DPP4 and Myalgia: Because the enzyme dipeptidyl peptidase exists in several forms and because DPP-4 activity is specifically exhibited by the cell surface protein CD26 of the T-lymphocyte, this class of drugs has also been associated with various disorders resulting from modulation of immune function such as autoimmune-related skin conditions (notably bullous pemphigoid), arthralgia, myalgia, and nasopharyngitis [40].