Drug repurposing-a promising approach for patients with angina but non-obstructive coronary artery disease (ANOCA)

Abstract

In today's era of individualized precision medicine drug repurposing represents a promising approach to offer patients fast access to novel treatments. Apart from drug repurposing in cancer treatments, cardiovascular pharmacology is another attractive field for this approach. Patients with angina pectoris without obstructive coronary artery disease (ANOCA) report refractory angina despite standard medications in up to 40% of cases. Drug repurposing also appears to be an auspicious option for this indication. From a pathophysiological point of view ANOCA patients frequently suffer from vasomotor disorders such as coronary spasm and/or impaired microvascular vasodilatation. Consequently, we carefully screened the literature and identified two potential therapeutic targets: the blockade of the endothelin-1 (ET-1) receptor and the stimulation of soluble guanylate cyclase (sGC). Genetically increased endothelin expression results in elevated levels of ET-1, justifying ET-1 receptor blockers as drug candidates to treat coronary spasm. sGC stimulators may be beneficial as they stimulate the NO-sGC-cGMP pathway leading to GMP-mediated vasodilatation.

Keywords: ANOCA; ET-1 receptor blockers; drug repurposing; refractory angina; sGC stimulators.

Figure 1

Illustration portraying the various influences of different drugs in altering signaling pathways in vascular smooth muscle cells in coronary arteries.

Figure 2

Overview of different approaches used to identify novel candidates for drug repurposing.