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Review
. 2023 Jun 16:10:1156456.
doi: 10.3389/fcvm.2023.1156456. eCollection 2023.

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

Johanna McChord #  1 , Valeria Martínez Pereyra #  1 , Sarah Froebel  1 , Raffi Bekeredjian  1 , Matthias Schwab  2   3 , Peter Ong  1
Affiliations
Review

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

Johanna McChord et al. Front Cardiovasc Med. .

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.

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Conflict of interest statement

MS has received research grants outside the submitted work from Green Cross WellBeing Co. Ltd, Gilead Sciences Inc., Agena Bioscience GmbH, Corat Therapeutics GmbH, CED Service GmbH, and from the Robert Bosch GmbH, and has received honoraria for oral presentations at academically organized congresses and meetings. MS is in part supported by the Robert Bosch Stiftung, Stuttgart, Germany. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Figures

Figure 1
Figure 1
Illustration portraying the various influences of different drugs in altering signaling pathways in vascular smooth muscle cells in coronary arteries.
Figure 2
Figure 2
Overview of different approaches used to identify novel candidates for drug repurposing.
See this image and copyright information in PMC

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