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Angiotensin-(1-9) retro-enantiomer is a synthetic peptide biologic designed as a protease-resistant analog of the naturally occurring angiotensin-(1-9) peptide. It is synthesized using non-natural D-amino acids in a reversed sequence (retro-inverso) compared to the original L-peptide, which significantly enhances its chemical stability and extends its plasma half-life while maintaining biological activity. The drug acts as an agonist of the angiotensin type 2 receptor (AT2R), functioning within the counter-regulatory arm of the renin-angiotensin system. Preclinical studies have demonstrated its efficacy in preventing hypertension, cardiac hypertrophy, and diastolic dysfunction, particularly in models of heart failure with preserved ejection fraction (HFpEF). It also reduces pro-inflammatory macrophage infiltration in the myocardium and improves glucose tolerance.
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