Cited by 45Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesCardiac Imaging and Diagnostics

Calcific aortic stenosis: omics-based target discovery and therapy development

Open access
Blaser, Mark C, Bäck, Magnus, Lüscher, Thomas F, Aikawa, Elena·2025·European Heart Journal

Abstract

Calcific aortic valve disease (CAVD) resulting in aortic stenosis (AS) is the most common form of valvular heart disease, affecting 2% of those over age 65. Those who develop symptomatic severe AS have an average further lifespan of <2 years without valve replacement, and three-quarters of these patients will develop heart failure, undergo valve replacement, or die within 5 years. There are no approved pharmaceutical therapies for AS, due primarily to a limited understanding of the molecular mechanisms that direct CAVD progression in the complex haemodynamic environment. Here, advances in efforts to understand the pathogenesis of CAVD and to identify putative drug targets derived from recent multi-omics studies [including (epi)genomics, transcriptomics, proteomics, and metabolomics] of blood and valvular tissues are reviewed. The recent explosion of single-cell omics-based studies in CAVD and the pathobiological and potential drug discovery insights gained from the application of omics to this disease area are a primary focus. Lastly, the translation of knowledge gained in valvular pathobiology into clinical therapies is addressed, with a particular emphasis on treatment regimens that consider sex-specific, renal, and lipid-mediated contributors to CAVD, and ongoing Phase I/II/III trials aimed at the prevention/treatment of AS are described.

Integrity signals

Registry

Crossref · 10.1093/eurheartj/ehae829

Cites

178 of 184 references verified1 citation errors · 5 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 4 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    In the TAVR era, surgical aortic valve replacement volumes have fallen sharply, with some estimates indicating a reduction of nearly 45% over the past decade.

    “in the TAVR era, SAVR volumes have dropped precipitously-some estimates place this reduction at almost 45% over the past decade.188”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [188] Mehta, 2024, Age-stratified surgical aortic valve replacement for aortic stenosis, Ann Thorac Surg source
  • Interpretationreasoning

    The resulting shortage of diseased human tissue from surgical aortic valve replacement is becoming an obstacle to basic science research.

    “The resultant scarcity of SAVR-derived diseased human tissue samples is becoming an impediment to basic science efforts”
    Quote in the paperSubstantial claim
  • Premisereasoning

    The shortage of surgical aortic valve replacement-derived diseased human tissue has led to renewed efforts to create new animal models or engineer organoids and other three-dimensional models of calcific aortic valve disease.

    “has prompted renewed attempts to develop new animal models (reviewed in Sider et al. 37 and Zhu et al. 189 ) or engineer organoids and other suitable 3D models of CAVD.108,109,[190][191][192]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Sider et al. 37

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Zhu et al. 189

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites 108,109,[190][191][192]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisereasoning

    Without treatment, patients with symptomatic aortic stenosis usually progress rapidly to heart failure.

    “Left untreated, these patients typically progress rapidly to heart failure”
    Quote in the paperSubstantial claim
  • Premisenone given

    Low-density lipoprotein cholesterol has a clear causal role in aortic stenosis.

    “A clear causal role for low-density lipoprotein choles-”
    • Also stated in: § Conclusions · plain
      “terol in aortic stenosis has driven extensive trials of lipid-lowering therapies including statins, proprotein convertase subtilisin/kexin type 9 inhibitors, and lipoprotein(a) inhibitors.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 4
  • May combine two claims. 6
  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Inhibition of the renin-angiotensin system by angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors may prevent monocyte activation and/or pro-inflammatory macrophage-derived signalling.

    “though inhibition of the renin-angiotensin system by angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors may prevent monocyte activation and/or pro-inflammatory macrophage-derived signalling.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisenone given

    Drug targets implicated in pathological valvular interstitial cell differentiation include cadherin 11 (blocked by the monoclonal antibody SYN0012) and soluble guanylate cyclase (activated by Ataciguat).

    “Drug targets implicated in pathological valvular interstitial cell differentiation also include cadherin 11 (blocked by the monoclonal antibody SYN0012) and soluble guanylate cyclase (activated by Ataciguat).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisenone given

    In a small fraction of patients with valvular sclerosis, roughly 2% per year, largely unknown mechanisms drive valve cell osteogenesis and cause leaflet mineralization.

    “Subsequently, in a small proportion of patients with valvular sclerosis (∼2% yearly), still largely unknown mechanisms drive valve cell osteogenesis and result in leaflet mineralization”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Novel omics-derived pharmaceutical targets that remain to be tested in clinical trials include Sortilin (driver of valvular interstitial cell myofibro/osteogenesis), major facilitator superfamily domain containing 5 [lipoprotein(a) receptor], Apolipoprotein C-III, annexin A1/A5 (extracellular vesicle cargo/tethering), amyloid precursor protein, monoamine oxidase A, and aortic valve calcification--

    “Novel omics-derived pharmaceutical targets that remain to be tested in clinical trials include Sortilin (driver of valvular interstitial cell myofibro/osteogenesis), major facilitator superfamily domain containing 5 [lipoprotein(a) receptor], Apolipoprotein C-III, annexin A1/A5 (extracellular vesicle cargo/tethering), amyloid precursor protein, monoamine oxidase A, and aortic valve calcification-”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    Within five years of developing symptomatic aortic stenosis, about 75% of patients will need aortic valve replacement or will die.

    “within 5 years of developing symptomatic aortic stenosis, ∼75% will require aortic valve replacement or die”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisenone given

    Sodium-glucose cotransporter-2 inhibitors and angiotensin II receptor blockers appear to lower mortality in aortic stenosis by mitigating heart failure and normalizing blood pressure.

    “Sodium-glucose cotransporter-2 inhibitors and angiotensin II receptor blockers appear to reduce mortality in aortic stenosis via mitigation of heart failure and normalization of blood pressure”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Other therapeutics aim to directly target calcification by impairing hydroxyapatite mineral formation (inositol-based SNF472 and INS-3001) or by stabilizing common constituents of amyloidosis (Tafamidis) that may be contained in extracellular vesicles released from osteogenic valvular interstitial cells.

    “Other therapeutics aim to directly target calcification by impairing hydroxyapatite mineral formation (inositol-based SNF472 and INS-3001) or by stabilizing common constituents of amyloidosis (Tafamidis) that may be contained in extracellular vesicles released from osteogenic valvular interstitial cells.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisereasoning

    Leaflet mineralization reduces valve opening, raises left ventricular afterload, and induces cardiac hypertrophy.

    “which reduces valve opening, increases left ventricular afterload, and induces cardiac hypertrophy.”
    Quote in the paperSubstantial claim
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Ataciguat is described as both nitric oxide-dependent and independent

    Minor

    The table calls Ataciguat a nitric oxide-dependent sGC activator, while the main text calls it nitric oxide-independent.

1 of 1

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Authors
Blaser, M. C., Bäck, M., Lüscher, T. F., & Aikawa, E.
Affiliations
  • Brigham and Women's Hospital (US)
  • Karolinska University Hospital (SE)
  • University of Zurich (CH)
Corresponding author
Aikawa, Elena
Venue
European Heart Journal
Published
2024-12-04
Volume
46
Issue
7
Pages
620-634
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
OpenAlex
W4405230198
Cited by
45
References
178
Citations by year
2026: 27 · 2025: 18
FWCI
3.56
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • Swedish Research Council
  • Swedish Heart and Lung Foundation
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
calcific aortic stenosis, calcific aortic valve disease, valvular heart disease, drug target identification, multi-omics, single-cell omics, epigenomics, transcriptomics, proteomics, metabolomics, sex differences, renal function, lipid metabolism, aortic valve replacement, clinical trials
MeSH terms
Aortic Valve, Aortic Valve Stenosis, Calcinosis, Humans, Genomics, Proteomics, Metabolomics, Drug Discovery

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