Abstract 186: Superiority of Sacubitril/Valsartan Over Valsartan Alone in Attenuating Pressure Overload-induced Cardiac Fibrosis and Oxidative Stress

Abstract

Background: Sacubitril/valsartan, a first-in-class Angiotensin Receptor-Neprilysin Inhibitor (ARNi), is superior to valsartan in reducing blood pressure in hypertensive patients. However, cardiac effects of sacubitril/valsartan in hypertension treatment and its potential superiority over valsartan are unclear. This study was designed to investigate effects of sacubitril/valsartan on cardiac structural remodeling and oxidative stress using a pressure overload rat model induced by ascending aortic constriction (AAC) and to address whether direct regulation of cardiac myocytes and/or fibroblasts is involved in the cardiac effects independent of afterload changes. Methods and Results: 1 week after AAC surgery, adult male Sprague-Dawley rats were randomized for 10 weeks treatment with vehicle, valsartan, or sacubitril/valsartan. Sacubitril/valsartan was superior to valsartan in inhibiting ventricular fibrosis, while both equally inhibited cardiomyocyte hypertrophy at the cellular level. These findings were supported by in vitro experiments showing that combined LBQ657 (sacubitrilat, active form of sacubitril) and valsartan was superior to valsartan alone in inhibiting angiotensin II (Ang II)-induced adult ventricular fibroblast activation, but not adult cardiomyocyte hypertrophy. In adult cardiomyocytes LBQ657 effectively inhibited Ang II-induced mitochondrial superoxide, and combined LBQ657 and valsartan was superior to valsartan or LBQ657 alone. Importantly, sacubitril/valsartan was also superior to valsartan in reducing mitochondrial superoxide in cardiomyocytes from pressure-overloaded hearts and improved cardiomyocyte mitochondrial maximal and spare respiration capacity. Conclusions: These findings provide direct evidence and novel mechanistic insights on the superior cardioprotective effects of sacubitril/valsartan in the setting of pressure overload: independent of afterload reduction, sacubitril/valsartan is superior to valsartan in attenuating cardiac fibrosis and myocyte oxidative stress and improves myocyte mitochondrial function in rats. Our study thus suggests a greater therapeutic effect of sacubitril/valsartan in the early stage of hypertensive heart disease before heart failure.