Nat Rev Cardiol 17(9):559573 Pieske B, Tschpe C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP et al (2019) How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)
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Their large peptide structure (Figure 1) makes them prone to enzymatic degradation, lowering bioavailability, and can trigger immunogenicity causing anti-drug antibodies (ADAs)
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