Aims Sacubitril/valsartan (sac/val) has shown superior effect compared with blockade of the renin-angiotensin-aldosterone system in heart failure with reduced ejection fraction. We aimed to investigate effects of sac/val compared with valsartan in a pressure overload model of heart failure with preserved ejection fraction (HFpEF). Methods and results Sprague-Dawley rats underwent aortic banding or sham (n = 16) surgery and were randomized to sac/val (n = 28), valsartan (n = 29), or vehicle (n = 26) treatment for 8 weeks. Sac/val reduced left ventricular weight by 11% compared with vehicle (P = 0.01) and 9% compared with valsartan alone (P = 0.04). Only valsartan reduced blood pressure compared with sham (P = 0.02). Longitudinal early diastolic strain rate was preserved in sac/val compared with sham, while it was reduced by 23% in vehicle (P = 0.03) and 24% in valsartan (P = 0.02). Diastolic dysfunction, measured by E/e'SR, increased by 68% in vehicle (P < 0.01) and 80% in valsartan alone (P < 0.001), while sac/val showed no increase. Neither sac/val nor valsartan prevented interstitial fibrosis. Although ejection fraction was preserved, we observed mild systolic dysfunction, with vehicle showing a 28% decrease in longitudinal strain (P < 0.01). Neither sac/val nor valsartan treatment improved this dysfunction. Conclusions In a model of HFpEF induced by cardiac pressure overload, sac/val reduced hypertrophy compared with valsartan alone and ameliorated diastolic dysfunction. These effects were independent of blood pressure. Early systolic dysfunction was not affected, supporting the notion that sac/val has the largest potential in conditions characterized by reduced ejection fraction. Observed anti-hypertrophic effects in preserved ejection fraction implicate potential benefit of sac/val in the clinical setting of hypertrophic remodelling and impaired diastolic function.

Background and purposeGuanylyl cyclase‐A (GC‐A), activated by endogenous atrial natriuretic peptide (ANP) and B‐type natriuretic peptide (BNP), plays an important role in the regulation of cardiovascular and renal homeostasis and is an attractive drug target. Even though small molecule modulators allow oral administration and longer half‐life, drug targeting of GC‐A has so far been limited to peptides. Thus, in this study we aimed to develop small molecular activators of GC‐A.Experimental approachHits were identified through high‐throughput screening and optimized by in silico design. Cyclic GMP measurements were performed in QBI HEK293 cells expressing GC‐A, GC‐B or chimerae of the two receptors using Alpha Screen technology. Binding assays were performed in membrane preparations or whole cells using 125I‐ANP. Vasorelaxation was measured in aortic rings isolated from Wistar rats.Key resultsWe have identified small molecular allosteric enhancers of GC‐A, which enhanced ANP or BNP effects in cellular systems and ANP‐induced vasorelaxation in rat aortic rings. The mechanism of action appears novel and not mediated through previously described allosteric binding sites. In addition, the selectivity and activity depend on a single amino acid residue that differs between the two similar receptors GC‐A and GC‐B.Conclusion and implicationsWe describe a novel allosteric binding site on GC‐A, which can be targeted by small molecules that enhance ANP and BNP effects. These compounds will be valuable tools in further development and proof‐of‐concept of GC‐A enhancement for the potential use in cardiovascular therapy.