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Current and emerging drug targets in heart failure treatment

After initial strategies targeting inotropism and congestion, the neurohormonal interpretative model of heart failure (HF) pathophysiology has set the basis for current pharmacological management of HF, as most of guideline recommended drug classes, including beta-blockers, angiotensin-converting en...

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Autores principales: Ghionzoli, Nicolò, Gentile, Francesco, Del Franco, Anna Maria, Castiglione, Vincenzo, Aimo, Alberto, Giannoni, Alberto, Burchielli, Silvia, Cameli, Matteo, Emdin, Michele, Vergaro, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197912/
https://www.ncbi.nlm.nih.gov/pubmed/34273070
http://dx.doi.org/10.1007/s10741-021-10137-2
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author Ghionzoli, Nicolò
Gentile, Francesco
Del Franco, Anna Maria
Castiglione, Vincenzo
Aimo, Alberto
Giannoni, Alberto
Burchielli, Silvia
Cameli, Matteo
Emdin, Michele
Vergaro, Giuseppe
author_facet Ghionzoli, Nicolò
Gentile, Francesco
Del Franco, Anna Maria
Castiglione, Vincenzo
Aimo, Alberto
Giannoni, Alberto
Burchielli, Silvia
Cameli, Matteo
Emdin, Michele
Vergaro, Giuseppe
author_sort Ghionzoli, Nicolò
collection PubMed
description After initial strategies targeting inotropism and congestion, the neurohormonal interpretative model of heart failure (HF) pathophysiology has set the basis for current pharmacological management of HF, as most of guideline recommended drug classes, including beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists, blunt the activation of detrimental neurohormonal axes, namely sympathetic and renin–angiotensin–aldosterone (RAAS) systems. More recently, sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor, combining inhibition of RAAS and potentiation of the counter-regulatory natriuretic peptide system, has been consistently demonstrated to reduce mortality and HF-related hospitalization. A number of novel pharmacological approaches have been tested during the latest years, leading to mixed results. Among them, drugs acting directly at a second messenger level, such as the soluble guanylate cyclase stimulator vericiguat, or other addressing myocardial energetics and mitochondrial function, such as elamipretide or omecamtiv-mecarbil, will likely change the therapeutic management of patients with HF. Sodium glucose cotransporter 2 inhibitors, initially designed for the management of type 2 diabetes mellitus, have been recently demonstrated to improve outcome in HF, although mechanisms of their action on cardiovascular system are yet to be elucidated. Most of these emerging approaches have shifted the therapeutic target from neurohormonal systems to the heart, by improving cardiac contractility, metabolism, fibrosis, inflammation, and remodeling. In the present paper, we review from a pathophysiological perspective current and novel therapeutic strategies in chronic HF.
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spelling pubmed-91979122022-06-16 Current and emerging drug targets in heart failure treatment Ghionzoli, Nicolò Gentile, Francesco Del Franco, Anna Maria Castiglione, Vincenzo Aimo, Alberto Giannoni, Alberto Burchielli, Silvia Cameli, Matteo Emdin, Michele Vergaro, Giuseppe Heart Fail Rev Article After initial strategies targeting inotropism and congestion, the neurohormonal interpretative model of heart failure (HF) pathophysiology has set the basis for current pharmacological management of HF, as most of guideline recommended drug classes, including beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists, blunt the activation of detrimental neurohormonal axes, namely sympathetic and renin–angiotensin–aldosterone (RAAS) systems. More recently, sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor, combining inhibition of RAAS and potentiation of the counter-regulatory natriuretic peptide system, has been consistently demonstrated to reduce mortality and HF-related hospitalization. A number of novel pharmacological approaches have been tested during the latest years, leading to mixed results. Among them, drugs acting directly at a second messenger level, such as the soluble guanylate cyclase stimulator vericiguat, or other addressing myocardial energetics and mitochondrial function, such as elamipretide or omecamtiv-mecarbil, will likely change the therapeutic management of patients with HF. Sodium glucose cotransporter 2 inhibitors, initially designed for the management of type 2 diabetes mellitus, have been recently demonstrated to improve outcome in HF, although mechanisms of their action on cardiovascular system are yet to be elucidated. Most of these emerging approaches have shifted the therapeutic target from neurohormonal systems to the heart, by improving cardiac contractility, metabolism, fibrosis, inflammation, and remodeling. In the present paper, we review from a pathophysiological perspective current and novel therapeutic strategies in chronic HF. Springer US 2021-07-17 2022 /pmc/articles/PMC9197912/ /pubmed/34273070 http://dx.doi.org/10.1007/s10741-021-10137-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Ghionzoli, Nicolò
Gentile, Francesco
Del Franco, Anna Maria
Castiglione, Vincenzo
Aimo, Alberto
Giannoni, Alberto
Burchielli, Silvia
Cameli, Matteo
Emdin, Michele
Vergaro, Giuseppe
Current and emerging drug targets in heart failure treatment
title Current and emerging drug targets in heart failure treatment
title_full Current and emerging drug targets in heart failure treatment
title_fullStr Current and emerging drug targets in heart failure treatment
title_full_unstemmed Current and emerging drug targets in heart failure treatment
title_short Current and emerging drug targets in heart failure treatment
title_sort current and emerging drug targets in heart failure treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197912/
https://www.ncbi.nlm.nih.gov/pubmed/34273070
http://dx.doi.org/10.1007/s10741-021-10137-2
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