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Natriuretic peptides and therapeutic applications

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Abstract

Since the discovery of atrial natriuretic factor by de Bold et al., there has been tremendous progress in our understanding of the physiologic, diagnostic and therapeutic roles of the natriuretic peptides (NPs) in health and disease. Natriuretic peptides are endogenous hormones that are released by the heart in response to myocardial stretch and overload. Three mammalian NPs have been identified and characterized, including atrial natriuretic peptide (ANP or atrial natriuretic factor), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). In addition, Dendroaspis natriuretic peptide (DNP) has been isolated from the venom of Dendroaspis angusticeps (the green mamba snake), and urodilatin from human urine. These peptides are structurally similar and they consist of a 17-amino-acid core ring and a cysteine bridge. Both ANP and BNP bind to natriuretic peptide receptor A (NPR-A) that are expressed in the heart and other organs. Activation of NPR-A generates an increase in cyclic guanosine monophosphate, which mediates natriuresis, inhibition of renin and aldosterone, as well as vasorelaxant, anti-fibrotic, anti-hypertrophic, and lusitropic effects. The NP system thus serves as an important compensatory mechanism against neurohumoral activation in heart failure. This provides a strong rationale for the use of exogenous NPs in the management of acutely decompensated heart failure. In this article, the therapeutic applications of NPs in the acute heart failure syndromes are reviewed. Emerging therapeutic agents and areas for future research are discussed.

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Acknowledgments

Supported by grants from the National Institutes of Health (HL36634; PO1 HL76611 and HL80732) and the Mayo Foundation. Dr. Lee is supported by the Clinical Research Initiative Fellowship from the Canadian Institutes of Health Research.

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Authors and Affiliations

  1. Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Internal Medicine and Physiology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Candace Y. W. Lee & John C. Burnett Jr.

  2. Division of Clinical Pharmacology, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN, USA

    Candace Y. W. Lee & John C. Burnett Jr.

  3. Cardiorenal Research Laboratory, Guggenheim 915, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN, 55906, USA

    Candace Y. W. Lee

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  1. Candace Y. W. Lee
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Correspondence to Candace Y. W. Lee.

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Lee, C.Y.W., Burnett, J.C. Natriuretic peptides and therapeutic applications. Heart Fail Rev 12, 131–142 (2007). https://doi.org/10.1007/s10741-007-9016-3

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