Abstract-Production and clearance of plasma C-type natriuretic peptide (CNP) and amino terminal (NT)-proCNP immunoreactivity in the human circulation remain poorly characterized. Accordingly, we have measured arterial and venous concentrations of CNP and NT-proCNP across multiple tissue beds during cardiac catheterization in 120 subjects (age: 64.2Ϯ9.0 years; 73% men) investigated for cardiovascular disorders. The heart, head and neck, and musculoskeletal tissues made the clearest contributions to both plasma CNP and NT-proCNP (PϽ0.05). Net release of NT-proCNP was also observed from hepatic tissue (PϽ0.001). Negative arteriovenous gradients for CNP were observed across renal, hepatic, and pulmonary tissue (PϽ0.05), indicating net clearance, whereas no tissue-specific site of NT-proCNP clearance was identified. Age, mean pulmonary artery pressure, left ventricular end diastolic pressure, Brandt score of myocardial jeopardy, and troponin I were independent predictors of circulating CNP levels in multivariable analysis. Sex and kidney function were independently predictive of arterial NT-proCNP. The proportional step-up of CNP (ϩ60%) across the heart was less than for brain natriuretic peptide (ϩ123%) but greater than for NT-pro-brain natriuretic peptide (NT-proBNP) (ϩ36%) and NT-proCNP (ϩ42%; PϽ0.001 for all). We conclude that cardiac and head and neck tissue are important sources of CNP. Circulating CNP but not NT-proCNP concentrations are related to cardiac hemodynamic load and ischemic burden. Although cardiac release is most evident, multiple additional tissues release NT-proCNP immunoreactivity without evidence for an organ-specific site for NT-proCNP degradation. Taken together, differences in magnitude and direction of transorgan gradients for CNP compared with NT-proCNP suggest net generalized cosecretion with differing mechanisms of clearance. Key Words: natriuretic peptides Ⅲ circulation Ⅲ plasma Ⅲ glomerular filtration rate Ⅲ human C -type natriuretic peptide (CNP), a vasoactive and antiproliferative peptide, 1,2 shares sequence homology and biological actions 3 with the endocrine cardiac peptides, atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). After the isolation of CNP from porcine brain tissue, 4 both CNP and CNP mRNA have been identified in vascular endothelium 5,6 and cardiac, 7,8 renal, 9 skeletal, 10 and reproductive 11,12 tissues. Although ANP and BNP activate the guanylate cyclase-coupled natriuretic peptide receptor (NPR)-A and promote natriuresis and diuresis, 3 CNP is the predominant ligand for another NPR, NPR-B, 13 which is also widely distributed in tissues including brain, 14 vascular endothelium, smooth muscle cells, 15 and myocardium. 16 Binding to NPR-B, CNP induces in vitro venodilatation, 17 cardiac inotropy, and chronotropy 18 and inhibits vascular smooth muscle proliferation. 15 Recent studies have shown that CNP exhibits antihypertrophic and antifibrotic properties during ventricular modeling after experimental myocardial infarction. 19 Distinct from ANP a...