Lung-to-Heart Nano-in-Micro Peptide Promotes Cardiac Recovery in a Pig Model of Chronic Heart Failure.

Background: The lack of disease-modifying drugs is one of the major unmet needs in patients with heart failure (HF). Peptides are highly selective molecules with the potential to act directly on cardiomyocytes. However, a strategy for effective delivery of therapeutics to the heart is lacking.
Objectives: In this study, the authors sought to assess tolerability and efficacy of an inhalable lung-to-heart nano-in-micro technology (LungToHeartNIM) for cardiac-specific targeting of a mimetic peptide (MP), a first-in-class for modulating impaired L-type calcium channel (LTCC) trafficking, in a clinically relevant porcine model of HF.
Methods: Heart failure with reduced ejection fraction (HFrEF) was induced in Göttingen minipigs by means of tachypacing over 6 weeks. In a setting of overt HFrEF (left ventricular ejection fraction [LVEF] 30% ± 8%), animals were randomized and treatment was started after 4 weeks of tachypacing. HFrEF animals inhaled either a dry powder composed of mannitol-based microparticles embedding biocompatible MP-loaded calcium phosphate nanoparticles (dpCaP-MP) or the LungToHeartNIM only (dpCaP without MP). Efficacy was evaluated with the use of echocardiography, invasive hemodynamics, and biomarker assessment.
Results: DpCaP-MP inhalation restored systolic function, as shown by an absolute LVEF increase over the treatment period of 17% ± 6%, while reversing cardiac remodeling and reducing pulmonary congestion. The effect was recapitulated ex vivo in cardiac myofibrils from treated HF animals. The treatment was well tolerated, and no adverse events occurred.
Conclusions: The overall tolerability of LungToHeartNIM along with the beneficial effects of the LTCC modulator point toward a game-changing treatment for HFrEF patients, also demonstrating the effective delivery of a therapeutic peptide to the diseased heart.
Competing Interests: Funding Support and Author Disclosures This project was supported by H2020-NMBP-2016 720834 CUPIDO to Drs Alogna, Catalucci, de Luca, Iafisco, Guillot, Longinotti-Buitoni, and Post. Dr Alogna is supported by the Clinician Scientist Program of the Berlin Institute of Health, Germany. This work is additionally funded by the Deutsche Forschungsgemeinschaft (German Research Foundation; SFB-1470, Z01). Dr Catalucci is author on patent application no. MI2014A000097 and PCT/EP2015/051376 (WO2015/110589) “Mimetic peptides and their use in medicine” submitted by the Italian National Research Council, which covers MP that, through a novel mechanism, directly target the LTCC and are suitable for use in the treatment of conditions where LTCC density and function are altered. Drs Catalucci and Iafisco are authors on patent application nos. MI2014A002207 and PCT/EP2015/080991 (WO2016/102576), “Products for the delivery of therapeutic/diagnostic compounds to the heart,” submitted by the Italian National Research Council (75%) and the Italian Istituto Nazionale Assicurazione Infortuni sul Lavoro (25%), which cover a process for the preparation of a product comprising 1 or more nanoparticles of CaP that are suitable for use as a vehicle for 1 or more diagnostic/therapeutic compounds for the treatment of CVDs. Drs Colombo, Quarta, Catalucci, and Iafisco are inventors of the patent WO WO2022/053955 “Powder composition based on microparticles embedding nanoparticles for the delivery of therapeutic/diagnostic compounds” submitted by the Italian National Research Council (50%) and PlumeStars (50%), which relates to a powder composition for inhalation use comprising a population of microparticles comprising at least 1 water-soluble pharmaceutical carrier embedding at least one nanoparticle of calcium phosphate for the delivery of therapeutic/diagnostic compounds. Drs de Luca, Catalucci, Iafisco, and Alogna are founders of NanoPhoria, a preclinical-stage biotech company and National Research Council spin-off that is developing a versatile, nonviral drug delivery platform based on inorganic nanoparticles. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)