Selective inhibition of the C-domain of ACE (angiotensin-converting enzyme) combined with inhibition of NEP (neprilysin): a potential new therapy for hypertension

Alves-Lopes, R. et al. (2021) Selective inhibition of the C-domain of ACE (angiotensin-converting enzyme) combined with inhibition of NEP (neprilysin): a potential new therapy for hypertension. Hypertension, 78(3), pp. 604-616. (doi: 10.1161/HYPERTENSIONAHA.121.17041) (PMID:34304582) (PMCID:PMC8357049)

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Combined inhibition of NEP (neutral endopeptidase) and ACE (angiotensin-converting enzyme), without unwanted effects, remains an attractive therapeutic strategy in cardiovascular medicine. Omapatrilat, a dual NEP inhibitor–ACE inhibitor, was a promising antihypertensive drug but failed in trials due to angioedema, an effect possibly caused by inhibition of both the N- and C-domains of ACE. Here, we aimed to determine whether lisinopril-tryptophan (lisW-S), a C-domain specific ACE inhibitor that preserves the N-domain catalytic activity, together with sacubitril (NEP inhibitor), differentially influences cardiovascular function and vascular permeability in hypertension compared with omapatrilat and lisinopril+sacubitril which inhibits both the ACE C- and N-domains. Ang II (angiotensin II)–dependent hypertensive mice (transgenic mice expressing active human renin in the liver [also known as LinA3]) received vehicle, sacubitril, lisW-S, lisinopril, lisinopril+sacubitril, or lisW-S+sacubitril for 4 weeks. Systolic blood pressure was increased in LinA3 mice, along with cardiac hypertrophy/dysfunction, impaired endothelium-dependent vasorelaxation, hypercontractile responses, vascular remodeling, and renal inflammation. LisW-S+sacubitril, lisinopril+sacubitril, and omapatrilat reduced systolic blood pressure and normalized cardiovascular remodeling and vascular hypercontractile responses in LinA3 mice. Although lisinopril+sacubitril and omapatrilat improved Ach-induced vasorelaxation, lisW-S+sacubitril had no effect. Endothelial permeability (Evans Blue assessment) was increased in omapatrilat but not in LisW-S+sacubitril–treated mice. In conclusion, lisW-S combined with sacubitril reduced systolic blood pressure and improved cardiac dysfunction in LinA3 mice, similar to omapatrilat but without effects on endothelium-dependent vasorelaxation. Moreover, increased vascular leakage (plasma extravasation) induced by omapatrilat was not evident in mice treated with lisW-S+sacubitril. Targeting ACE C-domain and NEP as a combination therapy may be as effective as omapatrilat in lowering systolic blood pressure, but without inducing vascular permeability and endothelial injury.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Rios, Dr Francisco and Harvey, Dr Adam and Skiba, Mr Dominik and Graham, Dr Delyth and Guzik, Professor Tomasz and Alves Moreira Lopes, Dr Rheure and Montezano, Dr Augusto and Touyz, Professor Rhian and Neves, Dr Karla
Authors: Alves-Lopes, R., Montezano, A. C., Neves, K. B., Harvey, A., Rios, F. J., Skiba, D. S., Arendse, L. B., Guzik, T. J., Graham, D., Poglitsch, M., Sturrock, E., and Touyz, R. M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Hypertension
Publisher:American Heart Association
ISSN (Online):1524-4563
Published Online:26 July 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Hypertension 78(3): 604-616
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
172586Thiol Modification and Redox SignallingNeil BulleidMedical Research Council (MRC)MC_PC_15076Institute of Molecular, Cell & Systems Biology
300689Vascular Noxs as therapeutic targets and biomarkers in hypertensionRhian TouyzBritish Heart Foundation (BHF)CH/12/4/29762CAMS - Cardiovascular Science