Natriuretic Peptides: It Is Time for Guided Therapeutic Strategies Based on Their Molecular Mechanisms.
Giovanna GalloSperanza RubattuCamillo AutoreMassimo VolpePublished in: International journal of molecular sciences (2023)
Natriuretic peptides (NPs) are the principal expression products of the endocrine function of the heart. They exert several beneficial effects, mostly mediated through guanylate cyclase-A coupled receptors, including natriuresis, diuresis, vasorelaxation, blood volume and blood pressure reduction, and regulation of electrolyte homeostasis. As a result of their biological functions, NPs counterbalance neurohormonal dysregulation in heart failure and other cardiovascular diseases. NPs have been also validated as diagnostic and prognostic biomarkers in cardiovascular diseases such as atrial fibrillation, coronary artery disease, and valvular heart disease, as well as in the presence of left ventricular hypertrophy and severe cardiac remodeling. Serial measurements of their levels may be used to contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations and to guide tailored pharmacological and non-pharmacological strategies with the aim to improve clinical outcomes. On these premises, multiple therapeutic strategies based on the biological properties of NPs have been attempted to develop new targeted cardiovascular therapies. Apart from the introduction of the class of angiotensin receptor/neprilysin inhibitors to the current management of heart failure, novel promising molecules including M-atrial natriuretic peptide (a novel atrial NP-based compound) have been tested for the treatment of human hypertension with promising results. Moreover, different therapeutic strategies based on the molecular mechanisms involved in NP regulation and function are under development for the management of heart failure, hypertension, and other cardiovascular conditions.
Keyphrases
- heart failure
- atrial fibrillation
- left ventricular
- blood pressure
- left atrial
- cardiovascular disease
- cardiac resynchronization therapy
- ejection fraction
- catheter ablation
- coronary artery disease
- oral anticoagulants
- end stage renal disease
- left atrial appendage
- direct oral anticoagulants
- aortic stenosis
- acute heart failure
- hypertrophic cardiomyopathy
- endothelial cells
- oxide nanoparticles
- prognostic factors
- hypertensive patients
- peritoneal dialysis
- percutaneous coronary intervention
- chronic kidney disease
- cancer therapy
- newly diagnosed
- acute coronary syndrome
- early onset
- pulmonary hypertension
- venous thromboembolism
- replacement therapy
- adipose tissue
- induced pluripotent stem cells
- binding protein
- aortic valve
- poor prognosis