Eugene Braunwald, the father of modern cardiology, has called the experimental cholesterol drug inclirisan the future “heart attack vaccine”, a term that has sparked some doubts in the scientific community. In fact, the word “vaccine” must be used with caution, to avoid improper definitions and excessive hopes.
The definition of vaccine
According to the AIFA definition, vaccines are substances capable of activating the immune system to prevent the infection of viral diseases.
These “activating” substances can be inactivated or killed microorganisms (bacteria or viruses), specific parts (antigens) of microorganisms or substances produced by the microorganism itself (toxins). On the occasion of the fight against Covid-19, the first RNA vaccines were introduced, which are able to carry the sequence of the genetic code necessary for the production of the viral protein target of the immune system into the cell.
Heart attack vaccine, trial in Italy is underway
Antibodies against the protein are then produced; thus, if the person comes into contact with the virus, they protect him from infection. Therefore, a vaccine does not cure a disease, but prevents it, even if it must be said that the concept is being redefined.
Why is there talk of an anti-heart attack “vaccine”?
There are experimental therapeutic vaccines in oncology. The purpose of cancer vaccines is to teach patients’ immune systems to recognize cancer cells in order to eliminate them. In cardiology there are no superimposable situations and therefore, in the strict sense of the term, the definition of “anti-heart attack vaccine” is not perfectly applicable.
So why was it used by a great cardiologist like Braunwald? To sensitize doctors and patients about the arrival of a new class of RNA drugs that act with a precision “gene silencing” mechanism and have reduced toxicity. These are molecules that interfere in a targeted way on specific genes, deactivating them.
How inclirisan works
In the case of inclirisan, by silencing a sequence of messenger RNA in the liver cells, the drug modifies the molecular mechanisms underlying the overproduction of low-density cholesterol (LDL), the so-called “bad cholesterol”. Another key point is that, like a vaccine and its booster, inclirisan is given as a subcutaneous injection twice a year in the office.
This modality overcomes the serious problem of the patient’s adherence to daily therapies. Many studies show that in the post-heart attack up to 40% of pharmacological prescriptions are disregarded for various reasons over the 12 months following the event, canceling the benefit and keeping the risk of a second heart attack high.
Also for this reason, many cardiologists, and we at Monzino too, strongly believe in this cutting-edge drug, which has what it takes to become a lifesaver for patients at high risk of heart attack.
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A drug not for everyone
As with all innovative and expensive biological therapies, this drug is not for everyone. At the moment it is reserved for the most severe forms of hypercholesterolemia, not responsive to traditional drugs. However, other drugs of the same class are coming in the near future. This new therapeutic frontier will allow us to further reduce the cardiovascular risk associated with hypercholesterolemia.
* Scientific Director of the Monzino Cardiology Center, Irccs. Head of the Vascular Biology and Regenerative Medicine Unit
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