Cardiac natriuretic peptides - hope or hype?

Abstract

In recent years, biomedical science has witnessed the emergence of peptide biochemicals as significant topics of research. Some of these peptides are of little potential clinical use, while others, of which cardiac natriuretic peptides are an example, appear to be promising. This particular group of peptides (i.e. ANP, BNP and CNP) shows promising diagnostic as well as therapeutic potential for various pathological conditions. In the case of acute myocardial infarction, these peptides have significant diagnostic and predictive properties, more so than other biochemicals such as adrenaline, renin and aldosterone. In addition, ANP is found to have significant benefits over the classical anti‐anginal drug glyceryl trinitrate. However, as is the case with other peptides, applying these benefits clinically may not be easy because of the structure of the compounds, but various strategies are now being applied to solve this problem. These include the use of non‐peptide receptor ligands, inhibitors of ANP metabolism, gene therapy and so on. The development of drugs in clinical practice, which exploits the natriuretic peptides system therefore seems to be promising, and this article reviews advances in our understanding of these compounds.

NT-proBNP as a tool to stratify disease severity in pulmonary arterial hypertension

“…Natriuretic peptides have been used as markers of heart disease based on the observation that they are involved in the activation of the cyclic guanylate cyclase system as a counterregulatory mechanism in heart failure, probably with increased cardiac wall stress as the trigger mechanism. 27,28 Natriuretic peptides have also been correlated with hemodynamic parameters and prognosis in patients with heart failure. 29,30 In pulmonary hypertension, NT-proBNP has been correlated to the hemodynamics and to the acute response to nitric oxide.…”

Experimental investigation of direct myocardial protective effect of atrial natriuretic peptide in cardiac surgery

“…A human atrial natriuretic peptide (hANP) preparation, carperitide, was developed and has been used mainly for treatment of heart failure because it improves preload and afterload by diuresis 2,3 and vasodilatation. [4][5][6] In the past 25 years, studies have revealed the role of ANP in cardiovascular endocrinologic systems and elucidated the details of its metabolism. It has been demonstrated to exert various effects, including inhibition of reninangiotensin, myocardial hypertrophy, and fibrosis.…”

B-Type Natriuretic Peptide Concentrations and Myocardial Dysfunction in Critical Illness

“…The cardiac natriuretic peptides have been actively researched over the past two decades 1,2 . Three types of natriuretic peptides have been described in Anaesthesia and Intensive Care, Vol.…”