Mawakamten – pionierski inhibitor miozyny sercowej w terapii kardiomiopatii przerostowej
Keywords:
mawakamten, kardiomiopatia przerostowa, inhibitor miozyny sercowejSynopsis
Abstrakt:
Mawakamten, selektywny, allosteryczny i odwracalny inhibitor miozyny sercowej wprowadza przełomowe podejście w terapii kardiomiopatii przerostowej (ang. hypertrophic cardiomyopathy, HCM), zdecydowanie różniąc się od klasycznych terapii. Mawakamten działa bezpośrednio na patofizjologię choroby precyzyjnie redukując nadmierną kurczliwość redukując ilość głów miozyny. Skutkuje to poprawą parametrów sercowych i krążeniowych u pacjentów, a także umożliwia cofanie patologicznego przerostu mięśnia sercowego. Dzięki temu może nie tylko poprawić funkcję serca ale również zapobiegać lub opóźniać konieczność interwencji chirurgicznych , stanowiąc obiecującą alternatywę w terapii HCM. Dodatkowo jego innowacyjny uchwyt działania otwiera możliwość stosowania leku i innych chorobach mięśnia sercowego o podobnym patomechanizmie.
Słowa kluczowe: mawakamten, kardiomiopatia przerostowa, inhibitor miozyny sercowej
Mavacamten, a selective, allosteric, and reversible cardiac myosin inhibitor, introduces a groundbreaking approach to the treatment of hypertrophic cardiomyopathy (HCM), markedly differing from conventional therapies. Mavacamten acts directly on the pathophysiological mechanism of the disease by precisely reducing excessive contractility through a decrease in the number of active myosin heads. This leads to an improvement in cardiac and hemodynamic parameters in patients and enables regression of pathological myocardial hypertrophy. As a result, it may not only improve cardiac function but also prevent or delay the need for surgical intervention, representing a promising alternative in HCM therapy. Moreover, its innovative mechanism of action opens the possibility for its application in other myocardial diseases sharing similar pathophysiological pathways.
Keywords: mavacamten, hypertrophic cardiomyopathy, cardiac myosin inhibitor
References
Referencje
Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020;142(25):e558-e631. doi:10.1161/CIR.0000000000000937
Marian AJ, Braunwald E. Hypertrophic Cardiomyopathy. Circ Res. 2017;121(7):749-770. doi:10.1161/CIRCRESAHA.117.311059
Ommen SR, Ho CY, Asif IM, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(23):e1239-e1311. doi:10.1161/CIR.0000000000001250
Bayonas-Ruiz A, Muñoz-Franco FM, Sabater-Molina M, Oliva-Sandoval MJ, Gimeno JR, Bonacasa B. Current therapies for hypertrophic cardiomyopathy: a systematic review and meta-analysis of the literature. ESC Heart Fail. 2023;10(1):8-23. doi:10.1002/ehf2.14142
Pinto G, Chiarito M, Puscas T, et al. Comparative Influences of Beta blockers and Verapamil on Cardiac Outcomes in Hypertrophic Cardiomyopathy. Am J Cardiol. 2025;235:9-15. doi:10.1016/j.amjcard.2024.10.029
Iavarone M, Monda E, Vritz O, et al. Medical treatment of patients with hypertrophic cardiomyopathy: An overview of current and emerging therapy. Arch Cardiovasc Dis. 2022;115(10):529-537. doi:10.1016/j.acvd.2022.06.003
Topriceanu CC, Field E, Boleti O, Cervi E, Kaski JP, Norrish G. Disopyramide is a safe and effective treatment for children with obstructive hypertrophic cardiomyopathy. Int J Cardiol. 2023;371:523-525. doi:10.1016/j.ijcard.2022.09.044
Fifer MA. Choice of Septal Reduction Therapies and Alcohol Septal Ablation. Cardiol Clin. 2019;37(1):83-93. doi:10.1016/j.ccl.2018.08.009
Iavarone M, Monda E, Vritz O, et al. Medical treatment of patients with hypertrophic cardiomyopathy: An overview of current and emerging therapy. Arch Cardiovasc Dis. 2022;115(10):529-537. doi:10.1016/j.acvd.2022.06.003
Green EM, Wakimoto H, Anderson RL, et al. A small-molecule inhibitor of sarcomere contractility suppresses hypertrophic cardiomyopathy in mice. Science. 2016;351(6273):617-621. doi:10.1126/science.aad3456
Iavarone M, Monda E, Vritz O, et al. Medical treatment of patients with hypertrophic cardiomyopathy: An overview of current and emerging therapy. Arch Cardiovasc Dis. 2022;115(10):529-537. doi:10.1016/j.acvd.2022.06.003
The myosin mesa and a possible unifying hypothesis for the molecular basis of human hypertrophic cardiomyopathy. Biochem Soc Trans. 2015;43(1):64-72. doi:10.1042/BST20140324
McNamara JW, Li A, Dos Remedios CG, Cooke R. The role of super-relaxed myosin in skeletal and cardiac muscle. Biophys Rev. 2015;7(1):5-14. doi:10.1007/s12551-014-0151-5
Kalinski JK, Xu B, Boyd R, et al. Novel Cardiac Myosin Inhibitor Therapy for Hypertrophic Cardiomyopathy in Adults: A Contemporary Review. Am J Cardiovasc Drugs Drugs Devices Interv. 2024;24(5):591-602. doi:10.1007/s40256-024-00667-z
Anderson RL, Trivedi DV, Sarkar SS, et al. Deciphering the super relaxed state of human β-cardiac myosin and the mode of action of mavacamten from myosin molecules to muscle fibers. Proc Natl Acad Sci U S A. 2018;115(35):E8143-E8152. doi:10.1073/pnas.1809540115
Trivedi DV, Adhikari AS, Sarkar SS, Ruppel KM, Spudich JA. Hypertrophic cardiomyopathy and the myosin mesa: viewing an old disease in a new light. Biophys Rev. 2018;10(1):27-48. doi:10.1007/s12551-017-0274-6
Kawas RF, Anderson RL, Ingle SRB, Song Y, Sran AS, Rodriguez HM. A small-molecule modulator of cardiac myosin acts on multiple stages of the myosin chemomechanical cycle. J Biol Chem. 2017;292(40):16571-16577. doi:10.1074/jbc.M117.776815
Woodland M, Al-Horani RA. New Era: Mavacamten for Obstructive Hypertrophic Cardiomyopathy. Cardiovasc Hematol Agents Med Chem. 2023;21(2):78-83. doi:10.2174/1871525721666221019095218
Nag S, Gollapudi SK, Rio CL del, Spudich JA, McDowell R. Mavacamten, a precision medicine for hypertrophic cardiomyopathy: From a motor protein to patients. Sci Adv. Published online July 2023. doi:10.1126/sciadv.abo7622
Schmid M, Toepfer CN. Cardiac myosin super relaxation (SRX): a perspective on fundamental biology, human disease and therapeutics. Biol Open. 2021;10(2):bio057646. doi:10.1242/bio.057646
Sitbon YH, Diaz F, Kazmierczak K, Liang J, Wangpaichitr M, Szczesna-Cordary D. Cardiomyopathic mutations in essential light chain reveal mechanisms regulating the super relaxed state of myosin. J Gen Physiol. 2021;153(7):e202012801. doi:10.1085/jgp.202012801
Braunwald E, Saberi S, Abraham TP, Elliott PM, Olivotto I. Mavacamten: a first-in-class myosin inhibitor for obstructive hypertrophic cardiomyopathy. Eur Heart J. 2023;44(44):4622-4633. doi:10.1093/eurheartj/ehad637
Jacoby D, Lester S, Owens A, et al. Reduction in left ventricular outflow tract gradient with mavacamten (myk-461) in symptomatic obstructive hypertrophic cardiomyopathy patients (pioneer-hcm). JACC. 2018;71(11_Supplement):A644-A644. doi:10.1016/S0735-1097(18)31185-9
Heitner SB, Jacoby D, , et al. Mavacamten Treatment for Obstructive Hypertrophic Cardiomyopathy. Ann Intern Med. 2019;170(11):741-748. doi:10.7326/M18-3016
MyoKardia, Inc. A Phase 2 Open-Label Pilot Study to Evaluate Efficacy, Pharmacokinetics, Pharmacodynamics, Safety, and Tolerability of MYK-461 in Subjects With Symptomatic Hypertrophic Cardiomyopathy and Left Ventricular Outflow Tract Obstruction. clinicaltrials.gov; 2021. Accessed April 14, 2025. https://clinicaltrials.gov/study/NCT02842242
Ho CY, Mealiffe ME, Bach RG, et al. Evaluation of Mavacamten in Symptomatic Patients With Nonobstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2020;75(21):2649-2660. doi:10.1016/j.jacc.2020.03.064
Camzyos (mavacamten) FDA Approval History. Drugs.com. Accessed April 14, 2025. https://www.drugs.com/history/camzyos.html
Masri A, Lester SJ, Stendahl JC, et al. Long-Term Safety and Efficacy of Mavacamten in Symptomatic Obstructive Hypertrophic Cardiomyopathy: Interim Results of the PIONEER-OLE Study. J Am Heart Assoc. 2024;13(8):e030607. doi:10.1161/JAHA.123.030607
Bristol-Myers Squibb. An Open-Label Extension Study of Mavacamten (MYK-461) in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy Previously Enrolled in Study MYK-461-004 (PIONEER). clinicaltrials.gov; 2025. Accessed April 14, 2025. https://clinicaltrials.gov/study/NCT03496168
Drugs@FDA: FDA-Approved Drugs. Accessed April 14, 2025. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=214998
MyoKardia Announces Receipt of Breakthrough Therapy Designation from FDA for Mavacamten for the Treatment of Symptomatic, Obstructive Hypertrophic Cardiomyopathy - Drugs.com MedNews. Drugs.com. Accessed April 14, 2025. https://www.drugs.com/clinical_trials/myokardia-announces-receipt-breakthrough-therapy-designation-fda-mavacamten-symptomatic-obstructive-18749.html
Braunwald E, Saberi S, Abraham TP, Elliott PM, Olivotto I. Mavacamten: a first-in-class myosin inhibitor for obstructive hypertrophic cardiomyopathy. Eur Heart J. 2023;44(44):4622-4633. doi:10.1093/eurheartj/ehad637
Olivotto I, Oreziak A, Barriales-Villa R, et al. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet. 2020;396(10253):759-769. doi:10.1016/S0140-6736(20)31792-X
FDA approves new drug to improve heart function in adults with rare heart condition | FDA. Accessed April 14, 2025. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-improve-heart-function-adults-rare-heart-condition
DeVries JH, Irs A, Hillege HL. The European Medicines Agency assessment of mavacamten as treatment of symptomatic obstructive hypertrophic cardiomyopathy in adult patients. Eur Heart J. 2023;44(37):3492-3494. doi:10.1093/eurheartj/ehad429
Lancellotti P, de Marneffe N, Scheen A. [Mavacamten (Camzyos ®) : first myosin modulator for obstructive hypertrophic cardiomyopathy treatment]. Rev Med Liege. 2024;79(2):120-128.
Shang E, Tan H. Comparison of Drug Therapy Efficacy in Patients With Hypertrophic Cardiomyopathy: A Network Meta-Analysis. Am J Cardiol. 2024;226:97-107. doi:10.1016/j.amjcard.2024.07.007
Kim MK, Kim B, Lee JY, et al. Tissue Doppler-derived E/e’ ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease. Korean J Intern Med. 2013;28(1):35-44. doi:10.3904/kjim.2013.28.1.35
Salanti G, Nikolakopoulou A, Efthimiou O, Mavridis D, Egger M, White IR. Introducing the Treatment Hierarchy Question in Network Meta-Analysis. Am J Epidemiol. 2021;191(5):930-938. doi:10.1093/aje/kwab278
Published
License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.