Neprilysin inhibition: a new therapeutic option for type 2 diabetes?

• Published in: Diabetologia 2019-07, Vol.62 (7), p.1113-1122
• Main Authors: Esser, Nathalie, Zraika, Sakeneh
• Format: Article
• Language: English
• Subjects: Angiotensin; Angiotensin II; Angiotensin Receptor Antagonists - therapeutic use; Animals; Antihypertensive Agents - therapeutic use; Antineoplastic Agents - therapeutic use; Blood Glucose - drug effects; Congestive heart failure; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2/drug therapy/metabolism; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Endocrinologie, métabolisme & nutrition; Endocrinology, metabolism & nutrition; GLP-1; Glucose; Glucose metabolism; Homeostasis; Human health sciences; Human Physiology; Humans; Insulin; Insulin resistance; Insulin secretion; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Neprilysin; Neprilysin - antagonists & inhibitors; Neprilysin - metabolism; Neprilysin/antagonists & inhibitors/metabolism; Obesity; Peptidase; Renin; Renin-Angiotensin System - drug effects; Review; Sciences de la santé humaine; Substrate specificity; Type 2 diabetes
• ISSN: 0012-186X; 1432-0428; 1432-0428
• DOI: 10.1007/s00125-019-4889-y

Neprilysin is a widely expressed peptidase with broad substrate specificity that preferentially hydrolyses oligopeptide substrates, many of which regulate the cardiovascular, nervous and immune systems. Emerging evidence suggests that neprilysin also hydrolyses peptides that play an important role in glucose metabolism. In recent studies in humans, a dual angiotensin receptor–neprilysin inhibitor (ARNi) improved glycaemic control and insulin sensitivity in individuals with type 2 diabetes and/or obesity. Moreover, preclinical studies have also reported that neprilysin inhibition, alone or in combination with renin–angiotensin system blockers, elicits beneficial effects on glucose homeostasis. Since neprilysin inhibitors have been approved for the treatment of heart failure, their repurposing for treating type 2 diabetes would provide a novel therapeutic strategy. In this review, we evaluate existing evidence from preclinical and clinical studies in which neprilysin is deleted/inhibited, we highlight potential mechanisms underlying the beneficial glycaemic effects of neprilysin inhibition, and discuss possible deleterious effects that may limit the efficacy and safety of neprilysin inhibitors in the clinic. We also review the favourable impact neprilysin inhibition can have on diabetic complications, in addition to glucose control. Finally, we conclude that neprilysin inhibitors may be a useful therapeutic option for treating type 2 diabetes; however, their combination with angiotensin II receptor blockers is needed to circumvent deleterious consequences of neprilysin inhibition alone.