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Ajay A, Rasoul D, Abdullah A, Lee Wei En B, Mashida K, Al-Munaer M, Ajay H, Duvva D, Mathew J, Adenaya A, Lip GYH, Sankaranarayanan R. Augmentation of natriuretic peptide (NP) receptor A and B (NPR-A and NPR-B) and cyclic guanosine monophosphate (cGMP) signalling as a therapeutic strategy in heart failure. Expert Opin Investig Drugs 2023; 32:1157-1170. [PMID: 38032188 DOI: 10.1080/13543784.2023.2290064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Heart failure is a complex, debilitating condition and despite advances in treatment, it remains a significant cause of morbidity and mortality worldwide. Therefore, the need for alternative treatment strategies is essential. In this review, we explore the therapeutic strategies of augmenting natriuretic peptide receptors (NPR-A and NPR-B) and cyclic guanosine monophosphate (cGMP) in heart failure. AREAS COVERED We aim to provide an overview of the evidence of preclinical and clinical studies on novel heart failure treatment strategies. Papers collected in this review have been filtered and screened following PubMed searches. This includes epigenetics, modulating enzyme activity in natriuretic peptide (NP) synthesis, gene therapy, modulation of downstream signaling by augmenting soluble guanylate cyclase (sGC) and phosphodiesterase (PDE) inhibition, nitrates, c-GMP-dependent protein kinase, synthetic and designer NP and RNA therapy. EXPERT OPINION The novel treatment strategies mentioned above have shown great potential, however, large randomized controlled trials are still lacking. The biggest challenge is translating the results seen in preclinical trials into clinical trials. We recommend a multi-disciplinary team approach with cardiologists, geneticist, pharmacologists, bioengineers, researchers, regulators, and patients to improve heart failure outcomes. Future management can involve telemedicine, remote monitoring, and artificial intelligence to optimize patient care.
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Affiliation(s)
- Ashwin Ajay
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Debar Rasoul
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Alend Abdullah
- General Medicine, The Dudley Group NHS Foundation Trust Dudley, Dudley, United Kingdom
| | - Benjamin Lee Wei En
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Knievel Mashida
- Cedar House, University of Liverpool, Liverpool, United Kingdom
| | | | - Hanan Ajay
- General Medicine, Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom
| | - Dileep Duvva
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Jean Mathew
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Adeoye Adenaya
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Cedar House, University of Liverpool, Liverpool, United Kingdom
- Cardiology Department, Liverpool Heart & Chest Hospital NHS Trust, Liverpool, United Kingdom
- Cardiology Department, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rajiv Sankaranarayanan
- Cardiology Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Cedar House, University of Liverpool, Liverpool, United Kingdom
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Kalk P, Sharkovska Y, Kashina E, von Websky K, Relle K, Pfab T, Alter M, Guillaume P, Provost D, Hoffmann K, Fischer Y, Hocher B. Endothelin-Converting Enzyme/Neutral Endopeptidase Inhibitor SLV338 Prevents Hypertensive Cardiac Remodeling in a Blood Pressure–Independent Manner. Hypertension 2011; 57:755-63. [DOI: 10.1161/hypertensionaha.110.163972] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertensive heart disease is a major contributor to cardiovascular mortality. Endothelin is a potent vasoconstrictive and profibrotic mediator produced by the endothelin-converting enzyme (ECE), whereas natriuretic peptides, degraded by the neutral endopeptidase (NEP), have diuretic, vasodilatory, and antifibrotic properties. Thus, combined ECE/NEP inhibition may halt hypertensive cardiac remodeling. This study examined effects of SLV338, a novel ECE/NEP inhibitor, on cardiac protection in experimental renovascular hypertension (2-kidney, 1-clip [2K1C]). Male rats were allocated to 5 groups: sham-operated rats, untreated animals with 2K1C, 2K1C animals treated with oral SLV338 (30 and 100 mg/kg per day), and 2K1C animals treated with oral losartan (20 mg/kg per day). Treatment duration was 12 weeks. Blood pressure was assessed every 4 weeks. At study end, hearts were taken for histology/computer-aided histomorphometry/immunohistochemistry. Pharmacological properties of SLV338 are described. SLV338 is a dual ECE/NEP inhibitor, as demonstrated both in vitro and in vivo. In the 2K1C study, losartan lowered blood pressure by ≤46 mm Hg, whereas both dosages of SLV338 had no effect. However, SLV338 (both dosages) completely normalized cardiac interstitial fibrosis, perivascular fibrosis, myocyte diameter, and media:lumen ratio of cardiac arteries, as did losartan. Cardiac transforming growth factor-β1 expression was significantly enhanced in untreated 2K1C rats versus controls, whereas treatment with SLV338 and losartan prevented this effect. Taken together, dual ECE/NEP inhibitor SLV338 prevents cardiac remodeling to the same extent as losartan, but in a blood pressure–independent manner, in a rat model of renovascular hypertension. This effect is at least partially mediated via suppression of cardiac transforming growth factor-β1 expression.
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Affiliation(s)
- Philipp Kalk
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Yuliya Sharkovska
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Elena Kashina
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Karoline von Websky
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Katharina Relle
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Thiemo Pfab
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Markus Alter
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Philippe Guillaume
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Daniel Provost
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Katrin Hoffmann
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Yvan Fischer
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
| | - Berthold Hocher
- From the Department of Nephrology (P.K., T.P., M.A.), Charité, Campus Benjamin Franklin, Berlin, Germany; Center for Cardiovascular Research/Institute of Pharmacology (P.K., Y.S., E.K., K.v.W., K.R., T.P., M.A., B.H.), Charité, Campus Mitte, Berlin, Germany; Institute for Nutritional Science (Y.S., K.v.W., K.R., B.H.), University of Potsdam, Potsdam, Germany; Porsolt and Partners Pharmacology (P.G., D.P.), Le Genest-Saint-Isle, France; Abbott Products GmbH (K.H., Y.F.), Hannover, Germany; and
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