Rahman Md Moshiur, Rahman Asadur, Nishiyama Akira
Department of Pharmacology, Faculty of Medicine, Kagawa University, Takamatsu, Japan.
Department of Pharmacology and Toxicology, Faculty of Animal Science and Veterinary Medicine, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh.
Front Med (Lausanne). 2025 Jan 7;11:1451450. doi: 10.3389/fmed.2024.1451450. eCollection 2024.
Angiotensin receptor-neprilysin inhibitors (ARNIs) represent a novel class of medications characterized by their dual action on major cardiorenal regulators, specifically the renin-angiotensin system (RAS) and the natriuretic peptide (NP) system. Sacubitril/valsartan, a pioneering ARNI, has demonstrated strong antihypertensive effect as well as superior efficacy in preserving renal function compared to RAS inhibitors in heart failure patients with reduced ejection fraction. Here, we gathered evidence on the impact of sacubitril/valsartan on the preservation of kidney function in patients with cardiorenal syndrome (CRS). In particular, we present a comprehensive summary of the latest advancements and findings from clinical trials, studies, and meta-analyses on the impact of ARNIs in maintaining or improving renal function. We also discussed the pre-clinical evidence supporting the use of sacubitril/valsartan for improving renal function, along with the underlying molecular mechanisms in animal models mimicking various clinical scenarios. Altogether, the analysis of published data from both pre-clinical and clinical studies provides substantial support for the usefulness of ARNIs in enhancing renal protection in subjects with CRS.
血管紧张素受体脑啡肽酶抑制剂（ARNI）是一类新型药物，其特点是对主要的心肾调节因子具有双重作用，特别是肾素-血管紧张素系统（RAS）和利钠肽（NP）系统。沙库巴曲缬沙坦作为一种开创性的ARNI，与射血分数降低的心力衰竭患者使用的RAS抑制剂相比，已显示出强大的降压作用以及在保护肾功能方面的卓越疗效。在此，我们收集了关于沙库巴曲缬沙坦对心肾综合征（CRS）患者肾功能保护影响的证据。特别是，我们全面总结了临床试验、研究以及荟萃分析中关于ARNI对维持或改善肾功能影响的最新进展和发现。我们还讨论了支持使用沙库巴曲缬沙坦改善肾功能的临床前证据，以及在模拟各种临床情况的动物模型中的潜在分子机制。总之，对临床前和临床研究已发表数据的分析为ARNI在增强CRS患者肾脏保护方面的有用性提供了大量支持。
