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Cimlanod is a second-generation nitroxyl (HNO) donor developed for the treatment of acute decompensated heart failure. It acts as a prodrug that releases HNO via pH-dependent chemical breakdown in the bloodstream. The drug exerts positive lusitropic and inotropic effects and also acts as a vasodilator. Mechanistically, HNO causes post-translational modification of thiol residues in proteins such as those found in cardiomyocyte sarcoplasmic reticulum, leading to improved myocardial contractility and vascular relaxation. Cimlanod was originally discovered by Cardioxyl Pharmaceuticals, which was later acquired by Bristol-Myers Squibb. It is classified as a small molecule sulfonamide and has completed phase II clinical trials for heart failure[1][3][4][6].
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