Sacubitril/Valsartan Improves Sexual Function and Fibrosis of the Clitoral and Vaginal Tissues in Female Spontaneously Hypertensive Rats

Sacubitril/valsartan alleviates myocardial infarction-induced inflammation in mice by promoting M2 macrophage polarisation via regulation of PI3K/Akt pathway

BACKGROUND

Macrophage polarisation-mediated inflammation plays a critical role in ventricular remodelling after myocardial infarction (MI). Sacubitril/Valsartan (Sac/Val) is an angiotensin receptor-neprilysin inhibitor that has shown beneficial effects on MI and heart failure. This study aims to further explore the mechanisms by which Sac/Val exerts its protective effects against MI.

METHODS

A mouse MI model was induced by ligating the left anterior descending coronary artery, followed by Sac/Val administration. TTC staining and Masson trichrome staining were employed for estimating myocardial infarct size and fibrosis, respectively. The expression levels of proinflammatory factors were determined by ELISA and RT-qPCR. Flow cytometry and immunofluorescence staining were implemented to detect CD206-positive cell infiltration in mouse hearts. Western blotting was conducted to assess protein levels of Arg1, pro-fibrotic factors, and PI3K/Akt signalling-related markers.

RESULTS

Sac/Val treatment reduced myocardial infarct size and fibrosis in mice after MI. Sac/Val administration decreased proinflammatory cytokine production and facilitated M2 macrophage polarisation in MI mouse cardiac tissues. Sac/Val activated PI3K/Akt signalling in MI mouse hearts. Blocking PI3K/Akt signalling counteracted Sac/Val-mediated protective effects in MI mice.

CONCLUSION

Sac/Val ameliorates MI-induced inflammation by facilitating M2 macrophage polarisation and activating PI3K/Akt signalling.

Impact of Treatment With Sacubitril/Valsartan on Erectile Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction

Sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and relieve symptoms in patients with chronic heart failure with reduced ejection fraction. The objective of this study was to assess the effects of S/V on erectile dysfunction in patients with heart failure with reduced ejection fraction (HFrEF). A prospective, open-label study was conducted with 59 male patients diagnosed with HFrEF and concomitant erectile dysfunction. Patients were treated with S/V for a duration of 1 month. The International Index of Erectile Function (IIEF) questionnaire was used to assess the severity of erectile dysfunction and sexual activities at baseline and follow-up visits. Other clinical parameters, including heart rate, were also monitored. After S/V treatment, a significant improvement was observed in sexual activities at the 1-month follow-up visit. The IIEF score showed a statistically significant increase, indicating a decrease in the severity of erectile dysfunction. However, it should be noted that the numerical increase in the IIEF score did not reach clinical significance. This study suggests that S/V treatment in patients with HFrEF may lead to improvements in sexual activities and a reduction in the severity of erectile dysfunction as measured by the IIEF score.

Effect of angiotensin receptor-neprilysin inhibitor treatment on erectile dysfunction in heart failure with a reduced ejection fraction

Objective: Erectile dysfunction (ED) is a common condition in patients with heart failure (HF), which impairs quality of life. Our study aimed to compare those patients, who received traditional treatment with a diagnosis of HF and those who received angiotensin receptor-neprilysin inhibitor (ARNI) treatment in addition to the current treatment, in terms of ED at the end of 6 months. Patients and Methods: The study was planned as a single-center, prospective study. The study included 200 patients with heart failure. The patients’ demographic, clinical, and echocardiographic characteristics were recorded, and an international ED scoring questionnaire was applied. The participants in the study were divided into two groups: those who received ARNI treatment and those who did not. After 6 months, the ED questionnaire was applied to the patients again and the groups were compared. Results: The median age of the patients was 53 (years). The median ejection fraction (EF) value was calculated to be 30% and no significant difference was found between the groups (p: 0.122). It was found that N-terminal pro-brain natriuretic peptide (NT-pro- BNP) levels measured at the end of the 6th month were significantly lower in patients who had received ARNI treatment than in those who had not (respectively, 245 pg/ml, 200 pg/ml; p: 0.003). In the analysis performed to detect the presence of ED, it was discovered that the ED score change was significantly higher in the group that had received 6 months of ARNI treatment (p: 0.031) compared to that in the group that had not (p: 0.031). When the ED sub-parameters were compared in terms of the 6-month change rate, it was found that the ARNI group had a significant increase in terms of ED and sexual satisfaction scores, but no significant difference was found in the other parameters (p: 0.001, p: 0.029). Conclusion: Erectile dysfunction is more common in patients with heart failure compared to the rest of society and impairs quality of life. In our study, it was determined that ED complaints decreased significantly in HF patients, who had received ARNI treatment for 6 months than in patients who had not.