The myosin activator omecamtiv mecarbil: a promising new inotropic agent.
Heart failure became a leading cause of mortality in the past few decades with a progressively increasing prevalence. Its current therapy is restricted largely to the suppression of the sympathetic activity and the renin-angiotensin system in combination with diuretics. This restrictive strategy is due to the potential long-term adverse effects of inotropic agents despite their effective influence on cardiac function when employed for short durations. Positive inotropes include inhibitors of the Na+/K+pump, β-receptor agonists, and phosphodiesterase inhibitors. Theoretically, Ca2+sensitizers may also increase cardiac contractility without resulting in Ca2+overload; nevertheless, their mechanism of action is frequently complicated by other pleiotropic effects. Recently, a new positive inotropic agent, the myosin activator omecamtiv mecarbil, has been developed. Omecamtiv mecarbil binds directly to β-myosin heavy chain and enhances cardiac contractility by increasing the number of the active force-generating cross-bridges, presumably without major off-target effects. This review focuses on recent in vivo and in vitro results obtained with omecamtiv mecarbil, and discusses its mechanism of action at a molecular level. Based on clinical data, omecamtiv mecarbil is a promising new tool in the treatment of systolic heart failure.
a Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Péter
P
Nánási
b Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Krisztina
K
Váczi
c Division of Clinical Physiology, Department of Cardiology, Research Center for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Zoltán
Z
Papp
CK-1827452; activateur de la myosine cardiaque; agents inotropes; calcium sensitizer; cardiac contractility; cardiac myosin activator; contractilité cardiaque; heart failure; inotropic agents; insuffisance cardiaque; omecamtiv mecarbil; sensibilisateur de calcium