title: Cinaciguat, a soluble guanylate cyclase activator for the potential treatment of acute heart failure.
abstract: The nitric oxide (NO)/soluble guanylate cyclase (sGC)/cyclic guanosine-3',5'-monophosphate (cGMP) pathway plays an important role in cardiovascular regulation by producing vasodilation and inhibiting platelet aggregation and vascular smooth muscle proliferation. The NO/SGC/cGMP pathway is disrupted in patients with heart failure as a result of a decrease in NO bioavailability and an increase in NO-insensitive forms of sGC, resulting in insufficient vasodilation. Drugs that activate sGC in a NO-independent manner may provide considerable therapeutic advantages in treating these patients. Cinaciguat (BAY-58-2667), currently in development by Bayer AG, preferentially activates sGC in its oxidized or heme-free state, when the enzyme is insensitive to both NO and nitrovasodilators. Cinaciguat exhibits potent vasodilator and antiplatelet activity, a long-lasting antihypertensive effect and a hemodynamic profile similar to that of nitrates. In clinical trials in patients with acute decompensated heart failure, cinaciguat potently unloaded the heart, increased cardiac output and renal blood flow, and preserved renal function and sodium and water excretion without further neurohumoral activation. The pharmacokinetics of cinaciguat demonstrated dose-proportionality with low individual variability and a low incidence of adverse events. The phase I and II clinical trials performed with cinaciguat so far, however, are insufficient to provide convincing evidence on the efficacy and safety of the drug. Thus, caution should be exerted before extrapolating the present preliminary data to the clinical practice.
authors: Universidad Complutense de Madrid, School of Medicine, Department of Pharmacology, Ciudad Universitaria, 28040 Madrid, Spain. jtamargo@med.ucm.es
authors: Juan
authors: J
authors: Tamargo
authors: Juan
authors: J
authors: Duarte
authors: Ricardo
authors: R
authors: Caballero
authors: Eva
authors: E
authors: Delpón
mesh_terms: D000208:Acute Disease; D000818:Animals; D001565:Benzoates / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002319:Cardiovascular System / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D020536:Enzyme Activators / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D006162:Guanylate Cyclase / Q000378:metabolism*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D014665:Vasodilator Agents / Q000378:metabolism / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001565:Benzoates; D020536:Enzyme Activators; D014665:Vasodilator Agents; C480588:BAY 58-2667; D006162:Guanylate Cyclase