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Sacubitril/valsartan: beyond natriuretic peptides
Jagdeep S S Singh1, Louise M Burrell2, Myriam Cherif3
1Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Heart (British Cardiac Society)
|July 10, 2017
Summary
Sacubitril/valsartan enhances the natriuretic peptide system (NPS) and offers therapeutic benefits beyond augmenting B-type natriuretic peptide (BNP) in heart failure (HF). This drug may also impact other hormones and amyloid-beta homeostasis.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- Natriuretic peptides, particularly BNP, are established heart failure (HF) biomarkers.
- These peptides also possess therapeutic potential due to beneficial physiological effects.
- Sacubitril/valsartan inhibits neprilysin (NEP) and the renin-angiotensin-aldosterone system (RAAS).
Purpose of the Study:
- To review the multifaceted effects of sacubitril/valsartan beyond BNP augmentation.
- To explore the altered natriuretic peptide system (NPS) physiology in HF patients.
- To discuss potential implications for neurodegenerative diseases and amyloid-beta homeostasis.
Main Methods:
- Literature review focusing on sacubitril/valsartan's mechanisms of action.
- Analysis of NPS physiology in healthy versus HF states.
- Exploration of sacubitril/valsartan's impact on various hormones and amyloid-beta.
Main Results:
- Sacubitril/valsartan augments NPS, counteracting RAAS dominance and natriuretic deficiency in HF.
- The drug elevates bradykinin, substance P, and adrenomedullin, contributing to HF efficacy.
- Potential interference with amyloid-beta homeostasis warrants further investigation.
Conclusions:
- Sacubitril/valsartan's benefits in HF extend beyond BNP augmentation, involving other vasoactive peptides.
- The drug's mechanism may mimic or enhance the 'autoinhibition' phenomenon for rapid decompensation reversal.
- Understanding these broader effects is crucial for optimizing HF treatment and assessing potential risks.
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