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Chiu HW, Wu CH, Lin WY, Wong WT, Tsai WC, Hsu HT, Ho CL, Cheng SM, Cheng CC, Yang SP, Li LH, Hua KF. The Angiotensin II Receptor Neprilysin Inhibitor LCZ696 Inhibits the NLRP3 Inflammasome By Reducing Mitochondrial Dysfunction in Macrophages and Alleviates Dextran Sulfate Sodium-induced Colitis in a Mouse Model. Inflammation 2024; 47:696-717. [PMID: 38319541 DOI: 10.1007/s10753-023-01939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 02/07/2024]
Abstract
The intracellular sensor protein complex known as the NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome plays a crucial role in regulating inflammatory diseases by overseeing the production of interleukin (IL)-1β and IL-18. Targeting its abnormal activation with drugs holds significant promise for inflammation treatment. This study highlights LCZ696, an angiotensin receptor-neprilysin inhibitor, as an effective suppressor of NLRP3 inflammasome activation in macrophages stimulated by ATP, nigericin, and monosodium urate. LCZ696 also reduces caspase-11 and GSDMD activation, lactate dehydrogenase release, propidium iodide uptake, and the extracellular release of NLRP3 and apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) in ATP-activated macrophages, suggesting a potential mitigation of pyroptosis. Mechanistically, LCZ696 lowers mitochondrial reactive oxygen species and preserves mitochondrial integrity. Importantly, it does not significantly impact NLRP3, proIL-1β, inducible nitric oxide synthase, cyclooxygenase-2 expression, or NF-κB activation in lipopolysaccharide-activated macrophages. LCZ696 partially inhibits the NLRP3 inflammasome through the induction of autophagy. In an in vivo context, LCZ696 alleviates NLRP3-associated colitis in a mouse model by reducing colonic expression of IL-1β and tumor necrosis factor-α. Collectively, these findings suggest that LCZ696 holds significant promise as a therapeutic agent for ameliorating NLRP3 inflammasome activation in various inflammatory diseases, extending beyond its established use in hypertension and heart failure treatment.
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Affiliation(s)
- Hsiao-Wen Chiu
- Department of Biotechnology and Animal Science, National Ilan University, Ilan, Taiwan
| | - Chun-Hsien Wu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yu Lin
- Department of Biotechnology and Animal Science, National Ilan University, Ilan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ting Wong
- Department of Biotechnology and Animal Science, National Ilan University, Ilan, Taiwan
| | - Wei-Che Tsai
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsien-Ta Hsu
- Division of Neurosurgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chen-Lung Ho
- Division of Wood Cellulose, Taiwan Forestry Research Institute, Taipei, Taiwan
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chung Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ping Yang
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Lan-Hui Li
- Department of Laboratory Medicine, Linsen, Chinese Medicine and Kunming Branch, Taipei City Hospital, Taipei, Taiwan.
| | - Kuo-Feng Hua
- Department of Biotechnology and Animal Science, National Ilan University, Ilan, Taiwan.
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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Ali NH, Al‐Kuraishy HM, Al‐Gareeb AI, Alnaaim SA, Alexiou A, Papadakis M, Khalifa AA, Saad HM, Batiha GE. Neprilysin inhibitors and risk of Alzheimer's disease: A future perspective. J Cell Mol Med 2024; 28:e17993. [PMID: 37847125 PMCID: PMC10826440 DOI: 10.1111/jcmm.17993] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/15/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
Alzheimer's disease (AD) is a heterogeneous neurodegenerative disease with multifaceted neuropathological disorders. AD is characterized by intracellular accumulation of phosphorylated tau proteins and extracellular deposition of amyloid beta (Aβ). Various protease enzymes, including neprilysin (NEP), are concerned with the degradation and clearance of Aβ. Indeed, a defective neuronal clearance pathway due to the dysfunction of degradation enzymes might be a possible mechanism for the accumulation of Aβ and subsequent progression of AD neuropathology. NEP is one of the most imperative metalloproteinase enzymes involved in the clearance of Aβ. This review aimed to highlight the possible role of NEP inhibitors in AD. The combination of sacubitril and valsartan which is called angiotensin receptor blocker and NEP inhibitor (ARNI) may produce beneficial and deleterious effects on AD neuropathology. NEP inhibitors might increase the risk of AD by the inhibition of Aβ clearance, and increase brain bradykinin (BK) and natriuretic peptides (NPs), which augment the pathogenesis of AD. These verdicts come from animal model studies, though they may not be applied to humans. However, clinical studies revealed promising safety findings regarding the use of ARNI. Moreover, NEP inhibition increases various neuroprotective peptides involved in inflammation, glucose homeostasis and nerve conduction. Also, NEP inhibitors may inhibit dipeptidyl peptidase 4 (DPP4) expression, ameliorating insulin and glucagon-like peptide 1 (GLP-1) levels. These findings proposed that NEP inhibitors may have a protective effect against AD development by increasing GLP-1, neuropeptide Y (NPY) and substance P, and deleterious effects by increasing brain BK. Preclinical and clinical studies are recommended in this regard.
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Affiliation(s)
- Naif H. Ali
- Department of Internal Medicine, Medical CollegeNajran UniversityNajranSaudi Arabia
| | - Hayder M. Al‐Kuraishy
- Department of Clinical Pharmacology and Medicine, College of MedicineMustansiriyah UniversityBaghdadIraq
| | - Ali I. Al‐Gareeb
- Department of Clinical Pharmacology and Medicine, College of MedicineMustansiriyah UniversityBaghdadIraq
| | - Saud A. Alnaaim
- Clinical Neurosciences Department, College of MedicineKing Faisal UniversityHofufSaudi Arabia
| | - Athanasios Alexiou
- Department of Science and EngineeringNovel Global Community Educational FoundationHebershamNew South WalesAustralia
- AFNP MedWienAustria
| | - Marios Papadakis
- Department of Surgery IIUniversity Hospital Witten‐Herdecke, University of Witten‐HerdeckeWuppertalGermany
| | - Asmaa A. Khalifa
- Department of Pharmacology and Therapeutics, Faculty of PharmacyPharos University in AlexandriaAlexandriaEgypt
| | - Hebatallah M. Saad
- Department of Pathology, Faculty of Veterinary MedicineMatrouh UniversityMatrouhEgypt
| | - Gaber El‐Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary MedicineDamanhour UniversityDamanhourAlBeheiraEgypt
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Zhang R, Sun X, Li Y, He W, Zhu H, Liu B, Zhang A. The Efficacy and Safety of Sacubitril/Valsartan in Heart Failure Patients: A Review. J Cardiovasc Pharmacol Ther 2022; 27:10742484211058681. [PMID: 34994233 DOI: 10.1177/10742484211058681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has been approved for the treatment of HF. At present, there have been few systematic and detailed reviews discussing the efficacy and safety of sacubitril/valsartan in HF. In this review, we first introduced the pharmacological mechanisms of sacubitril/valsartan, including the reduction in the degradation of natriuretic peptides in the natriuretic peptide system and inhibition of the renin-angiotensin system. Then, we summarized the efficacy of sacubitril/valsartan in HF patients with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) including the reduction in risks of mortality and hospitalization, reversal of cardiac remodeling, regulation of biomarkers of HF, improvement of the quality of life, antiarrhythmia, improving renal dysfunction and regulation of metabolism. Finally, we discussed the safety and tolerability of sacubitril/valsartan in the treatment of HFrEF or HFpEF. Compared with ACEIs/ARBs or placebo, sacubitril/valsartan showed good safety and tolerability, although the risk of hypotension might be high. In conclusion, the overwhelming majority of studies show that sacubitril/valsartan is effective and safe in the treatment of HFrEF patients but that it has little benefit in HFpEF patients. Sacubitril/valsartan will probably be a promising anti-HF drug in the near future.
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Affiliation(s)
- Rui Zhang
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaotong Sun
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, Department of Anesthesiology, Weifang Medical University, Weifang, China
| | - Ya Li
- Department of Cardiology, Shanghai General Hospital, School of Medicine, 12474Shanghai Jiaotong University, Hongkou District, Shanghai, China
| | - Wenzheng He
- Intensive Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Hongguang Zhu
- Dental Department, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Baoshan Liu
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Aiyuan Zhang
- Department of Cardiology, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Care Unit, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China.,Cardiac Rehabilitation Centre, 117907Weifang People's Hospital, the First Affiliated Hospital of Weifang Medical University, Weifang, China
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Guion-Firmin J, Tessier S, Lepelley M, Faillie JL, Montastruc JL. Diarrhoea with the angiotensin receptor neprilysin inhibitor sacubitril + valsartan: A pharmacovigilance study. Fundam Clin Pharmacol 2021; 36:378-389. [PMID: 34260768 DOI: 10.1111/fcp.12717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/17/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
Diarrhoea is an adverse drug reaction of the angiotensin receptor neprilysin inhibitor (ARNI) sacubitril + valsartan. It was also described with olmesartan and more recently with other angiotensin receptor blockers. The study was performed to compare diarrhoea reports in pharmacovigilance databases with sacubitril + valsartan and valsartan. The study used reports of diarrhoea with the ARNI sacubitril + valsartan registered: first in the French PharmacoVigilance Database (FPVD) and second in Vigibase®, the WHO Global Individual Case Safety Report database. After description of the main characteristics, disproportionality analyses were performed. Results are reported as reporting odds ratios (ROR) with 95% confidence interval. We found 29 reports of diarrhoea with sacubitril + valsartan in the FPVD and 686 in Vigibase®. With sacubitril + valsartan, diarrhoea occurred more frequently in males around 70 years with a median delay of 3 days. With valsartan, diarrhoea occurred more frequently in females around 68 years with a median delay of 0.5 days. In the FPVD, a significant association was found with sacubitril + valsartan in comparison with valsartan alone before (ROR = 8.78 [5.19-14.85]) and after (ROR = 11.19 [5.89-21.25]) exclusion of concomitant drugs known to be associated with diarrhoea. A significant association was also found in Vigibase® after adjustment on age, sex, reporter and its location (ROR = 1.31 [1.14-1.50]). Diarrhoea reported with sacubitril + valsartan has marked differences in gender, delay of occurrence and frequency of reporting in comparison with diarrhoea with valsartan. From a pharmacodynamic point of view, these results suggest a specific role of sacubitril in diarrhoea.
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Affiliation(s)
- Julia Guion-Firmin
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidemiologie et d'Informations sur le Médicament, CIC INSERM 1436, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France
| | - Samuel Tessier
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidemiologie et d'Informations sur le Médicament, CIC INSERM 1436, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France
| | - Marion Lepelley
- Centre de Pharmacovigilance, Centre Hospitalier Universitaire, Université de Grenoble, Grenoble, France
| | - Jean-Luc Faillie
- Centre de Pharmacovigilance, Centre Hospitalier Universitaire, Université de Montpellier, Montpellier, France
| | - Jean-Louis Montastruc
- Service de Pharmacologie Médicale et Clinique, Centre de Pharmacovigilance de Pharmacoépidemiologie et d'Informations sur le Médicament, CIC INSERM 1436, Centre Hospitalier Universitaire-Faculté de Médecine, Toulouse, France
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Adverse events of sacubitril/valsartan: a meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol 2021; 78:202-210. [PMID: 33929386 DOI: 10.1097/fjc.0000000000001049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
ABSTRACT This review aimed to summarize the adverse events (AEs) reported during the use of sacubitril/valsartan versus ACEI/ARB. Studies containing safety outcomes or AEs during the use of sacubitril/valsartan versus ACEI/ARB were retrieved from the Medline, Embase, and Cochrane library databases and clinical trials. From the selected studies, the pooled risk ratios (RR) with 95% confidence intervals (CI) of dichotomous outcomes were assessed by a random or fixed effects model in our meta-analysis. Fourteen studies involving 20261 patients were included in this review. No significant differences were found in total AEs between the sacubitril/valsartan and ACEI/ARB groups. Compared with ACEI/ARB, sacubitril/valsartan decreased the risk of death, discontinuation due to AEs and renal dysfunction, while it increased the risk of hypotension. Specifically, sacubitril/valsartan decreased the risk of death compared with ACEI/ARB, while it increased the risk of hypotension for patients with heart failure (HF) and decreased the risk of discontinuation due to AEs in Caucasians. It also increased the risk of dizziness in Asians and decreased the risk of hyperkalemia and renal dysfunction, while it increased the risk of hypotension when the study duration ≥48 weeks. The available evidence showed that sacubitril/valsartan was associated with fewer side effects than ACEI/ARB, except for hypotension. Study duration, race, and patients with primary diseases affected the AEs of sacubitril/valsartan.
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Geng Q, Li S, Wang Z, Ren Y. Efficacy and safety of combined neprilysin and RAS inhibition in heart failure: A meta-analysis of randomized controlled trials. Int J Cardiol 2019; 293:159-164. [DOI: 10.1016/j.ijcard.2019.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/28/2022]
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Li Q, Li L, Wang F, Zhang W, Guo Y, Wang F, Liu Y, Jia J, Lin S. Effect and safety of LCZ696 in the treatment of hypertension: A meta-analysis of 9 RCT studies. Medicine (Baltimore) 2019; 98:e16093. [PMID: 31305392 PMCID: PMC6641826 DOI: 10.1097/md.0000000000016093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND LCZ696 has been introduced in patients with hypertension in several trials. Here, we performed a meta-analysis to evaluate the effect and safety of LCZ696 in hypertensive patients. METHODS PubMed, Embase, the Cochrane Library and ClinicalTrials.gov databases were searched to identify the available randomized controlled trials (RCTs) investigating the effect and safety of LCZ696 in hypertension patients. The last search date was October 31, 2018. RESULTS Nine RCTs with 6765 subjects were finally included, in which 8 trials compared the effect and safety between LCZ696 and angiotensin receptor antagonists (ARBs). Evidences showed LCZ696, compared with ARBs, achieved a better blood pressure control rate (OR 1.24, 95% CI: 1.14-1.35), specifically, LCZ696 were better at reducing systolic blood pressure [WMD -4.11 mmHg, 95% CI: (-5.13, -3.08) mmHg], diastolic blood pressure [WMD -1.79 mmHg, 95% CI: (-2.22, -1.37) mmHg], mean 24-hour ambulatory systolic blood pressure [WMD -3.24 mmHg, 95% CI: (-4.48, -1.99) mmHg] and mean 24-hour ambulatory diastolic blood pressure [WMD -1.25 mmHg, 95% CI: (-1.81, -0.69) mmHg]. There was no difference in the events of adverse events (risk ratio [RR] 1.01, 95% CI: 0.39-1.09), serious adverse events (RR 0.80, 95% CI: 0.52-1.22) and discontinuation of treatment for any adverse events (RR 0.79, 95% CI: 0.56-1.11) between LCZ696 group and ARB/placebo group, except LCZ696 reduced the rate of headaches (RR 0.69, 95% CI: 0.48-0.99) while increased cough (RR 2.12, 95% CI: 1.11-4.04; P = .02; I = 25%). CONCLUSION Our finding provides evidence that LCZ 696 was more effective than ARB on blood pressure control and was safe enough in patients with hypertension.
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Affiliation(s)
- Qiongqiong Li
- Department of Nephrology, General Hospital of Tianjin Medical University
| | - Lina Li
- Department of Nephrology, General Hospital of Tianjin Medical University
| | - Fanghao Wang
- Department of Nephrology, General Hospital of Tianjin Medical University
| | - Wei Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital
| | - Yipeng Guo
- Department of Epidemiology, Tianjin Public Health Bureau, Tianjin
| | - Fuzhen Wang
- Department of Statistics, Fenyang Hospital of Shanxi Province, Fenyang, China
| | - Youxia Liu
- Department of Nephrology, General Hospital of Tianjin Medical University
| | - Junya Jia
- Department of Nephrology, General Hospital of Tianjin Medical University
| | - Shan Lin
- Department of Nephrology, General Hospital of Tianjin Medical University
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Manolis AS, Manolis TA, Manolis AA, Melita H. Neprilysin Inhibitors: Filling a Gap in Heart Failure Management, Albeit Amidst Controversy and at a Significant Cost. Am J Cardiovasc Drugs 2019; 19:21-36. [PMID: 29926350 DOI: 10.1007/s40256-018-0289-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dual angiotensin and neprilysin inhibition using the combination drug sacubitril-valsartan has ushered in a new era in the treatment of heart failure (HF). The randomized controlled PARADIGM-HF trial, which randomized 8399 patients with HF to enalapril or sacubitril-valsartan, showed a 20% reduction in mortality and HF hospitalization with the new drug. This has been heralded as a step toward filling a crucial gap in HF management by providing strong evidence that combined inhibition of the angiotensin receptor and neprilysin is superior to inhibition of the renin-angiotensin system alone in stable patients with chronic HF as it negates the deleterious effects of angiotensin while concomitantly augmenting the beneficial effects of the endogenous natriuretic peptide system. This new therapy is costly, and other confirmatory studies have been lacking for over 2 years since its approval by major regulatory authorities. As such, controversy and heated discussions have amassed, as has detailed information from a plethora of secondary analyses of this pivotal trial about the pros and cons of this promising new therapeutic strategy in HF management. The aim of this review was to provide a critical assessment of all these aspects.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Vas. Sofias 114, 115 27, Athens, Greece.
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Potential Uses of Sacubitril/Valsartan: Need for Data on Efficacy and Safety. Am J Cardiovasc Drugs 2019; 19:1-10. [PMID: 30345485 DOI: 10.1007/s40256-018-0306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been the cornerstone for the treatment of heart failure (HF) with reduced ejection fraction for decades. According to recent and promising studies, sacubitril/valsartan (SV) might be efficient in alternative indications in the area of HF with preserved left ventricular ejection fraction, chronic kidney disease, and so on. This review briefly summarizes these promising therapeutic options regarding SV and the potential limits and pitfalls for its use in routine practice (due to cognitive uncertainties).
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Tillman F, Kim J, Makhlouf T, Osae L. A comprehensive review of chronic heart failure pharmacotherapy treatment approaches in African Americans. Ther Adv Cardiovasc Dis 2019; 13:1753944719840192. [PMID: 31092128 PMCID: PMC6535737 DOI: 10.1177/1753944719840192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our aim was to review the published literature evaluating treatment approaches for chronic heart failure (HF), notably as it relates to African American patients. METHOD We undertook a comprehensive database search (1986-2017) of PubMed, EMBASE, and Ovid/MEDLINE utilizing terms 'African American', 'black', 'chronic heart failure', 'heart failure', 'medication', 'chronic therapy', and 'clinical trials'. Additional notable studies were obtained from ClinicalTrials.gov . Studies published in English that examine treatment modalities of chronic HF in African American and non-African American patients were included. RESULTS Examples of current gaps worthy of investigation include whether to maximize thiazides and calcium-channel blockers prior to adding renin-angiotensin system (RAS) inhibitors or beta blockers in HF with preserved ejection fraction; whether hydralazine/isosorbide dinitrate (ISDN) should be initiated during earlier HF stages; whether to prioritize hydralazine/ISDN over other agents such as RAS inhibitors; varying response of African Americans to different agents within drug classes; and the role of mineralocorticoid receptor antagonists. CONCLUSION Further studies are needed in order for consensus guidelines to clarify how best to treat this population.
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Affiliation(s)
- Frank Tillman
- University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599-7360, USA
| | - Jennifer Kim
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA Cone Health Internal Medicine Center, Greensboro, NC, USA Greensboro Area Health Education Center, Greensoboro, NC, USA
| | - Tanya Makhlouf
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Leah Osae
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Guo Q, Liu J, Zhu P, Liu Y, Dong N, Shi J, Peng H. Evaluation of Drug-Related Receptors in Children With Dilated Cardiomyopathy. Front Pediatr 2019; 7:387. [PMID: 31632936 PMCID: PMC6779825 DOI: 10.3389/fped.2019.00387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Effective treatments for pediatric dilated cardiomyopathy (DCM) are limited. Currently, pediatric DCM therapy mainly includes supportive heart failure (HF) treatment. While the treatment for child DCM patients is generally the same as that for adult DCM patients, few randomized prospective studies on the clinical efficacy of treatments for pediatric DCM have been published. We explored the appropriate treatments for child patients. Methods: The ultrastructure of pediatric DCM and control hearts was analyzed by electron microscopy and HE staining. Left ventricular tissues from children in the DCM and control groups were subjected to quantitative RT-PCR (qRT-PCR) to study the mRNA expression of receptors related to various treatments, including drugs targeting the renin-angiotensin-aldosterone system (RAAS) system, digoxin, milrinone, and β-receptor blockers, in child patients in the clinic. Furthermore, the differences in drug receptors in heart tissues between children and adults with DCM were analyzed. Results: Compared with the control children, the children in the DCM group showed marked abnormalities in structure and organelles. The mRNA levels of angiotensin-converting enzyme (ACE), REN, prorenin receptor (PRR), NEP, ATP1A1, and phosphodiesterase3 (PDE3A) were higher in the pediatric DCM group than the control group. Interestingly, the mRNA expression of these treatment-related receptors was much higher in children than in adults. Conclusion: ACE inhibitors, PRR or REN receptor inhibitors, PDE3 inhibitors and LCZ696 may be effective in children with DCM. However, β-receptor blockers are not valid treatments for pediatric DCM. Moreover, high receptor expression was observed in children. These data will improve the selection of drugs for DCM patients, enhance treatment, and increase the survival rate.
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Affiliation(s)
- Qing Guo
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Liu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yali Liu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Peng
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Primary care physicians play a significant role in managing heart failure (HF), with the goals of reducing mortality, avoiding hospitalization, and improving patients’ quality of life. Most HF-related hospitalizations and deaths occur in patients with New York Heart Association functional class II or III, many of whom are perceived to have stable disease, which often progresses without clinical symptoms due to underlying deleterious effects of neurohormonal imbalance and endothelial dysfunction. Management includes lifestyle changes and stepped pharmacological therapy directed at the four stages of HF, with aggressive uptitration of therapies, including beta-blockers and inhibitors of the renin-angiotensin-aldosterone system. Recently, two new HF treatments have become available in clinical practice. Ivabradine was approved to reduce the risk of hospitalization for HF in patients with stable, symptomatic HF. Additionally, the angiotensin receptor–neprilysin inhibitor (ARNI), sacubitril/valsartan, was found to be significantly superior to enalapril in reducing risks of cardiovascular death and HF-related hospitalization. The respective 2016 and 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America clinical practice guideline updates recommend that patients taking angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy be switched to ARNI therapy to further reduce morbidity and mortality. For HF management to be maximally effective, physicians must be knowledgeable about the risks and benefits of treatments and stay engaged with patients to identify signs of disease progression. This article provides an overview of the progressive nature of HF in apparently stable patients and describes areas for treatment improvement that may help to optimize patient care.
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Affiliation(s)
- Inder Anand
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, 55455, USA.
- VA Medical Center, One Veterans Dr., Minneapolis, MN, 55417, USA.
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Davidson EP, Coppey LJ, Shevalye H, Obrosov A, Yorek MA. Vascular and Neural Complications in Type 2 Diabetic Rats: Improvement by Sacubitril/Valsartan Greater Than Valsartan Alone. Diabetes 2018; 67:1616-1626. [PMID: 29941448 DOI: 10.2337/db18-0062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/15/2018] [Indexed: 11/13/2022]
Abstract
Previously, we had shown that a vasopeptidase inhibitor drug containing ACE and neprilysin inhibitors was an effective treatment for diabetic vascular and neural complications. However, side effects prevented further development. This led to the development of sacubitril/valsartan, a drug containing angiotensin II receptor blocker and neprilysin inhibitor that we hypothesized would be an effective treatment for diabetic peripheral neuropathy. Using early and late intervention protocols (4 and 12 weeks posthyperglycemia, respectively), type 2 diabetic rats were treated with valsartan or sacubitril/valsartan for 12 weeks followed by an extensive evaluation of vascular and neural end points. The results demonstrated efficacy of sacubitril/valsartan in improving vascular and neural function was superior to valsartan alone. In the early intervention protocol, sacubitril/valsartan treatment was found to slow progression of these deficits and, with late intervention treatment, was found to stimulate restoration of vascular reactivity, motor and sensory nerve conduction velocities, and sensitivity/regeneration of sensory nerves of the skin and cornea in a rat model of type 2 diabetes. These preclinical studies suggest that sacubitril/valsartan may be an effective treatment for diabetic peripheral neuropathy, but additional studies will be needed to investigate these effects further.
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Affiliation(s)
- Eric P Davidson
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | | | - Hanna Shevalye
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | | | - Mark A Yorek
- Department of Internal Medicine, University of Iowa, Iowa City, IA
- Department of Veterans Affairs, Iowa City VA Health Care System, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
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