidyl peptidase 3 in the new era of cardiovascular biomarkers
Davide Ramoni, Luca Liberale, Federico Carbone, Fabrizio Montecucco
Davide Ramoni, Luca Liberale, Federico Carbone, Fabrizio Montecucco, Department of Internal Medicine, University of Genoa, Genoa 16132, Italy
Luca Liberale, Federico Carbone, Fabrizio Montecucco, First Clinic of Internal Medicine, Department of Internal Medicine, Italian Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genoa 16132, Italy
Author contributions: Montecucco F designed the manuscript; Ramoni D wrote the full paper; Carbone F and Liberale L critically revised the entire work; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: There are no conflicts of interest or financial activities for any aspect of the submitted manuscript. Outside the submitted work, declaration of competing interest LL is coinventor on the International Patent (WO/2020/226993) filed in April 2020 and relating to the use of antibodies which specifically bind IL-1α to reduce various sequelae of ischemia–reperfusion injury to the central nervous system. LL has received speaker fees outside of this work from Daichi-Sankyo. MF and CF have received funding from the Italian Ministry of Health. The other authors have no conflict to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrizio Montecucco, MD, PhD, Professor, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 6, Genoa 16132, Italy. fabrizio.montecucco@unige.it
Received: August 26, 2025
Revised: September 18, 2025
Accepted: November 25, 2025
Published online: December 26, 2025
Processing time: 121 Days and 0.7 Hours
Core Tip

Core Tip: Dipeptidyl peptidase 3 (DPP3) is a novel biomarker and active mediator in cardiovascular disease. Unlike traditional markers that simply reflect tissue injury, circulating DPP3 (cDPP3) directly influences hemodynamics by degrading angiotensin II and other vasoactive peptides, contributing to vasodilation, myocardial depression, and shock progression. Elevated cDPP3 predicts cardiogenic shock and mortality in acute coronary syndromes and heart failure, while its dynamic trajectory provides unique prognostic value. Beyond risk stratification, therapeutic neutralization of cDPP3 shows promise in reversing circulatory failure, positioning it at the interface of biomarker discovery and targeted intervention.