Positive cardiac inotrope omecamtiv mecarbil activates muscle despite suppressing the myosin working stroke

Nat Commun. 2018 Sep 21;9(1):3838. doi: 10.1038/s41467-018-06193-2.

Abstract

Omecamtiv mecarbil (OM) is a positive cardiac inotrope in phase-3 clinical trials for treatment of heart failure. Although initially described as a direct myosin activator, subsequent studies are at odds with this description and do not explain OM-mediated increases in cardiac performance. Here we show, via single-molecule, biophysical experiments on cardiac myosin, that OM suppresses myosin's working stroke and prolongs actomyosin attachment 5-fold, which explains inhibitory actions of the drug observed in vitro. OM also causes the actin-detachment rate to become independent of both applied load and ATP concentration. Surprisingly, increased myocardial force output in the presence of OM can be explained by cooperative thin-filament activation by OM-inhibited myosin molecules. Selective suppression of myosin is an unanticipated route to muscle activation that may guide future development of therapeutic drugs.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Triphosphate
  • Animals
  • Cardiotonic Agents / pharmacology*
  • Cell Line
  • Drug Evaluation, Preclinical
  • Mice
  • Monte Carlo Method
  • Myosins / drug effects*
  • Optical Tweezers
  • Swine
  • Urea / analogs & derivatives*
  • Urea / pharmacology

Substances

  • Cardiotonic Agents
  • omecamtiv mecarbil
  • Adenosine Triphosphate
  • Urea
  • Myosins