Effects of chronic treatment with the new ultra-long-acting [beta]2-adrenoceptor agonist indacaterol alone or in combination with the [beta]1-adrenoceptor blocker metoprolol on cardiac remodelling

Background and Purpose The ability of a chronic treatment with indacaterol, a new ultra-long-acting [beta]2-adrenoceptor agonist, to reverse cardiac remodelling and its effects in combination with metoprolol, a selective [beta]1-adrenoceptor antagonist, were investigated on myocardial infarction in a rat model of heart failure (HF). Experimental Approach We investigated the effects of indacaterol and metoprolol, administered alone or in combination, on myocardial histology, [beta]-adrenoceptor-mediated pathways, markers of remodelling and haemodynamic parameters in a rat model of HF. Five groups of rats were assessed: sham-operated rats; HF rats; HF + indacaterol 0.3mg·kg-1·day-1; HF + metoprolol 100mg·kg-1·day-1; HF + metoprolol + indacaterol. All pharmacological treatments continued for 15 weeks. Key Results Treatment with either indacaterol or metoprolol significantly reduced the infarct size in HF rats. However, the combination of indacaterol and metoprolol reduced the infarct size even further, reduced both BP and heart rate, reversed the decrease in ejection fraction, normalized left ventricular systolic and diastolic internal diameters, normalized the decreased [beta]1 adrenoceptor mRNA expression as well as cardiac cAMP levels and reduced cardiac GPCR kinase 2 expression, compared with the untreated HF group. Conclusion and Implications The results of our study demonstrated an additive interaction between indacaterol and metoprolol in normalizing and reversing cardiac remodelling in our experimental model of HF. The translation of these findings to clinical practice might be of interest, as this combination of drugs could be safer and more effective in patients suffering from HF and COPD.