101
|
Kampourakis T, Zhang X, Sun YB, Irving M. Omecamtiv mercabil and blebbistatin modulate cardiac contractility by perturbing the regulatory state of the myosin filament. J Physiol 2017; 596:31-46. [PMID: 29052230 PMCID: PMC5746517 DOI: 10.1113/jp275050] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/06/2017] [Indexed: 01/10/2023] Open
Abstract
Key points Omecamtiv mecarbil and blebbistatin perturb the regulatory state of the thick filament in heart muscle. Omecamtiv mecarbil increases contractility at low levels of activation by stabilizing the ON state of the thick filament. Omecamtiv mecarbil decreases contractility at high levels of activation by disrupting the acto‐myosin ATPase cycle. Blebbistatin reduces contractility by stabilizing the thick filament OFF state and inhibiting acto‐myosin ATPase. Thick filament regulation is a promising target for novel therapeutics in heart disease.
Abstract Contraction of heart muscle is triggered by a transient rise in intracellular free calcium concentration linked to a change in the structure of the actin‐containing thin filaments that allows the head or motor domains of myosin from the thick filaments to bind to them and induce filament sliding. It is becoming increasingly clear that cardiac contractility is also regulated through structural changes in the thick filaments, although the molecular mechanisms underlying thick filament regulation are still relatively poorly understood. Here we investigated those mechanisms using small molecules – omecamtiv mecarbil (OM) and blebbistatin (BS) – that bind specifically to myosin and respectively activate or inhibit contractility in demembranated cardiac muscle cells. We measured isometric force and ATP utilization at different calcium and small‐molecule concentrations in parallel with in situ structural changes determined using fluorescent probes on the myosin regulatory light chain in the thick filaments and on troponin C in the thin filaments. The results show that BS inhibits contractility and actin‐myosin ATPase by stabilizing the OFF state of the thick filament in which myosin head domains are more parallel to the filament axis. In contrast, OM stabilizes the ON state of the thick filament, but inhibits contractility at high intracellular calcium concentration by disrupting the actin‐myosin ATPase pathway. The effects of BS and OM on the calcium sensitivity of isometric force and filament structural changes suggest that the co‐operativity of calcium activation in physiological conditions is due to positive coupling between the regulatory states of the thin and thick filaments. Omecamtiv mecarbil and blebbistatin perturb the regulatory state of the thick filament in heart muscle. Omecamtiv mecarbil increases contractility at low levels of activation by stabilizing the ON state of the thick filament. Omecamtiv mecarbil decreases contractility at high levels of activation by disrupting the acto‐myosin ATPase cycle. Blebbistatin reduces contractility by stabilizing the thick filament OFF state and inhibiting acto‐myosin ATPase. Thick filament regulation is a promising target for novel therapeutics in heart disease.
Collapse
Affiliation(s)
- Thomas Kampourakis
- Randall Centre for Cell and Molecular Biophysics and British Heart Foundation Centre of Research Excellence, King's College London, London, SE1 1UL, UK
| | - Xuemeng Zhang
- Randall Centre for Cell and Molecular Biophysics and British Heart Foundation Centre of Research Excellence, King's College London, London, SE1 1UL, UK
| | - Yin-Biao Sun
- Randall Centre for Cell and Molecular Biophysics and British Heart Foundation Centre of Research Excellence, King's College London, London, SE1 1UL, UK
| | - Malcolm Irving
- Randall Centre for Cell and Molecular Biophysics and British Heart Foundation Centre of Research Excellence, King's College London, London, SE1 1UL, UK
| |
Collapse
|
102
|
Hashem S, Tiberti M, Fornili A. Allosteric modulation of cardiac myosin dynamics by omecamtiv mecarbil. PLoS Comput Biol 2017; 13:e1005826. [PMID: 29108014 PMCID: PMC5690683 DOI: 10.1371/journal.pcbi.1005826] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/16/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023] Open
Abstract
New promising avenues for the pharmacological treatment of skeletal and heart muscle diseases rely on direct sarcomeric modulators, which are molecules that can directly bind to sarcomeric proteins and either inhibit or enhance their activity. A recent breakthrough has been the discovery of the myosin activator omecamtiv mecarbil (OM), which has been shown to increase the power output of the cardiac muscle and is currently in clinical trials for the treatment of heart failure. While the overall effect of OM on the mechano-chemical cycle of myosin is to increase the fraction of myosin molecules in the sarcomere that are strongly bound to actin, the molecular basis of its action is still not completely clear. We present here a Molecular Dynamics study of the motor domain of human cardiac myosin bound to OM, where the effects of the drug on the dynamical properties of the protein are investigated for the first time with atomistic resolution. We found that OM has a double effect on myosin dynamics, inducing a) an increased coupling of the motions of the converter and lever arm subdomains to the rest of the protein and b) a rewiring of the network of dynamic correlations, which produces preferential communication pathways between the OM binding site and distant functional regions. The location of the residues responsible for these effects suggests possible strategies for the future development of improved drugs and the targeting of specific cardiomyopathy-related mutations.
Collapse
Affiliation(s)
- Shaima Hashem
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Matteo Tiberti
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Arianna Fornili
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
- The Thomas Young Centre for Theory and Simulation of Materials, London, United Kingdom
- * E-mail:
| |
Collapse
|
103
|
Teichman SL, Thomson KS, Regnier M. Cardiac Myosin Activation with Gene Therapy Produces Sustained Inotropic Effects and May Treat Heart Failure with Reduced Ejection Fraction. Handb Exp Pharmacol 2017; 243:447-464. [PMID: 27590227 DOI: 10.1007/164_2016_31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic inotropic therapy is effective for the treatment of heart failure with reduced ejection fraction, but has been limited by adverse long-term safety profiles, development of tolerance, and the need for chronic parenteral administration. A safe and convenient therapeutic agent that produces sustained inotropic effects could improve symptoms, functional capacity, and quality of life. Small amounts of 2-deoxy-adenosine triphosphate (dATP) activate cardiac myosin leading to enhanced contractility in normal and failing heart muscle. Cardiac myosin activation triggers faster myosin crossbridge cycling with greater force generation during each contraction. This paper describes the rationale and results of a translational medicine effort to increase dATP levels using a gene therapy strategy to deliver and upregulate ribonucleotide reductase (R1R2), the enzyme responsible for dATP synthesis, selectively in cardiomyocytes. In small and large animal models of heart failure, a single dose of this gene therapy has led to sustained inotropic effects with a benign safety profile. Further animal studies are appropriate with the goal of testing this agent in patients with heart failure.
Collapse
Affiliation(s)
- Sam L Teichman
- BEAT Biotherapeutics Corp, 1380 112th Ave., NE, Suite 200, Seattle, WA, 98004, USA.
| | | | - Michael Regnier
- Department of Bioengineering, University of Washington, Seattle, WA, USA.,Center for Cardiovascular Biology, Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
104
|
Mamidi R, Li J, Gresham KS, Verma S, Doh CY, Li A, Lal S, Dos Remedios CG, Stelzer JE. Dose-Dependent Effects of the Myosin Activator Omecamtiv Mecarbil on Cross-Bridge Behavior and Force Generation in Failing Human Myocardium. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004257. [PMID: 29030372 DOI: 10.1161/circheartfailure.117.004257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/12/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Omecamtiv mecarbil (OM) enhances systolic function in vivo by directly binding the myosin cross-bridges (XBs) in the sarcomere. However, the mechanistic details governing OM-induced modulation of XB behavior in failing human myocardium are unclear. METHODS AND RESULTS The effects of OM on steady state and dynamic XB behavior were measured in chemically skinned myocardial preparations isolated from human donor and heart failure (HF) left ventricle. HF myocardium exhibited impaired contractile function as evidenced by reduced maximal force, magnitude of XB recruitment (Pdf), and a slowed rate of XB detachment (krel) at submaximal Ca2+ activations. Ca2+ sensitivity of force generation (pCa50) was higher in HF myocardium when compared with donor myocardium, both prior to and after OM incubations. OM incubation (0.5 and 1.0 μmol/L) enhanced force generation at submaximal Ca2+ activations in a dose-dependent manner. Notably, OM induced a slowing in krel with 1.0 μmol/L OM but not with 0.5 μmol/L OM in HF myocardium. Additionally, OM exerted other differential effects on XB behavior in HF myocardium as evidenced by a greater enhancement in Pdf and slowing in the time course of cooperative XB recruitment (Trec), which collectively prolonged achievement of peak force development (Tpk), compared with donor myocardium. CONCLUSIONS Our findings demonstrate that OM augments force generation but also prolongs the time course of XB transitions to force-bearing states in remodeled HF myocardium, which may extend the systolic ejection time in vivo. Optimal OM dosing is critical for eliciting enhanced systolic function without excessive prolongation of systolic ejection time, which may compromise diastolic filling.
Collapse
Affiliation(s)
- Ranganath Mamidi
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Jiayang Li
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Kenneth S Gresham
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Sujeet Verma
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Chang Yoon Doh
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Amy Li
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Sean Lal
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Cristobal G Dos Remedios
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.)
| | - Julian E Stelzer
- From the Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH (R.M., J.L., C.Y.D., J.E.S.); Center for Translational Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA (K.S.G); Department of Horticulture Sciences, IFAS, Gulf Coast Research and Education Center, University of Florida, Wimauma (S.V.); Sydney Heart Bank, Discipline of Anatomy & Histology, Bosch Institute, University of Sydney, Australia (A.L., S.L., C.G.d.R.).
| |
Collapse
|
105
|
Affiliation(s)
- V. Bistola
- Heart Failure Unit; 2nd Department of Cardiology; Attikon University Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - O. Chioncel
- Institute of Emergency for Cardiovascular Diseases ‘Prof. C.C. Iliescu’; University of Medicine and Pharmacy Carol Davila; Bucuresti Romania
| |
Collapse
|
106
|
Moin DS, Sackheim J, Hamo CE, Butler J. Cardiac Myosin Activators in Systolic Heart Failure: More Friend than Foe? Curr Cardiol Rep 2017; 18:100. [PMID: 27568794 DOI: 10.1007/s11886-016-0778-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite the rising prevalence of HF, new evidence-based novel therapies for patients with worsening HF remain lacking, e.g., safe inotropic therapies. Traditional inotropes increase contractility by altering intracellular calcium flux, a pathway that may be responsible for the multitude of adverse effects associated with current options. Omecamtiv mecarbil, a direct myosin activator, increases contractility through a distinct pathway by increasing the proportion of myosin heads that are bound to actin in a high-affinity state. Phase II clinical trials in patients with chronic HF with this agent seem promising. A phase III trial investigating this therapy has not yet been pursued to date.
Collapse
Affiliation(s)
- Danyaal S Moin
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Julia Sackheim
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Carine E Hamo
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA. .,Health Sciences Center, Stony Brook University Medical Center, T16-080, Stony Brook, NY, 11794, USA.
| |
Collapse
|
107
|
The evolution of heart failure with reduced ejection fraction pharmacotherapy: What do we have and where are we going? Pharmacol Ther 2017; 178:67-82. [DOI: 10.1016/j.pharmthera.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
108
|
Horváth B, Szentandrássy N, Veress R, Almássy J, Magyar J, Bányász T, Tóth A, Papp Z, Nánási PP. Frequency-dependent effects of omecamtiv mecarbil on cell shortening of isolated canine ventricular cardiomyocytes. Naunyn Schmiedebergs Arch Pharmacol 2017; 390:1239-1246. [PMID: 28940010 DOI: 10.1007/s00210-017-1422-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/31/2017] [Indexed: 01/10/2023]
Abstract
Omecamtiv mecarbil (OM) is a myosin activator agent developed for the treatment of heart failure. OM was reported to increase left ventricular ejection fraction and systolic ejection time, but little is known about the effect of heart rate on the action of OM. The present study, therefore, was designed to investigate the effects of OM on unloaded cell shortening and intracellular Ca2+ ([Ca2+]i) transients as a function of the pacing frequency. Isolated cardiomyocytes were stimulated at various frequencies under steady-state conditions. Cell length was monitored by an optical edge detector and changes in [Ca2+]i were followed using the Ca2+-sensitive dye Fura-2. At the pacing frequency of 1 Hz, OM (1-10 μM) significantly decreased both diastolic and systolic cell length, however, fractional shortening was augmented only by 1 μM OM. Time to peak tension and time of 90% relaxation were progressively increased by OM. At the frequency of 2 Hz, diastolic cell length was reduced by 10 μM OM to a larger extent than systolic cell length, resulting in a significantly decreased fractional shortening under these conditions. OM had no effect on the parameters of the [Ca2+]i transient at any pacing frequency. The results suggest that supratherapeutic concentrations of OM may decrease rather than increase the force of cardiac contraction especially in tachycardic patients.
Collapse
Affiliation(s)
- Balázs Horváth
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary.,Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Norbert Szentandrássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary.,Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Roland Veress
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary
| | - János Almássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary
| | - János Magyar
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary.,Division of Sport Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bányász
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Research Center for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Research Center for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Nagyerdei krt 98, Debrecen, 4012, Hungary. .,Department of Dental Physiology and Pharmacology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary.
| |
Collapse
|
109
|
Gollapudi SK, Reda SM, Chandra M. Omecamtiv Mecarbil Abolishes Length-Mediated Increase in Guinea Pig Cardiac Myofiber Ca 2+ Sensitivity. Biophys J 2017; 113:880-888. [PMID: 28834724 DOI: 10.1016/j.bpj.2017.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 01/14/2023] Open
Abstract
Omecamtiv mecarbil (OM) is a pharmacological agent that augments cardiac contractile function by enhancing myofilament Ca2+ sensitivity. Given that interventions that increase myofilament Ca2+ sensitivity have the potential to alter length-dependent activation (LDA) of cardiac myofilaments, we tested the influence of OM on this fundamental property of the heart. This is significant not only because LDA is prominent in cardiac muscle but also because it contributes to the Frank-Starling law, a mechanism by which the heart increases stroke volume in response to an increase in venous return. We measured steady-state and dynamic contractile indices in detergent-skinned guinea pig (Cavia porcellus) cardiac muscle fibers in the absence and presence of 0.3 and 3.0 μM OM at two different sarcomere lengths (SLs), short SL (1.9 μm) and long SL (2.3 μm). Myofilament Ca2+ sensitivity, as measured by pCa50 (-log of [Ca2+]free concentration required for half-maximal activation), increased significantly at both short and long SLs in OM-treated fibers when compared to untreated fibers; however, the magnitude of increase in pCa50 was twofold greater at short SL than at long SL. A consequence of this greater increase in pCa50 at short SL was that pCa50 did not increase any further at long SL, suggesting that OM abolished the SL dependency of pCa50. Furthermore, the SL dependency of rate constants of cross-bridge distortion dynamics (c) and force redevelopment (ktr) was abolished in 0.3-μM-OM-treated fibers. The negative impact of OM on the SL dependency of pCa50, c, and ktr was also observed in 3.0-μM-OM-treated fibers, indicating that cooperative mechanisms linked to LDA were altered by the OM-mediated effects on cardiac myofilaments.
Collapse
Affiliation(s)
- Sampath K Gollapudi
- Department of Integrative Physiology and Neuroscience (IPN), Washington State University, Pullman, Washington
| | - Sherif M Reda
- Department of Integrative Physiology and Neuroscience (IPN), Washington State University, Pullman, Washington
| | - Murali Chandra
- Department of Integrative Physiology and Neuroscience (IPN), Washington State University, Pullman, Washington.
| |
Collapse
|
110
|
Biering-Sørensen T, Querejeta Roca G, Hegde SM, Shah AM, Claggett B, Mosley TH, Butler KR, Solomon SD. Left ventricular ejection time is an independent predictor of incident heart failure in a community-based cohort. Eur J Heart Fail 2017; 20:1106-1114. [PMID: 28872225 DOI: 10.1002/ejhf.928] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/10/2023] Open
Abstract
AIMS Systolic time intervals change in the progress of cardiac dysfunction. The usefulness of left ventricular ejection time (LVET) to predict cardiovascular morbidity, however, is unknown. METHODS AND RESULTS We studied middle-aged African-Americans from one of four cohorts of the Atherosclerosis Risk in Communities study (Jackson cohort, n=1980) who underwent echocardiography between 1993 and 1995. Left ventricular ejection time was measured by pulsed-wave Doppler of the left ventricular outflow tract and related to outcomes. A shorter LVET was associated with younger age, male sex, higher diastolic blood pressure, higher proportion of diabetes, higher heart rate, higher blood glucose levels and worse fractional shortening. During a median follow-up of 17.6 years, 384 (19%) had incident heart failure (HF), 158 (8%) had a myocardial infarction, and 587 (30%) died. In univariable analysis, a lower LVET was significantly associated with increased risk of all events (P<0.05 for all). However, after multivariable adjustment for age, sex, hypertension, diabetes, body mass index, heart rate, systolic and diastolic blood pressure, fractional shortening and left atrial diameter, LVET remained an independent predictor only of incident HF [hazard ratio 1.07 (1.02-1.14), P=0.010 per 10 ms decrease]. In addition, LVET provided incremental prognostic information to the known risk factors included in the Framingham risk score, in regard to predicting all outcomes except for myocardial infarction. CONCLUSION Left ventricular ejection time is an independent predictor of incident HF in a community-based cohort and provides incremental prognostic information on the risk of future HF and death when added to known risk prediction models.
Collapse
Affiliation(s)
- Tor Biering-Sørensen
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Gabriela Querejeta Roca
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheila M Hegde
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amil M Shah
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Claggett
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth R Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Scott D Solomon
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
111
|
Planelles-Herrero VJ, Hartman JJ, Robert-Paganin J, Malik FI, Houdusse A. Mechanistic and structural basis for activation of cardiac myosin force production by omecamtiv mecarbil. Nat Commun 2017; 8:190. [PMID: 28775348 PMCID: PMC5543065 DOI: 10.1038/s41467-017-00176-5] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/07/2017] [Indexed: 01/10/2023] Open
Abstract
Omecamtiv mecarbil is a selective, small-molecule activator of cardiac myosin that is being developed as a potential treatment for heart failure with reduced ejection fraction. Here we determine the crystal structure of cardiac myosin in the pre-powerstroke state, the most relevant state suggested by kinetic studies, both with (2.45 Å) and without (3.10 Å) omecamtiv mecarbil bound. Omecamtiv mecarbil does not change the motor mechanism nor does it influence myosin structure. Instead, omecamtiv mecarbil binds to an allosteric site that stabilizes the lever arm in a primed position resulting in accumulation of cardiac myosin in the primed state prior to onset of cardiac contraction, thus increasing the number of heads that can bind to the actin filament and undergo a powerstroke once the cardiac cycle starts. The mechanism of action of omecamtiv mecarbil also provides insights into uncovering how force is generated by molecular motors.Omecamtiv mecarbil (OM) is a cardiac myosin activator that is currently in clinical trials for heart failure treatment. Here, the authors give insights into its mode of action and present the crystal structure of OM bound to bovine cardiac myosin, which shows that OM stabilizes the pre-powerstroke state of myosin.
Collapse
Affiliation(s)
- Vicente J Planelles-Herrero
- Structural Motility, Institut Curie, PSL Research University, CNRS, UMR 144, F-75005, Paris, France.,Sorbonne Universités, UPMC Univ Paris06, Sorbonne Universités, IFD, 4 Place Jussieu, 75252, Paris, cedex 05, France
| | - James J Hartman
- Research and Development, Cytokinetics, Inc., South San Francisco, CA, 94080, USA
| | - Julien Robert-Paganin
- Structural Motility, Institut Curie, PSL Research University, CNRS, UMR 144, F-75005, Paris, France
| | - Fady I Malik
- Research and Development, Cytokinetics, Inc., South San Francisco, CA, 94080, USA
| | - Anne Houdusse
- Structural Motility, Institut Curie, PSL Research University, CNRS, UMR 144, F-75005, Paris, France.
| |
Collapse
|
112
|
Advances in heart failure: a review of biomarkers, emerging pharmacological therapies, durable mechanical support and telemonitoring. Clin Sci (Lond) 2017; 131:553-566. [PMID: 28302916 DOI: 10.1042/cs20160196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/14/2016] [Accepted: 01/05/2017] [Indexed: 01/14/2023]
Abstract
The purpose of this review is to provide an overview of diagnosis, prognosis and management of heart failure (HF) with reduced ejection fraction (HFrEF). Specifically, this review is divided into three sections. The first section will address biomarkers. The discovery of biomarkers has allowed further understanding of the pathophysiology of HF and provides insight into potential therapeutic targets. This review will focus on novel applications of natriuretic peptides (NPs) in clinical trials. Next, emerging biomarkers of HF, such as ST2, galectin-3 and copeptin, will be discussed. The second section aims to highlight HF therapies, including novel drugs and durable devices. The last section will review home haemodynamic monitoring and mobile health. We aim to provide context for the understanding of novel diagnostic and therapeutic advances in HF that are still in phase II or III trials, and have yet to become widely available.
Collapse
|
113
|
Manickam M, Jalani HB, Pillaiyar T, Sharma N, Boggu PR, Venkateswararao E, Lee YJ, Jeon ES, Jung SH. Exploration of flexible phenylpropylurea scaffold as novel cardiac myosin activators for the treatment of systolic heart failure. Eur J Med Chem 2017; 134:379-391. [DOI: 10.1016/j.ejmech.2017.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 02/03/2023]
|
114
|
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. The development of therapeutic agents for the treatment of cardiovascular diseases has always been a priority because of the huge potential market for these drugs. These medications should be part of the anesthesiologist's armamentarium because the typical surgical patient is older and has more comorbidities than in the past. This article reviews commonly used cardiovascular medications that are important in managing patients with unstable hemodynamics.
Collapse
Affiliation(s)
- Camellia Asgarian
- Department of Anesthesiology, LSU School of Medicine, T6M5, 1542 Tulane Avenue, Room 656, New Orleans, LA 70112, USA.
| | - Henry Liu
- Department of Anesthesiology & Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, 245 North 15th Street, MS 310, Philadelphia, PA 19102, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU School of Medicine, T6M5, 1542 Tulane Avenue, Room 656, New Orleans, LA 70112, USA
| |
Collapse
|
115
|
Nánási P, Gaburjakova M, Gaburjakova J, Almássy J. Omecamtiv mecarbil activates ryanodine receptors from canine cardiac but not skeletal muscle. Eur J Pharmacol 2017; 809:73-79. [PMID: 28506910 DOI: 10.1016/j.ejphar.2017.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/01/2017] [Accepted: 05/12/2017] [Indexed: 01/10/2023]
Abstract
Due to the limited results achieved in the clinical treatment of heart failure, a new inotropic strategy of myosin motor activation has been developed. The lead molecule of myosin activator agents is omecamtiv mecarbil, which binds directly to the heavy chain of the cardiac β-myosin and enhances cardiac contractility by lengthening the lifetime of the acto-myosin complex and increasing the number of the active force-generating cross-bridges. In the absence of relevant data, the effect of omecamtiv mecarbil on canine cardiac ryanodine receptors (RyR 2) has been investigated in the present study by measuring the electrical activity of single RyR 2 channels incorporated into planar lipid bilayer. When applying 100nM Ca2+ concentration on the cis side ([Ca2+]cis) omecamtiv mecarbil (1-10µM) significantly increased the open probability and opening frequency of RyR 2, while the mean closed time was reduced. Mean open time was increased moderately by 10µM omecamtiv mecarbil. When [Ca2+]cis was elevated to 322 and 735nM, the effect of omecamtiv mecarbil on open probability was evident only at higher (3-10µM) concentrations. All effects of omecamtiv mecarbil were fully reversible upon washout. Omecamtiv mecarbil (up to 10µM) had no effect on the open probability of RyR 1, isolated from either canine or rabbit skeletal muscles. It is concluded that the direct stimulatory action of omecamtiv mecarbil on RyR 2 has to be taken into account when discussing the mechanism of action or the potential side effects of the compound.
Collapse
Affiliation(s)
- Péter Nánási
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marta Gaburjakova
- Institute of Molecular Physiology and Genetics, Centre of Biosciences, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Jana Gaburjakova
- Institute of Molecular Physiology and Genetics, Centre of Biosciences, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - János Almássy
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| |
Collapse
|
116
|
Alfaras I, Di Germanio C, Bernier M, Csiszar A, Ungvari Z, Lakatta EG, de Cabo R. Pharmacological Strategies to Retard Cardiovascular Aging. Circ Res 2017; 118:1626-42. [PMID: 27174954 DOI: 10.1161/circresaha.116.307475] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/08/2016] [Indexed: 01/10/2023]
Abstract
Aging is the major risk factor for cardiovascular diseases, which are the leading cause of death in the United States. Traditionally, the effort to prevent cardiovascular disease has been focused on addressing the conventional risk factors, including hypertension, hyperglycemia, hypercholesterolemia, and high circulating levels of triglycerides. However, recent preclinical studies have identified new approaches to combat cardiovascular disease. Calorie restriction has been reproducibly shown to prolong lifespan in various experimental model animals. This has led to the development of calorie restriction mimetics and other pharmacological interventions capable to delay age-related diseases. In this review, we will address the mechanistic effects of aging per se on the cardiovascular system and focus on the prolongevity benefits of various therapeutic strategies that support cardiovascular health.
Collapse
Affiliation(s)
- Irene Alfaras
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Clara Di Germanio
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Michel Bernier
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Anna Csiszar
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Zoltan Ungvari
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Edward G Lakatta
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.)
| | - Rafael de Cabo
- From the Experimental Gerontology Section, Translational Gerontology Branch (I.A., C.D.G., M.B., R.d.C.) and Laboratory of Cardiovascular Science (E.G.L.), National Institute on Aging, National Institutes of Health, Baltimore, MD; Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy (C.D.G.); and Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK (A.C., Z.U.).
| |
Collapse
|
117
|
Screever EM, Meijers WC, van Veldhuisen DJ, de Boer RA. New developments in the pharmacotherapeutic management of heart failure in elderly patients: concerns and considerations. Expert Opin Pharmacother 2017; 18:645-655. [PMID: 28375036 DOI: 10.1080/14656566.2017.1316377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Heart failure (HF) remains a major public health problem worldwide, affecting approximately 23 million patients, and is predominantly a disease of the elderly population. Elderly patients mostly suffer from HF with preserved ejection fraction (HFpEF), which often presents with multiple co-morbidities and they require multiple medical treatments. This, together with the heterogeneous phenotype of HFpEF, makes it a difficult syndrome to diagnose and treat. Areas covered: Although HF is most abundant in the elderly, this group is still underrepresented in clinical trials, which results in the lack of evidence-based medical regimens. The current review has focused on new potential therapies for this poorly studied population. The focus will be on several classes of drugs currently recommended or might be expected soon. These will include sacubitril/valsartan (former LCZ696), Omecamtiv mecarbil, Vericiguat, Ivabradine, mineralocorticoid receptor antagonists (MRAs) and potassium binders. Expert opinion: We discuss promising new treatments and hypothesize that personalized approaches will be needed to treat elderly patients optimally. Medical doctors should not only focus on HF therapy, but comorbidities and polypharmacy should also influence therapeutic decision making. Furthermore, the importance of quality of life as a management endpoint should not be underestimated in the frail elderly.
Collapse
Affiliation(s)
- Elles M Screever
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Wouter C Meijers
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Dirk J van Veldhuisen
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Rudolf A de Boer
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| |
Collapse
|
118
|
Krzysztofik J, Ponikowski P. Current and emerging pharmacologic options for the management of patients with chronic and acute decompensated heart failure. Expert Rev Clin Pharmacol 2017; 10:517-534. [PMID: 28358228 DOI: 10.1080/17512433.2017.1299574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION For many years heart failure (HF) was known as a fatal disease with an ominous prognosis. In the last decades better understanding of the pathophysiological mechanisms underlying HF has resulted in major breakthrough in the management and improvement in the natural history of this clinical syndrome. Areas covered: The review is focused on current and upcoming pharmacological therapies in patients with chronic and acute HF, starting with brief overview of drugs which improve the outcomes in patients with chronic HF with reduced ejection fraction (EF) including neurohormonal antagonists, angiotensin receptor neprilysin inhibitor and If- channel inhibitor, then presenting the summary of symptomatic treatment, the pharmacotherapy in chronic HF with preserved and mid-range EF and in acute HF. Finally, we report the emerging pharmacologic options and ongoing clinical trials and future directions in pharmacotherapy. Expert commentary: The guidelines-recommended therapies in HF with reduced EF need to be widely implemented into the everyday clinical practice. Better clinical characterization of HF with preserved, mid-range EF and acute HF, with better understanding of the underlying pathophysiological mechanisms may ultimately result in a development of effective strategies improving ominous outcomes in these patients.
Collapse
Affiliation(s)
- Justyna Krzysztofik
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
| | - Piotr Ponikowski
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
| |
Collapse
|
119
|
Yandrapalli S, Tariq S, Aronow WS. Advances in chemical pharmacotherapy for managing acute decompensated heart failure. Expert Opin Pharmacother 2017; 18:471-485. [PMID: 28276970 DOI: 10.1080/14656566.2017.1299708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Acute decompensated heart failure (ADHF) contributes largely to the burden of heart failure and is associated with a poorer prognosis. Although numerous clinical trials evaluated the benefit of newer medications for ADHF, most of them were not successful. Areas covered: This review focusses on the updates on recent developments in chemical pharmacotherapy for the management of ADHF. A MEDLINE search for relevant review articles and original investigations on newer drugs for ADHF provided us with necessary literature. Expert opinion: Currently, popular therapies like diuretics, vasodilators, and inotropes offer symptomatic relief but do not provide survival benefit. Although multiple medications targeting novel pathways in ADHF were studied extensively, they failed to show either symptomatic or mortality benefit in available randomized trials. Improving our understanding of the complex pathophysiology of ADHF along with designing studies which include patients who are more representative of the real-world heart failure population, standardizing methods for endpoint assessment, and evaluating the role on novel biomarkers of organ dysfunction is important to improve ADHF research. Enhancing preventive strategies like improving baseline therapy in chronic heart failure patients and developing strategies for early identification of ADHF are important as our quest for innovative ADHF pharmacotherapy continues.
Collapse
Affiliation(s)
- Srikanth Yandrapalli
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| | - Sohaib Tariq
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| | - Wilbert S Aronow
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| |
Collapse
|
120
|
Mullens W, Verbrugge FH, Nijst P, Tang WHW. Renal sodium avidity in heart failure: from pathophysiology to treatment strategies. Eur Heart J 2017; 38:1872-1882. [DOI: 10.1093/eurheartj/ehx035] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/16/2017] [Indexed: 01/10/2023] Open
|
121
|
Heart failure drug changes the mechanoenzymology of the cardiac myosin powerstroke. Proc Natl Acad Sci U S A 2017; 114:E1796-E1804. [PMID: 28223517 DOI: 10.1073/pnas.1611698114] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Omecamtiv mecarbil (OM), a putative heart failure therapeutic, increases cardiac contractility. We hypothesize that it does this by changing the structural kinetics of the myosin powerstroke. We tested this directly by performing transient time-resolved FRET on a ventricular cardiac myosin biosensor. Our results demonstrate that OM stabilizes myosin's prepowerstroke structural state, supporting previous measurements showing that the drug shifts the equilibrium constant for myosin-catalyzed ATP hydrolysis toward the posthydrolysis biochemical state. OM slowed the actin-induced powerstroke, despite a twofold increase in the rate constant for actin-activated phosphate release, the biochemical step in myosin's ATPase cycle associated with force generation and the conversion of chemical energy into mechanical work. We conclude that OM alters the energetics of cardiac myosin's mechanical cycle, causing the powerstroke to occur after myosin weakly binds to actin and releases phosphate. We discuss the physiological implications for these changes.
Collapse
|
122
|
Cuthbert JJ, Pellicori P, Shah P, Clark AL. New pharmacological approaches in heart failure therapy: developments and possibilities. Future Cardiol 2017; 13:173-188. [PMID: 28181443 DOI: 10.2217/fca-2016-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There have been few major breakthroughs in heart failure (HF) drug therapies in recent years yet HF morbidity and mortality remain high, and there is a clear need for further research. Several newer agents that appear promising in Phase I and II trials do not progress to show clinical benefit in later trials. Part of the failure to find new therapies may lie in flawed trial design compounded by the need for ever-increasing patient numbers in order to prove outcome benefit. We summarize some of the most recent and promising medical therapies for HF.
Collapse
Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Parin Shah
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull & East Yorkshire Medical Research & Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK
| |
Collapse
|
123
|
Swenson AM, Tang W, Blair CA, Fetrow CM, Unrath WC, Previs MJ, Campbell KS, Yengo CM. Omecamtiv Mecarbil Enhances the Duty Ratio of Human β-Cardiac Myosin Resulting in Increased Calcium Sensitivity and Slowed Force Development in Cardiac Muscle. J Biol Chem 2017; 292:3768-3778. [PMID: 28082673 DOI: 10.1074/jbc.m116.748780] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/05/2017] [Indexed: 01/10/2023] Open
Abstract
The small molecule drug omecamtiv mecarbil (OM) specifically targets cardiac muscle myosin and is known to enhance cardiac muscle performance, yet its impact on human cardiac myosin motor function is unclear. We expressed and purified human β-cardiac myosin subfragment 1 (M2β-S1) containing a C-terminal Avi tag. We demonstrate that the maximum actin-activated ATPase activity of M2β-S1 is slowed more than 4-fold in the presence of OM, whereas the actin concentration required for half-maximal ATPase was reduced dramatically (30-fold). We find OM does not change the overall actin affinity. Transient kinetic experiments suggest that there are two kinetic pathways in the presence of OM. The dominant pathway results in a slow transition between actomyosin·ADP states and increases the time myosin is strongly bound to actin. However, OM also traps a population of myosin heads in a weak actin affinity state with slow product release. We demonstrate that OM can reduce the actin sliding velocity more than 100-fold in the in vitro motility assay. The ionic strength dependence of in vitro motility suggests the inhibition may be at least partially due to drag forces from weakly attached myosin heads. OM causes an increase in duty ratio examined in the motility assay. Experiments with permeabilized human myocardium demonstrate that OM increases calcium sensitivity and slows force development (ktr) in a concentration-dependent manner, whereas the maximally activated force is unchanged. We propose that OM increases the myosin duty ratio, which results in enhanced calcium sensitivity but slower force development in human myocardium.
Collapse
Affiliation(s)
- Anja M Swenson
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Wanjian Tang
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Cheavar A Blair
- the Department of Physiology and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky 40536-0298, and
| | - Christopher M Fetrow
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - William C Unrath
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033
| | - Michael J Previs
- the Department of Molecular Physiology and Biophysics, Cardiovascular Research Institute, University of Vermont, Burlington, Vermont 05405
| | - Kenneth S Campbell
- the Department of Physiology and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky 40536-0298, and
| | - Christopher M Yengo
- From the Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033,
| |
Collapse
|
124
|
Tang W, Blair CA, Walton SD, Málnási-Csizmadia A, Campbell KS, Yengo CM. Modulating Beta-Cardiac Myosin Function at the Molecular and Tissue Levels. Front Physiol 2017; 7:659. [PMID: 28119616 PMCID: PMC5220080 DOI: 10.3389/fphys.2016.00659] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/15/2016] [Indexed: 01/10/2023] Open
Abstract
Inherited cardiomyopathies are a common form of heart disease that are caused by mutations in sarcomeric proteins with beta cardiac myosin (MYH7) being one of the most frequently affected genes. Since the discovery of the first cardiomyopathy associated mutation in beta-cardiac myosin, a major goal has been to correlate the in vitro myosin motor properties with the contractile performance of cardiac muscle. There has been substantial progress in developing assays to measure the force and velocity properties of purified cardiac muscle myosin but it is still challenging to correlate results from molecular and tissue-level experiments. Mutations that cause hypertrophic cardiomyopathy are more common than mutations that lead to dilated cardiomyopathy and are also often associated with increased isometric force and hyper-contractility. Therefore, the development of drugs designed to decrease isometric force by reducing the duty ratio (the proportion of time myosin spends bound to actin during its ATPase cycle) has been proposed for the treatment of hypertrophic cardiomyopathy. Para-Nitroblebbistatin is a small molecule drug proposed to decrease the duty ratio of class II myosins. We examined the impact of this drug on human beta cardiac myosin using purified myosin motor assays and studies of permeabilized muscle fiber mechanics. We find that with purified human beta-cardiac myosin para-Nitroblebbistatin slows actin-activated ATPase and in vitro motility without altering the ADP release rate constant. In permeabilized human myocardium, para-Nitroblebbistatin reduces isometric force, power, and calcium sensitivity while not changing shortening velocity or the rate of force development (ktr). Therefore, designing a drug that reduces the myosin duty ratio by inhibiting strong attachment to actin while not changing detachment can cause a reduction in force without changing shortening velocity or relaxation.
Collapse
Affiliation(s)
- Wanjian Tang
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine Hershey, PA, USA
| | - Cheavar A Blair
- Department of Physiology, University of Kentucky Lexington, KY, USA
| | - Shane D Walton
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine Hershey, PA, USA
| | | | - Kenneth S Campbell
- Department of Physiology, University of KentuckyLexington, KY, USA; Division of Cardiovascular Medicine, University of KentuckyLexington, KY, USA
| | - Christopher M Yengo
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine Hershey, PA, USA
| |
Collapse
|
125
|
|
126
|
Psotka MA, Teerlink JR. Direct Myosin Activation by Omecamtiv Mecarbil for Heart Failure with Reduced Ejection Fraction. Handb Exp Pharmacol 2017; 243:465-490. [PMID: 28315072 DOI: 10.1007/164_2017_13] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Myosin is the indispensable molecular motor that utilizes chemical energy to produce force for contraction within the cardiac myocyte. Myosin activity is gated by intracellular calcium levels which are regulated by multiple upstream signaling cascades that can be altered for clinical utility using inotropic medications. In contrast to clinically available cardiac inotropes, omecamtiv mecarbil is a novel direct myosin activator developed to augment left ventricular systolic function without the undesirable secondary effects of altered calcium homeostasis. Its identification and synthesis followed high-throughput screening of a reconstituted sarcomere, deliberate optimization, exquisite biochemical evaluation, and subsequently promising effects in animal models were demonstrated. Physiologically, it prolonged the duration of left ventricular systole in animal models, healthy adults, and patients with heart failure with reduced ejection fraction (HFrEF) without changing the velocity of pressure development, as assessed in animal models. It has been formulated for both intravenous and oral administration, and in both acute and chronic settings produced similar alterations in the duration of systole associated with beneficial increases in cardiac output, improvements in left ventricular volumes, and reductions in heart rate and often of natriuretic peptides. Small, asymptomatic increases in troponin were also observed in the absence of clinically evident ischemia. Clinically, the question remains as to whether the possible harm of this minimal troponin release is outweighed by the potential benefits of reduced neurohormonal activation, increased stroke volume and cardiac output, and improved ventricular remodeling in patients treated with omecamtiv mecarbil. The resolution of this question is being addressed by a phase III outcomes trial of this potential novel therapy for heart failure.
Collapse
Affiliation(s)
- Mitchell A Psotka
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Section of Cardiology, 111C, San Francisco Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA, 94121-1545, USA.
| |
Collapse
|
127
|
Brown DA, Perry JB, Allen ME, Sabbah HN, Stauffer BL, Shaikh SR, Cleland JGF, Colucci WS, Butler J, Voors AA, Anker SD, Pitt B, Pieske B, Filippatos G, Greene SJ, Gheorghiade M. Expert consensus document: Mitochondrial function as a therapeutic target in heart failure. Nat Rev Cardiol 2016; 14:238-250. [PMID: 28004807 PMCID: PMC5350035 DOI: 10.1038/nrcardio.2016.203] [Citation(s) in RCA: 477] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Heart failure is a pressing worldwide public-health problem with millions of patients having worsening heart failure. Despite all the available therapies, the condition carries a very poor prognosis. Existing therapies provide symptomatic and clinical benefit, but do not fully address molecular abnormalities that occur in cardiomyocytes. This shortcoming is particularly important given that most patients with heart failure have viable dysfunctional myocardium, in which an improvement or normalization of function might be possible. Although the pathophysiology of heart failure is complex, mitochondrial dysfunction seems to be an important target for therapy to improve cardiac function directly. Mitochondrial abnormalities include impaired mitochondrial electron transport chain activity, increased formation of reactive oxygen species, shifted metabolic substrate utilization, aberrant mitochondrial dynamics, and altered ion homeostasis. In this Consensus Statement, insights into the mechanisms of mitochondrial dysfunction in heart failure are presented, along with an overview of emerging treatments with the potential to improve the function of the failing heart by targeting mitochondria.
Collapse
Affiliation(s)
- David A Brown
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1035 Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
| | - Justin B Perry
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1035 Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
| | - Mitchell E Allen
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1035 Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, Virginia 24060, USA
| | - Hani N Sabbah
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, Michigan 48202, USA
| | - Brian L Stauffer
- Division of Cardiology, Department of Medicine, University of Colorado Denver, 12700 East 19th Avenue, B139, Aurora, Colorado 80045, USA
| | - Saame Raza Shaikh
- Department of Biochemistry and Molecular Biology, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, North Carolina 27834, USA
| | - John G F Cleland
- National Heart &Lung Institute, National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton &Harefield Hospitals, Imperial College, London, UK
| | - Wilson S Colucci
- Cardiovascular Medicine Section, Boston University School of Medicine and Boston Medical Center, 88 East Newton Street, C-8, Boston, Massachusetts 02118, USA
| | - Javed Butler
- Division of Cardiology, Health Sciences Center, T-16 Room 080, SUNY at Stony Brook, New York 11794, USA
| | - Adriaan A Voors
- University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen 9713 GZ, Netherlands
| | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Robert-Koch-Straße, D-37075, Göttingen, Germany
| | - Bertram Pitt
- University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109, USA
| | - Burkert Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, and German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Gerasimos Filippatos
- National and Kopodistrian University of Athens, School of Medicine, Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Rimini 1, Athens 12462, Greece
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, 2301 Erwin Road Suite 7400, Durham, North Carolina 27705, USA
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 201 East Huron, Galter 3-150, Chicago, Illinois 60611, USA
| |
Collapse
|
128
|
Teerlink JR, Felker GM, McMurray JJV, Solomon SD, Adams KF, Cleland JGF, Ezekowitz JA, Goudev A, Macdonald P, Metra M, Mitrovic V, Ponikowski P, Serpytis P, Spinar J, Tomcsányi J, Vandekerckhove HJ, Voors AA, Monsalvo ML, Johnston J, Malik FI, Honarpour N. Chronic Oral Study of Myosin Activation to Increase Contractility in Heart Failure (COSMIC-HF): a phase 2, pharmacokinetic, randomised, placebo-controlled trial. Lancet 2016; 388:2895-2903. [PMID: 27914656 DOI: 10.1016/s0140-6736(16)32049-9] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Impaired contractility is a feature of heart failure with reduced ejection fraction. We assessed the pharmacokinetics and effects on cardiac function and structure of the cardiac myosin activator, omecamtiv mecarbil. METHODS In this randomised, double-blind study, done at 87 sites in 13 countries, we recruited patients with stable, symptomatic chronic heart failure and left ventricular ejection fraction 40% or lower. Patients were randomly assigned equally, via an interactive web response system, to receive 25 mg oral omecamtiv mecarbil twice daily (fixed-dose group), 25 mg twice daily titrated to 50 mg twice daily guided by pharmacokinetics (pharmacokinetic-titration group), or placebo for 20 weeks. We assessed the maximum concentration of omecamtiv mecarbil in plasma (primary endpoint) and changes in cardiac function and ventricular diameters. This trial is registered with ClinicalTrials.gov, number NCT01786512. FINDINGS From March 17, 2014, to March 5, 2015, we enrolled 150 patients in the fixed-dose omecamtiv mecarbil group and 149 in the pharmacokinetic-titration and placebo groups. Mean maximum concentration of omecamtiv mecarbil at 12 weeks was 200 (SD 71) ng/mL in the fixed-dose group and 318 (129) ng/mL in the pharmacokinetic-titration group. For the pharmacokinetic-titration group versus placebo group at 20 weeks, least square mean differences were as follows: systolic ejection time 25 ms (95% CI 18-32, p<0·0001), stroke volume 3·6 mL (0·5-6·7, p=0·0217), left ventricular end-systolic diameter -1·8 mm (-2·9 to -0·6, p=0·0027), left ventricular end-diastolic diameter -1·3 mm, (-2·3 to 0·3, p=0·0128), heart rate -3·0 beats per min (-5·1 to -0·8, p=0·0070), and N-terminal pro B-type natriuretic peptide concentration in plasma -970 pg/mL (-1672 to -268, p=0·0069). The frequency of adverse clinical events did not differ between groups. INTERPRETATION Omecamtiv mecarbil dosing guided by pharmacokinetics achieved plasma concentrations associated with improved cardiac function and decreased ventricular diameter. FUNDING Amgen.
Collapse
Affiliation(s)
- John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, CA, USA; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kirkwood F Adams
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK; Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | | | - Assen Goudev
- Department of Cardiology, Queen Giovanna University Hospital and Medical University-Sofia, Sofia, Bulgaria
| | - Peter Macdonald
- Heart Transplant Unit, St Vincent's Hospital and Transplantation Research Laboratory, Victor Chang Cardiac Research Institute and University of New South Wales, Sydney, NSW, Australia
| | - Marco Metra
- Division of Cardiology, University of Brescia, Brescia, Italy
| | - Veselin Mitrovic
- Kerckhoff-Klinik Forschungsgesellschaft, Frankfurt, Germany; Johann-Wolfgang Goethe University, Main, Germany
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University and Centre for Heart Diseases, Military Hospital, Wrocław, Poland
| | - Pranas Serpytis
- Emergency Centre, Vilnius University Hospital Santariskiu Klinikos and Vilnius University, Vilnius, Lithuania
| | - Jindrich Spinar
- University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - János Tomcsányi
- Cardiology Department, St John of God Hospital, Budapest, Hungary
| | | | - Adriaan A Voors
- University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | | | | | | |
Collapse
|
129
|
Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
130
|
Translation of Cardiac Myosin Activation with 2-deoxy-ATP to Treat Heart Failure via an Experimental Ribonucleotide Reductase-Based Gene Therapy. JACC Basic Transl Sci 2016; 1:666-679. [PMID: 28553667 PMCID: PMC5444879 DOI: 10.1016/j.jacbts.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite recent advances, chronic heart failure remains a significant and growing unmet medical need, reaching epidemic proportions carrying substantial morbidity, mortality, and costs. A safe and convenient therapeutic agent that produces sustained inotropic effects could ameliorate symptoms and improve functional capacity and quality of life. The authors discovered that small amounts of 2-deoxy-ATP (dATP) activate cardiac myosin leading to enhanced contractility in normal and failing heart muscle. Cardiac myosin activation triggers faster myosin cross-bridge cycling with greater force generation during each contraction. They describe the rationale and results of a translational medicine effort to increase dATP levels using a gene therapy strategy that up-regulates ribonucleotide reductase, the rate-limiting enzyme for dATP synthesis, selectively in cardiomyocytes. In small and large animal models of heart failure, a single dose of this gene therapy has led to sustained inotropic effects with no toxicity or safety concerns identified to date. Further animal studies are being conducted with the goal of testing this agent in patients with heart failure.
Collapse
|
131
|
Affiliation(s)
- Jalal K Ghali
- a Division of Cardiology, Department of Medicine , Mercer University School of Medicine , Macon , GA USA
| |
Collapse
|
132
|
Heggermont WA, Papageorgiou AP, Heymans S, van Bilsen M. Metabolic support for the heart: complementary therapy for heart failure? Eur J Heart Fail 2016; 18:1420-1429. [DOI: 10.1002/ejhf.678] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- Ward A. Heggermont
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Research; University of Leuven; Belgium
- Cardiovascular Research Institute Maastricht; University of Maastricht; The Netherlands
- Cardiovascular Research Centre, Cardiology Service; OLV Hospital Aalst; Aalst Belgium
| | - Anna-Pia Papageorgiou
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Research; University of Leuven; Belgium
- Cardiovascular Research Institute Maastricht; University of Maastricht; The Netherlands
| | - Stephane Heymans
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Research; University of Leuven; Belgium
- Cardiovascular Research Institute Maastricht; University of Maastricht; The Netherlands
| | - Marc van Bilsen
- Cardiovascular Research Institute Maastricht; University of Maastricht; The Netherlands
| |
Collapse
|
133
|
Teerlink JR, Felker GM, McMurray JJV, Ponikowski P, Metra M, Filippatos GS, Ezekowitz JA, Dickstein K, Cleland JGF, Kim JB, Lei L, Knusel B, Wolff AA, Malik FI, Wasserman SM. Acute Treatment With Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure: The ATOMIC-AHF Study. J Am Coll Cardiol 2016; 67:1444-1455. [PMID: 27012405 DOI: 10.1016/j.jacc.2016.01.031] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Omecamtiv mecarbil (OM) is a selective cardiac myosin activator that increases myocardial function in healthy volunteers and in patients with chronic heart failure. OBJECTIVES This study evaluated the pharmacokinetics, pharmacodynamics, tolerability, safety, and efficacy of OM in patients with acute heart failure (AHF). METHODS Patients admitted for AHF with left ventricular ejection fraction ≤40%, dyspnea, and elevated plasma concentrations of natriuretic peptides were randomized to receive a double-blind, 48-h intravenous infusion of placebo or OM in 3 sequential, escalating-dose cohorts. RESULTS In 606 patients, OM did not improve the primary endpoint of dyspnea relief (3 OM dose groups and pooled placebo: placebo, 41%; OM cohort 1, 42%; cohort 2, 47%; cohort 3, 51%; p = 0.33) or any of the secondary outcomes studied. In supplemental, pre-specified analyses, OM resulted in greater dyspnea relief at 48 h (placebo, 37% vs. OM, 51%; p = 0.034) and through 5 days (p = 0.038) in the high-dose cohort. OM exerted plasma concentration-related increases in left ventricular systolic ejection time (p < 0.0001) and decreases in end-systolic dimension (p < 0.05). The adverse event profile and tolerability of OM were similar to those of placebo, without increases in ventricular or supraventricular tachyarrhythmias. Plasma troponin concentrations were higher in OM-treated patients compared with placebo (median difference at 48 h, 0.004 ng/ml), but with no obvious relationship with OM concentration (p = 0.95). CONCLUSIONS In patients with AHF, intravenous OM did not meet the primary endpoint of dyspnea improvement, but it was generally well tolerated, it increased systolic ejection time, and it may have improved dyspnea in the high-dose group. (Acute Treatment with Omecamtiv Mecarbil to Increase Contractility in Acute Heart Failure [ATOMIC-AHF]; NCT01300013).
Collapse
Affiliation(s)
- John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, California; Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California.
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Clinical Military Hospital, Wroclaw, Poland
| | - Marco Metra
- Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Kenneth Dickstein
- Cardiology Division, University of Bergen, Bergen, Norway; Cardiology Division, Stavanger University Hospital, Stavanger, Norway
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, United Kingdom
| | - Jae B Kim
- Amgen, Inc., Thousand Oaks, California
| | - Lei Lei
- Amgen, Inc., Thousand Oaks, California
| | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, California
| | | | | |
Collapse
|
134
|
Spinar J, Jarkovsky J, Spinarova L, Vitovec J, Linhart A, Widimsky P, Miklik R, Zeman K, Belohlavek J, Malek F, Cihalik C, Spac J, Felsoci M, Ostadal P, Dusek L, Kettner J, Vaclavik J, Littnerova S, Monhart Z, Malek J, Parenica J. Worse prognosis of real-world patients with acute heart failure from the Czech AHEAD registry in comparison to patients from the RELAX-AHF trial. ESC Heart Fail 2016; 4:8-15. [PMID: 28217307 PMCID: PMC5292638 DOI: 10.1002/ehf2.12105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 01/10/2023] Open
Abstract
Aims The randomized clinical trial RELAX‐AHF demonstrated a positive effect of vasodilator therapy with serelaxin in the treatment of AHF patients. The aim of our study was to compare clinical characteristics and outcomes of patients from the AHEAD registry who met criteria of the RELAX‐AHF trial (relax‐comparable group) with the same characteristics and outcomes of patients from the AHEAD registry who did not meet those criteria (relax‐non‐comparable group), and finally with characteristics and outcomes of patients from the RELAX‐AHF trial. Methods and results A total of 5856 patients from the AHEAD registry (Czech registry of AHF) were divided into two groups according to RELAX‐AHF criteria: relax‐comparable (n = 1361) and relax‐non‐comparable (n = 4495). As compared with the relax‐non‐comparable group, patients in the relax‐comparable group were older, had higher levels of systolic and diastolic blood pressure, lower creatinine clearance, and a higher number of comorbidities. Relax‐comparable patients also had significantly lower short‐term as well as long‐term mortality rates in comparison to relax‐non‐comparable patients, but a significantly higher mortality rate in comparison to the placebo group of patients from the RELAX‐AHF trial. Using AHEAD score, we have identified higher‐risk patients from relax‐comparable group who might potentially benefit from new therapeutic approaches in the future. Conclusions Only about one in five of all evaluated patients met criteria for the potential treatment with the new vasodilator serelaxin. AHF patients from the real clinical practice had a higher mortality when compared with patients from the randomized clinical trial.
Collapse
Affiliation(s)
- Jindrich Spinar
- Department of Internal Medicine and CardiologyUniversity Hospital BrnoBrnoCzech Republic; Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University Brno Czech Republic
| | - Lenka Spinarova
- Faculty of MedicineMasaryk UniversityBrnoCzech Republic; 1st Department of Internal Medicine, Cardiology and AngiologySt. Anne's University Hospital BrnoBrnoCzech Republic
| | - Jiri Vitovec
- Faculty of MedicineMasaryk UniversityBrnoCzech Republic; 1st Department of Internal Medicine, Cardiology and AngiologySt. Anne's University Hospital BrnoBrnoCzech Republic
| | - Ales Linhart
- 2nd Department of Internal Medicine, Cardiology and Angiology, First Faculty of Medicine Charles University in Prague, General University Hospital in Prague Prague Czech Republic
| | - Petr Widimsky
- University Hospital Kralovske Vinohrady, Third Faculty of Medicine Charles University in Prague Prague Czech Republic
| | - Roman Miklik
- Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine Hospital Frydek-Mistek Frydek-Mistek Czech Republic
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiology and Angiology, First Faculty of Medicine Charles University in Prague, General University Hospital in Prague Prague Czech Republic
| | - Filip Malek
- Department of Cardiology Na Homolce Hospital Prague Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine University Hospital Olomouc Olomouc Czech Republic
| | - Jiri Spac
- Faculty of MedicineMasaryk UniversityBrnoCzech Republic; 2nd Department of Internal MedicineSt. Anne's University Hospital BrnoBrnoCzech Republic
| | - Marian Felsoci
- Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic
| | - Petr Ostadal
- Department of Cardiology Na Homolce Hospital Prague Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University Brno Czech Republic
| | - Jiri Kettner
- Department of Cardiology Institute of Clinical and Experimental Medicine Prague Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine University Hospital Olomouc Olomouc Czech Republic
| | - Simona Littnerova
- Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University Brno Czech Republic
| | - Zdeněk Monhart
- Department of Internal Medicine Hospital Znojmo Znojmo Czech Republic
| | - Josef Malek
- Department of Internal Medicine Hospital Havlickuv Brod Havlickuv Brod Czech Republic
| | - Jiri Parenica
- Department of Internal Medicine and CardiologyUniversity Hospital BrnoBrnoCzech Republic; Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | | |
Collapse
|
135
|
Wiklund I, Anatchkova M, Oko-Osi H, von Maltzahn R, Chau D, Malik FI, Patrick DL, Spertus J, Teerlink JR. Incorporating development of a patient-reported outcome instrument in a clinical drug development program: examples from a heart failure program. Health Qual Life Outcomes 2016; 14:131. [PMID: 27629389 PMCID: PMC5024511 DOI: 10.1186/s12955-016-0529-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 09/06/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process. METHODS Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items. RESULTS During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders. CONCLUSION Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.
Collapse
Affiliation(s)
- Ingela Wiklund
- Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK.
| | | | | | | | | | | | | | | | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and University of California San Francisco School of Medicine, San Francisco, CA, USA
| |
Collapse
|
136
|
Ibrahim NE, Gaggin HK, Konstam MA, Januzzi JL. Established and Emerging Roles of Biomarkers in Heart Failure Clinical Trials. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.115.002528. [DOI: 10.1161/circheartfailure.115.002528] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The role of circulating biomarkers in heart failure clinical trials has evolved in recent decades. Increasing evidence behind the use of natriuretic peptides, emergence of novel biomarkers, and increased emphasis on targeting therapies toward physiological basis of disease (so-called precision medicine) have all contributed to the continued expansion of biomarker use in heart failure clinical trials. We will explore the advantages and pitfalls encountered through the use of biomarkers in clinical trials as an inclusion criterion, toxicity marker, and end point. We will also review their role in providing insights into the mechanism of action of therapeutics and guiding therapy in the management of patients with heart failure.
Collapse
Affiliation(s)
- Nasrien E. Ibrahim
- From the Cardiology Division, Massachusetts General Hospital, Boston (N.E.I., H.K.G., J.L.J.); Harvard Clinical Research Institute, Boston, MA (H.K.G., J.L.J.); and The Cardiovascular Center, Tufts Medical Center, Boston, MA (M.A.K.)
| | - Hanna K. Gaggin
- From the Cardiology Division, Massachusetts General Hospital, Boston (N.E.I., H.K.G., J.L.J.); Harvard Clinical Research Institute, Boston, MA (H.K.G., J.L.J.); and The Cardiovascular Center, Tufts Medical Center, Boston, MA (M.A.K.)
| | - Marvin A. Konstam
- From the Cardiology Division, Massachusetts General Hospital, Boston (N.E.I., H.K.G., J.L.J.); Harvard Clinical Research Institute, Boston, MA (H.K.G., J.L.J.); and The Cardiovascular Center, Tufts Medical Center, Boston, MA (M.A.K.)
| | - James L. Januzzi
- From the Cardiology Division, Massachusetts General Hospital, Boston (N.E.I., H.K.G., J.L.J.); Harvard Clinical Research Institute, Boston, MA (H.K.G., J.L.J.); and The Cardiovascular Center, Tufts Medical Center, Boston, MA (M.A.K.)
| |
Collapse
|
137
|
Abstract
Despite advances in therapy, patients with heart failure (HF) continue to experience unacceptably high rates of hospitalization and death, as well as poor quality of life. As a consequence, there is an urgent need for new treatments that can improve the clinical course of the growing worldwide population of HF patients. Serelaxin and ularatide, both based on naturally occurring peptides, have potent vasodilatory as well as other effects on the heart and kidneys. For both agents, phase 3 studies that are designed to determine whether they improve outcomes in patients with acute HF have completed enrollment. TRV027, a biased ligand for the type 1 angiotensin receptor with effects that extend beyond traditional angiotensin-receptor blockers is also being studied in the acute HF population. Omecamtiv mecarbil, an inotropic agent that improves myocardial contractility by a novel mechanism, and vericiguat, a drug that stimulates soluble guanylate cyclase, are both being developed to treat patients with chronic HF. Finally, despite the negative results of the CUPID study, gene transfer therapy continues to be explored as a means of improving the function of the failing heart. The basis for the use of these drugs and their current status in clinical trials are discussed. (Circ J 2016; 80: 1882-1891).
Collapse
|
138
|
Lother A, Hein L. Pharmacology of heart failure: From basic science to novel therapies. Pharmacol Ther 2016; 166:136-49. [PMID: 27456554 DOI: 10.1016/j.pharmthera.2016.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/08/2016] [Indexed: 01/10/2023]
Abstract
Chronic heart failure is one of the leading causes for hospitalization in the United States and Europe, and is accompanied by high mortality. Current pharmacological therapy of chronic heart failure with reduced ejection fraction is largely based on compounds that inhibit the detrimental action of the adrenergic and the renin-angiotensin-aldosterone systems on the heart. More than one decade after spironolactone, two novel therapeutic principles have been added to the very recently released guidelines on heart failure therapy: the HCN-channel inhibitor ivabradine and the combined angiotensin and neprilysin inhibitor valsartan/sacubitril. New compounds that are in phase II or III clinical evaluation include novel non-steroidal mineralocorticoid receptor antagonists, guanylate cyclase activators or myosine activators. A variety of novel candidate targets have been identified and the availability of gene transfer has just begun to accelerate translation from basic science to clinical application. This review provides an overview of current pharmacology and pharmacotherapy in chronic heart failure at three stages: the updated clinical guidelines of the American Heart Association and the European Society of Cardiology, new drugs which are in clinical development, and finally innovative drug targets and their mechanisms in heart failure which are emerging from preclinical studies will be discussed.
Collapse
Affiliation(s)
- Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Heart Center, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lutz Hein
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
139
|
Tran HA, Lin F, Greenberg BH. Potential new drug treatments for congestive heart failure. Expert Opin Investig Drugs 2016; 25:811-26. [DOI: 10.1080/13543784.2016.1181749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
140
|
Relative bioavailability, food effect, and safety of the single-dose pharmacokinetics of omecamtiv mecarbil following administration of different modified-release formulations in healthy subjects. Int J Clin Pharmacol Ther 2016; 54:217-27. [PMID: 26709596 PMCID: PMC4776255 DOI: 10.5414/cp202458] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 01/10/2023] Open
Abstract
Objective: Omecamtiv mecarbil is a novel small molecule that directly activates cardiac myosin and increases cardiac contractility without increasing cardiac myocyte intracellular calcium. This study evaluated the relative bioavailability, food effect, and safety of several modified-release (MR) formulations of omecamtiv mecarbil. Methods: This was a phase 1, randomized, open-label, 4-way crossover, incomplete block-design study evaluating 5 MR formulations of omecamtiv mecarbil vs. an immediate-release (IR) formulation. Materials: Healthy subjects were randomized to 1 of 30 possible sequences: within each sequence, subjects were assigned to receive a single 25-mg dose of 2 of the 6 possible formulations in the fasting and/or fed states. Results: 65 subjects were screened and enrolled; 5 were replacement subjects. Pharmacokinetic and safety data were analyzed from 62 and 63 subjects in the fasting and fed states, respectively. Compared with the IR formulation, median tmax was longer (0.5 vs. 2 – 10 hours), and mean Cmax was lower for all 5 MR formulations (262 vs. 34 – 78 ng/mL); t1/2,z was similar (18 – 21 hours). The relative bioavailability was high (> 75%) for three MR formulations but lower (< 65%) for the other two. Overall, the effect of food on omecamtiv mecarbil pharmacokinetics was minimal for four of the MR formulations. The pharmacokinetics of the inactive metabolites M3 and M4 were similar across all formulations. Conclusions: The relative bioavailability of omecamtiv mecarbil was high (> 75%) for 3 of the five MR formulations. Food had a marginal, nonclinically meaningful effect on the pharmacokinetics of the MR formulations of omecamtiv mecarbil.
Collapse
|
141
|
Tewari SG, Bugenhagen SM, Vinnakota KC, Rice JJ, Janssen PML, Beard DA. Influence of metabolic dysfunction on cardiac mechanics in decompensated hypertrophy and heart failure. J Mol Cell Cardiol 2016; 94:162-175. [PMID: 27085901 DOI: 10.1016/j.yjmcc.2016.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/28/2016] [Accepted: 04/07/2016] [Indexed: 01/10/2023]
Abstract
Alterations in energetic state of the myocardium are associated with decompensated heart failure in humans and in animal models. However, the functional consequences of the observed changes in energetic state on mechanical function are not known. The primary aim of the study was to quantify mechanical/energetic coupling in the heart and to determine if energetic dysfunction can contribute to mechanical failure. A secondary aim was to apply a quantitative systems pharmacology analysis to investigate the effects of drugs that target cross-bridge cycling kinetics in heart failure-associated energetic dysfunction. Herein, a model of metabolite- and calcium-dependent myocardial mechanics was developed from calcium concentration and tension time courses in rat cardiac muscle obtained at different lengths and stimulation frequencies. The muscle dynamics model accounting for the effect of metabolites was integrated into a model of the cardiac ventricles to simulate pressure-volume dynamics in the heart. This cardiac model was integrated into a simple model of the circulation to investigate the effects of metabolic state on whole-body function. Simulations predict that reductions in metabolite pools observed in canine models of heart failure can cause systolic dysfunction, blood volume expansion, venous congestion, and ventricular dilation. Simulations also predict that myosin-activating drugs may partially counteract the effects of energetic state on cross-bridge mechanics in heart failure while increasing myocardial oxygen consumption. Our model analysis demonstrates how metabolic changes observed in heart failure are alone sufficient to cause systolic dysfunction and whole-body heart failure symptoms.
Collapse
Affiliation(s)
- Shivendra G Tewari
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Scott M Bugenhagen
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, United States
| | - Kalyan C Vinnakota
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - J Jeremy Rice
- Functional Genomics and Systems Biology Group, IBM T.J. Watson Research Center, New York, United States
| | - Paul M L Janssen
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Daniel A Beard
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, United States.
| |
Collapse
|
142
|
Green EM, Wakimoto H, Anderson RL, Evanchik MJ, Gorham JM, Harrison BC, Henze M, Kawas R, Oslob JD, Rodriguez HM, Song Y, Wan W, Leinwand LA, Spudich JA, McDowell RS, Seidman JG, Seidman CE. A small-molecule inhibitor of sarcomere contractility suppresses hypertrophic cardiomyopathy in mice. Science 2016; 351:617-21. [PMID: 26912705 DOI: 10.1126/science.aad3456] [Citation(s) in RCA: 444] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited disease of heart muscle that can be caused by mutations in sarcomere proteins. Clinical diagnosis depends on an abnormal thickening of the heart, but the earliest signs of disease are hyperdynamic contraction and impaired relaxation. Whereas some in vitro studies of power generation by mutant and wild-type sarcomere proteins are consistent with mutant sarcomeres exhibiting enhanced contractile power, others are not. We identified a small molecule, MYK-461, that reduces contractility by decreasing the adenosine triphosphatase activity of the cardiac myosin heavy chain. Here we demonstrate that early, chronic administration of MYK-461 suppresses the development of ventricular hypertrophy, cardiomyocyte disarray, and myocardial fibrosis and attenuates hypertrophic and profibrotic gene expression in mice harboring heterozygous human mutations in the myosin heavy chain. These data indicate that hyperdynamic contraction is essential for HCM pathobiology and that inhibitors of sarcomere contraction may be a valuable therapeutic approach for HCM.
Collapse
Affiliation(s)
| | - Hiroko Wakimoto
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Joshua M Gorham
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Brooke C Harrison
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO 80309, USA
| | | | - Raja Kawas
- MyoKardia, South San Francisco, CA 94080, USA
| | | | | | | | - William Wan
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO 80309, USA
| | - Leslie A Leinwand
- Department of Molecular, Cellular, and Developmental Biology and BioFrontiers Institute, University of Colorado, Boulder, CO 80309, USA
| | - James A Spudich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - J G Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
| |
Collapse
|
143
|
Latini R, Masson S, Staszewsky L. Heart failure trials on pharmacological therapy in 2015: lessons learned and future outlook. Expert Rev Cardiovasc Ther 2016; 14:703-11. [DOI: 10.1586/14779072.2016.1159957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
144
|
Lemm H, Dietz S, Janusch M, Buerke M. [Modern drug therapy in cardiovascular intensive care medicine]. Internist (Berl) 2016; 56:702, 704-8, 710-2. [PMID: 26054838 DOI: 10.1007/s00108-015-3717-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Vasoactive drugs and inotropes are important in the hemodynamic management of patients with cardiogenic shock despite modest volume administration. Currently, the concept of cardiac relief is pursued in the treatment of acute heart failure. In this article we present the use of different drugs in the intensive care unit for acute heart failure and cardiogenic shock. In acute heart failure catecholamines are only used during the transition from heart failure to cardiogenic shock. Here, the therapeutic concept of ventricular unloading is more sought after. This can be achieved by the use of diuretics, nitrates, levosimendan (inodilatator), or in the future serelaxin. The hemodynamic management in cardiogenic shock occurs after moderate volume administration with dobutamine to increase inotropy. If no adequate perfusion pressures are achieved, norepinephrine can be administered as a vasopressor. If there is still no sufficient increase in cardiac output, the inodilatator levosimendan can be used. Levosimendan instead of phosphodiesterase inhibitors in this case is preferable. The maxim of hemodynamic management in cardiogenic shock is the transient use of inotropes and vasopressors in the lowest dose possible and only for as long as necessary. This means that one should continuously check whether the dose can be reduced. There are no mortality data demonstrating the utility of hemodynamic monitoring based on objective criteria—but it makes sense to use inotropes and vasopressors sparingly.
Collapse
Affiliation(s)
- H Lemm
- Medizinische Klinik II - Kardiologie, Angiologie, Internistische Intensivmedizin, St. Marienkrankenhaus Siegen, Kampenstr. 51, 57072, Siegen, Deutschland
| | | | | | | |
Collapse
|
145
|
Capítulo 13. Novedades en el tratamiento de la falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
146
|
Tolppanen H, Logeart D. Nouveaux médicaments dans l’insuffisance cardiaque aiguë. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-015-1167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
147
|
Bakkehaug JP, Kildal AB, Engstad ET, Boardman N, Næsheim T, Rønning L, Aasum E, Larsen TS, Myrmel T, How OJ. Response to Letter Regarding Article, "Myosin Activator Omecamtiv Mecarbil Increases Myocardial Oxygen Consumption and Impairs Cardiac Efficiency Mediated by Resting Myosin ATPase Activity". Circ Heart Fail 2016; 8:1142. [PMID: 26738203 DOI: 10.1161/circheartfailure.115.002548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jens Petter Bakkehaug
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anders Benjamin Kildal
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eirik Torgersen Engstad
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Neoma Boardman
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torvind Næsheim
- Cardiovascular Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Leif Rønning
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellen Aasum
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Terje S Larsen
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Truls Myrmel
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Ole-Jakob How
- Cardiovascular Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
148
|
Nánási P, Váczi K, Papp Z. The myosin activator omecamtiv mecarbil: a promising new inotropic agent. Can J Physiol Pharmacol 2016; 94:1033-1039. [PMID: 27322915 DOI: 10.1139/cjpp-2015-0573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Heart failure became a leading cause of mortality in the past few decades with a progressively increasing prevalence. Its current therapy is restricted largely to the suppression of the sympathetic activity and the renin-angiotensin system in combination with diuretics. This restrictive strategy is due to the potential long-term adverse effects of inotropic agents despite their effective influence on cardiac function when employed for short durations. Positive inotropes include inhibitors of the Na+/K+ pump, β-receptor agonists, and phosphodiesterase inhibitors. Theoretically, Ca2+ sensitizers may also increase cardiac contractility without resulting in Ca2+ overload; nevertheless, their mechanism of action is frequently complicated by other pleiotropic effects. Recently, a new positive inotropic agent, the myosin activator omecamtiv mecarbil, has been developed. Omecamtiv mecarbil binds directly to β-myosin heavy chain and enhances cardiac contractility by increasing the number of the active force-generating cross-bridges, presumably without major off-target effects. This review focuses on recent in vivo and in vitro results obtained with omecamtiv mecarbil, and discusses its mechanism of action at a molecular level. Based on clinical data, omecamtiv mecarbil is a promising new tool in the treatment of systolic heart failure.
Collapse
Affiliation(s)
- Péter Nánási
- a Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Krisztina Váczi
- b Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Papp
- c Division of Clinical Physiology, Department of Cardiology, Research Center for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
149
|
Bernardo BC, Blaxall BC. From Bench to Bedside: New Approaches to Therapeutic Discovery for Heart Failure. Heart Lung Circ 2016; 25:425-34. [PMID: 26993094 DOI: 10.1016/j.hlc.2016.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 01/10/2023]
Abstract
Heart failure is a significant global health problem, which is becoming worse as the population ages, and remains one of the biggest burdens on our economy. Despite significant advances in cardiovascular medicine, management and surgery, mortality rates remain high, with almost half of patients with heart failure dying within five years of diagnosis. As a multifactorial clinical syndrome, heart failure still represents an epidemic threat, highlighting the need for deeper insights into disease mechanisms and the development of innovative therapeutic strategies for both treatment and prevention. In this review, we discuss conventional heart failure therapies and highlight new pharmacological agents targeting pathophysiological features of the failing heart, for example, non-coding RNAs, angiotensin receptor-neprilysin inhibitors, cardiac myosin activators, BGP-15 and molecules targeting GRK2 including M119, gallein and paroxetine. Finally, we address the disparity between phase II and phase III clinical trials that prevent the translation of emerging HF therapies into new and approved therapies.
Collapse
Affiliation(s)
- Bianca C Bernardo
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Burns C Blaxall
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| |
Collapse
|
150
|
Abstract
Although the period from 1953 to 2001 resulted in the approval of more than 30 medications currently used to treat heart failure (HF), few novel drugs have been approved in the last decade. However, the investigational pipeline for HF medications once again appears promising. In patients with chronic heart failure with reduced ejection fraction (HFrEF), ivabradine and valsartan/sucubitril (LCZ696) were recently approved by the US Food and Drug Administration. Both agents have been shown to reduce the risk of cardiovascular death and HF hospitalization. In the treatment of acute HF, serelaxin and ularitide are the farthest along in development. Both agents have demonstrated favorable effects on surrogate end points and preliminary data suggest a possible mortality benefit with serelaxin. Consequently, phase 3 trials are ongoing to evaluate the effect of serelaxin and ularitide on clinical outcomes. Given the poor history of recent investigational acute HF drugs that have advanced to phase 3/4 studies, enthusiasm for both serelaxin and ularitide must be tempered until these trials are completed.
Collapse
Affiliation(s)
- Sarah Hanigan
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI, USA
| | - Robert J. DiDomenico
- Department of Pharmacy Practice, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| |
Collapse
|