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Tovinontrine is an orally administered, highly selective small molecule inhibitor of phosphodiesterase 9 (PDE9). It was originally developed for the treatment of sickle cell disease and beta-thalassemia but development for these indications has been discontinued due to lack of efficacy. Currently, it is being investigated in Phase II clinical trials for chronic heart failure, including both heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The drug works by inhibiting PDE9A, which increases levels of cyclic guanosine monophosphate (cGMP), a signaling molecule involved in vascular relaxation and cardiac function. By modulating cGMP pathways, tovinontrine may improve cardiac performance and reduce symptoms associated with heart failure[1][2][3][4][6][7].
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