{"corpus_id":216417969,"paper_sha":"95b5f06e6f7fc85fcb4ae67fcdb7562f09fbe12d","doi":"10.1016/j.cjca.2020.03.005","arxiv_id":null,"pmid":32389345,"pmcid":null,"mag_id":3010044841,"dblp_id":null,"acl_id":null,"title":"Targeting Brain Aminopeptidase A: A New Strategy for the Treatment of Hypertension and Heart Failure.","year":2020,"publication_date":"2020-05-01","venue":"Canadian Journal of Cardiology","journal":{"name":"The Canadian journal of cardiology","pages":"\n          721-731\n        ","volume":"36 5"},"journal_issn":null,"journal_title":null,"publication_types":["Review","JournalArticle"],"pubmed_pub_types":["Journal Article","Research Support, Non-U.S. Gov't","Review"],"s2_fields_of_study":["Medicine"],"reference_count":92,"citation_count":27,"influential_citation_count":0,"is_open_access":false,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Angiotensin II","mj":false,"qs":[{"q":"metabolism","mj":false,"ui":"Q000378"}],"ui":"D000804"},{"d":"Angiotensin III","mj":false,"qs":[{"q":"metabolism","mj":false,"ui":"Q000378"}],"ui":"D000805"},{"d":"Animals","mj":false,"ui":"D000818"},{"d":"Antihypertensive Agents","mj":false,"qs":[{"q":"pharmacology","mj":false,"ui":"Q000494"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D000959"},{"d":"Brain","mj":false,"qs":[{"q":"metabolism","mj":true,"ui":"Q000378"}],"ui":"D001921"},{"d":"Clinical Trials as Topic","mj":false,"ui":"D002986"},{"d":"Disulfides","mj":false,"qs":[{"q":"pharmacology","mj":false,"ui":"Q000494"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D004220"},{"d":"Glutamyl Aminopeptidase","mj":false,"qs":[{"q":"antagonists & inhibitors","mj":true,"ui":"Q000037"},{"q":"metabolism","mj":false,"ui":"Q000378"}],"ui":"D043384"},{"d":"Heart Failure","mj":false,"qs":[{"q":"etiology","mj":false,"ui":"Q000209"},{"q":"prevention & control","mj":true,"ui":"Q000517"}],"ui":"D006333"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Hypertension","mj":false,"qs":[{"q":"drug therapy","mj":true,"ui":"Q000188"},{"q":"metabolism","mj":false,"ui":"Q000378"}],"ui":"D006973"},{"d":"Myocardial Infarction","mj":false,"qs":[{"q":"complications","mj":false,"ui":"Q000150"}],"ui":"D009203"},{"d":"Renin-Angiotensin System","mj":false,"ui":"D012084"},{"d":"Sulfonic Acids","mj":false,"qs":[{"q":"pharmacology","mj":false,"ui":"Q000494"},{"q":"therapeutic use","mj":false,"ui":"Q000627"}],"ui":"D013451"}],"chemicals":[{"n":"Antihypertensive Agents","ui":"D000959","reg":"0"},{"n":"Disulfides","ui":"D004220","reg":"0"},{"n":"Sulfonic Acids","ui":"D013451","reg":"0"},{"n":"Angiotensin II","ui":"D000804","reg":"11128-99-7"},{"n":"Angiotensin III","ui":"D000805","reg":"12687-51-3"},{"n":"firibastat","ui":"C528573","reg":"638KY4573I"},{"n":"Glutamyl Aminopeptidase","ui":"D043384","reg":"EC 3.4.11.7"}],"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":null,"s2_open_access_landing_url":null,"s2_open_access_license":null,"s2_open_access_status":null,"pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"The pathophysiology of heart failure (HF) and hypertension are thought to involve brain renin-angiotensin system (RAS) hyperactivity. Angiotensin III, a key effector peptide in the brain RAS, provides tonic stimulatory control over blood pressure (BP) in hypertensive rats. Aminopeptidase A (APA), the enzyme responsible for generating brain angiotensin III, constitutes a potential therapeutic target for hypertension treatment. We focus here on studies of RB150/firibastat, the first prodrug of the specific and selective APA inhibitor EC33 able to cross the blood-brain barrier. We consider its development from therapeutic target discovery to clinical trials of the prodrug. After oral administration, firibastat crosses the gastrointestinal and blood-brain barriers. On arrival in the brain, it is cleaved to generate EC33, which inhibits brain APA activity, lowering BP in various experimental models of hypertension. Firibastat was clinically and biologically well tolerated, even at high doses, in phase I trials conducted in healthy human subjects. It was then shown to decrease BP effectively in patients of various ethnic origins with hypertension in phase II trials. Brain RAS hyperactivity leads to excessive sympathetic activity, which can contribute to HF after myocardial infarction (MI). Chronic treatment with oral firibastat (4 or 8 weeks after MI) has been shown to normalize brain APA activity in mice. This effect is accompanied by a normalization of brain RAS and sympathetic activities, reducing cardiac fibrosis and hypertrophy and preventing cardiac dysfunction. Firibastat may therefore represent a novel therapeutic advance in the clinical management of patients with hypertension and potentially with HF after MI.","claims":[{"public_id":"cl_af7e983878c5ad3ab6131aa1dba24651","status":"active","text":"Chronic oral firibastat treatment after myocardial infarction normalized brain aminopeptidase A activity, normalized brain renin-angiotensin system and sympathetic activities, reduced cardiac fibrosis and hypertrophy, and prevented cardiac dysfunction in mice.","confidence":0.97,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_af7e983878c5ad3ab6131aa1dba24651"},{"public_id":"cl_8f0d7fd9d5a5716b2e74e35b025354c6","status":"active","text":"Firibastat decreased blood pressure effectively in patients with hypertension from various ethnic origins in phase II 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subjects.","confidence":0.96,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_1a3bca2341d55c04de95b1f5b45d6840"},{"public_id":"cl_377182f635f20f00803de456d5157a56","status":"active","text":"Targeting brain aminopeptidase A is presented as a novel therapeutic strategy for hypertension and potentially for heart failure after myocardial infarction.","confidence":0.9,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_377182f635f20f00803de456d5157a56"}],"concepts":[{"public_id":"co_088cedb9db6f194836076ace5aab8250","status":"active","name":"blood-brain barrier","description":"The barrier separating the circulation from the brain that firibastat can cross.","types":["biological 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