Inadequately controlled diabetes is a risk factor for the heart is well known. Less well known is that, in the event of a heart attack and therefore a lack of blood and oxygen to an area of ​​the myocardium, the damage could be greater when one is affected by diabetes. The cells of the cardiac muscle tissue are in fact less able to tolerate the lack of nourishment and therefore can die more rapidly, with potentially greater repercussions on the outcomes of ischemia and on the future risk of developing heart failure. If this is the case, a possible solution could come from a drug currently under advanced study for forms of anemia related to chronic kidney disease.
The hypothesis that molidustat, this is the name of the active ingredient, can help to better protect the heart of people with diabetes and limit the risk of developing heart failure comes from a study funded by the British Heart Foundation and conducted by experts from theOxford University, appeared on Diabetes. Scientists have discovered that the drug is able to represent a sort of “invigorating” for the cells of the heart affected by ischemia. Its action in fact allows to increase the values ​​of a protein called HIF (Hypoxia Inducible Factor). Unfortunately, however, on average in people with diabetes the values ​​of this protein inside myocardial cells tend to be lower and therefore also the normal reaction of “push” upwards of the levels of HIF that occurs physiologically after an ischemia, useful for cell survival, are reduced.
The British researchers first found in heart cells with insulin resistance, a phenomenon typical of type 2 diabetes, a much lower increase than in healthy myocardial tissue in the increase in HIF. However, by treating the same cells with the investigational drug, the response of the HIF target genes was “turned on” and their values ​​increased. Then we moved on to the experimental animal after ischemia, comparing what happened in the hearts of diabetic and non-diabetic rats. Also in this case the treatment with molidustat allowed to obtain a return to function very similar to that observed in healthy animals. As if that were not enough, then, given that the HIF protein also comes into play in the mechanisms of neoangiogenesis, or in the autonomous growth of new blood vessels that try to compensate for the lack of oxygen in the part of the heart affected by a heart attack, there is hope. that also in this sense the pharmacological support can have a positive meaning. ”
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For people with diabetes this is a study of great interest, considering that even on the neoangiogenesis front, those suffering from the disease tend to have less effective responses – he explains Mariangela Ghiani, President for Sardinia of the Italian Diabetes Society (Sid). The perspectives are of great interest considering that above all it allows us to continue on the possible prevention of heart failure in the person with diabetes, which represents one of the most complex problems to be faced in this population. In fact, there are molecular mechanisms that have not yet been fully elucidated that can predispose these subjects to worse pictures. Above all, however, this study confirms that the way to use treatments designed for the treatment of diabetes also for chronic heart diseases such as heart failure is now outlined. The most recent drugs used for the treatment of diabetes have in fact made it possible to reduce mortality and hospitalizations due to heart failure “.
In short: on the chronicity front, the positive interaction of some diabetes therapies with heart failure is now clear. As for the possibility of limiting the damage in the event of an acute heart attack, improving the long-term prognosis and the damage to the heart, work is being done. The hope is that through drugs capable of stabilizing HIF values, increasing them also in those facing diabetes, the risk of heart failure after myocardial infarction can be reduced in this specific population. But only future clinical studies will be able to confirm this hypothesis.
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