Neprilysin and Natriuretic Peptide Regulation in Heart Failure.
Neprilysin is acknowledged as a key player in neurohormonal regulation, a cornerstone of modern drug therapy in chronic heart failure. In the cardiovascular system, neprilysin cleaves numerous vasoactive peptides, some with mainly vasodilating effects (natriuretic peptides, adrenomedullin, bradykinin) and other with mainly vasoconstrictor effects (angiotensin I and II, endothelin-1). For decades, neprilysin has been an important biotarget. Academia and industry have combined active efforts to search for neprilysin inhibitors (NEPIs) that might be useful in clinical practice. NEPI monotherapy was initially tested with little success due to efficacy issues. Next, combination of NEPI and ACE-inhibiting activity agents were abandoned due to safety concerns. Recently, the combination of NEPI and ARB, also known as ARNI, has shown better than expected results in heart failure with reduced ejection fraction, and multitude of ongoing studies are set to prove its value across the heart failure spectrum.
Heart Failure Clinic, Cardiology Service, Department of Medicine, UAB, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet, 08916, Badalona, Barcelona, Spain. abayesgenis@gmail.com.|Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain. abayesgenis@gmail.com.
Antoni
A
Bayes-Genis
Novartis Pharmaceuticals, Barcelona, Spain.
Nuria
N
Morant-Talamante
Heart Failure Clinic, Cardiology Service, Department of Medicine, UAB, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet, 08916, Badalona, Barcelona, Spain.|Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
Josep
J
Lupón
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D045265:Natriuretic Peptides / Q000378:metabolism; D015260:Neprilysin / Q000037:antagonists & inhibitors* / Q000502:physiology; D000075563:Vasopeptidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D045265:Natriuretic Peptides; D000075563:Vasopeptidase Inhibitors; D015260:Neprilysin
ARNI; Heart failure; Natriuretic peptides; Neprilysin