Key result
ARNi and SGLT2i therapies were not independently associated with lower expression of inflammasome pathway components in myocardial samples from patients with advanced heart failure.
Why the study?
Preclinical studies suggest ARNi and SGLT2i therapies attenuate inflammasome activation, but evidence regarding their effects in the failing human myocardium remains sparse.
Does treatment with ARNi and SGLT2i therapies reduce myocardial inflammasome pathway expression in patients with advanced heart failure?
Observational (n=104)
No
Does treatment with ARNi and SGLT2i therapies reduce myocardial inflammasome pathway expression in patients with advanced heart failure?
In advanced heart failure patients, ARNi and SGLT2i therapies were not independently associated with reduced myocardial inflammasome expression at the time of heart transplantation.
Does not support independent reduction of myocardial inflammasome expression by ARNi or SGLT2i in advanced HF; leaves open alternative anti-inflammatory mechanisms or effects in earlier-stage disease.
BACKGROUND: The inflammasome pathway has been implicated in the progression of heart failure (HF). Preclinical studies suggest that angiotensin receptor-neprilysin inhibitor (ARNi) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapies may attenuate inflammasome activation, yet evidence in the failing human myocardium remains sparse. Hence, we evaluated the associations between ARNi and SGLT2i therapies and myocardial priming of inflammasome pathway components in explanted hearts from heart transplantation (HTX) recipients. METHODS: Biobank samples from the left ventricular myocardium of 104 HTX recipients were analyzed. The mRNA and protein expression of inflammasome-related targets (absent in melanoma 2 [AIM2], NLR family pyrin domain containing 3 [NLRP3], caspase-1, gasdermin D, and nuclear factor kappa-light-chain-enhancer of activated B cells [NF-κB]) were quantified using qRT-PCR and Western blotting. Multivariable linear regression models were applied to assess the relationships between inflammasome component expression and clinical variables, including treatment with ARNi and SGLT2i. RESULTS: ARNi and SGLT2i therapies were associated with lower mRNA expression of AIM2, NLRP3, caspase-1, and NF-κB in univariate analyses. However, after adjustment for clinical covariates, these associations with inflammasome-related transcripts were no longer statistically significant. In multivariable models, only female sex, diabetes, time since heart transplantation, and serum potassium concentration remained associated with myocardial inflammasome pathway expression. CONCLUSIONS: In myocardial samples from patients with advanced HF, no clear differences in the expression of selected inflammasome priming-related targets were observed between treatment eras before and after the introduction of ARNi and SGLT2i therapies, despite their experimentally suggested anti-inflammatory effects, warranting further investigation.
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Nagy et al. (2026) conducted an observational in Advanced heart failure (n=104). ARNi and SGLT2i therapies vs. Standard therapy without ARNi or SGLT2i was evaluated on Myocardial mRNA and protein expression of inflammasome-related targets (AIM2, NLRP3, caspase-1, gasdermin D, NF-κB). ARNi and SGLT2i therapies were not independently associated with lower expression of inflammasome pathway components in myocardial samples from patients with advanced heart failure.
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