Soluble Guanylate Cyclase Activator Vericiguat Prevents Anthracycline–mediated Cardiotoxicity and Sarcopenia Through No–sgc–cgmp–nlrp3 Pathway: Potential Application in Cancer Patients

Abstract Background Anthracycline–induced cardiomyopathies and sarcopenia are frequently seen in cancer patients, affecting their overall survival and quality of life; therefore, new cardioprotective strategies are needed in cardioncology. Vericiguat is a new oral guanylate cyclase activator that reduces heart failure hospitalizations or cardiovascular death through improvement of smooth muscle cell relaxation and reduction of myocardial fibrosis and inflammation. In this study, we highlight on the potential cardioprotective properties of vericiguat against anthracycline.mediated cardiotoxicity and sarcopenia. Methods Human cardiomyocytes (AC–16 cells) and Primary Skeletal Muscle Cells (HSkMC cells) were exposed for 48h to doxorubicin (DOXO) at 0,3 and 1 µM or Vericiguat at 10–7,10–5,10–3 mM or both in combination. Mithocondrial cell viability, LDH and Citocrome C release were performed to study cytoprotective properties. TUNEL assay, cGMP and NLRP–3, Myd–88 intracellular levels were quantified through colorimetric and selective ELISA methods. IL–1β, IL–6, IL–8, CXCL–2, TGF–β and IL–18 were also analyzed in cardiac and muscle cell lysates after treatments. Results Vericiguat exerts a significant cytoprotective and anti–apoptotic effect in cardiac and muscle cell lines during exposure to DOXO. A drastic increase in cGMP expression and reduction in NLRP–3, Myd–88 levels were also seen in Vericiguat–DOXO groups vs DOXO groups (p0.001). Pro–inflammatory and cytotoxic cytokines were also downregulated after Vericiguat treatment during DOXO exposure. Conclusions Vericiguat significantly reduced cardiotoxic effects and sarcopenia induced by DOXO therapy though enhancement of cGMP levels and reduction of NLRP–3/Myd–88/cytokines pathways. These findings provide a framework for future studies aiming to assess vericiguat for the therapeutic targeting of anthracycline–mediated cardiotoxicity and sarcopenia.