The natriuretic peptides system in the pathophysiology of heart failure: from molecular basis to treatment
- PMID: 26637405
- PMCID: PMC5233571
- DOI: 10.1042/CS20150469
The natriuretic peptides system in the pathophysiology of heart failure: from molecular basis to treatment
Abstract
After its discovery in the early 1980s, the natriuretic peptide (NP) system has been extensively characterized and its potential influence in the development and progression of heart failure (HF) has been investigated. HF is a syndrome characterized by the activation of different neurohormonal systems, predominantly the renin-angiotensin (Ang)-aldosterone system (RAAS) and the sympathetic nervous system (SNS), but also the NP system. Pharmacological interventions have been developed to counteract the neuroendocrine dysregulation, through the down modulation of RAAS with ACE (Ang-converting enzyme) inhibitors, ARBs (Ang receptor blockers) and mineralcorticoid antagonists and of SNS with β-blockers. In the last years, growing attention has been paid to the NP system. In the present review, we have summarized the current knowledge on the NP system, focusing on its role in HF and we provide an overview of the pharmacological attempts to modulate NP in HF: from the negative results of the study with neprilysin (NEP) inhibitors, alone or associated with an ACE inhibitor and vasopeptidase inhibitors, to the most recently and extremely encouraging results obtained with the new pharmacological class of Ang receptor and NEP inhibitor, currently defined ARNI (Ang receptor NEP inhibitor). Indeed, this new class of drugs to manage HF, supported by the recent results and a vast clinical development programme, may prompt a conceptual shift in the treatment of HF, moving from the inhibition of RAAS and SNS to a more integrated target to rebalance neurohormonal dysregulation in HF.
Keywords: LCZ696 (sacubitril/valsartan); bradykinin; heart failure; natriuretic peptides; neprilysin; neuroendocrine syndrome.
© 2016 Authors; published by Portland Press Limited.
Figures
![Figure 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/5233571/bin/cs1300057fig1.gif)
![Figure 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/5233571/bin/cs1300057fig2.gif)
![Figure 3](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/5233571/bin/cs1300057fig3.gif)
![Figure 4](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/5233571/bin/cs1300057fig4.gif)
![Figure 5](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/5233571/bin/cs1300057fig5.gif)
Similar articles
-
Therapeutic Progress and Knowledge Basis on the Natriuretic Peptide System in Heart Failure.Curr Top Med Chem. 2019;19(20):1850-1866. doi: 10.2174/1568026619666190826163536. Curr Top Med Chem. 2019. PMID: 31448711 Review.
-
Modulation of RAAS-natriuretic peptides in the treatment of HF: Old guys and newcomers.Int J Cardiol. 2017 Jan 1;226:126-131. doi: 10.1016/j.ijcard.2016.03.085. Epub 2016 Mar 24. Int J Cardiol. 2017. PMID: 27075034 Review.
-
Neurohumoral Activation in Heart Failure.Int J Mol Sci. 2023 Oct 23;24(20):15472. doi: 10.3390/ijms242015472. Int J Mol Sci. 2023. PMID: 37895150 Free PMC article. Review.
-
Current role of neprilysin inhibitors in hypertension and heart failure.Pharmacol Ther. 2014 Oct;144(1):41-9. doi: 10.1016/j.pharmthera.2014.05.002. Epub 2014 May 14. Pharmacol Ther. 2014. PMID: 24836726 Review.
-
Angiotensin Receptor-Neprilysin Inhibition (ARNI) in Heart Failure.Int J Heart Fail. 2020 Mar 24;2(2):73-90. doi: 10.36628/ijhf.2020.0002. eCollection 2020 Apr. Int J Heart Fail. 2020. PMID: 36263291 Free PMC article. Review.
Cited by
-
Sacubitril/valsartan in Heart Failure and Beyond-From Molecular Mechanisms to Clinical Relevance.Rev Cardiovasc Med. 2022 Jun 24;23(7):238. doi: 10.31083/j.rcm2307238. eCollection 2022 Jul. Rev Cardiovasc Med. 2022. PMID: 39076908 Free PMC article. Review.
-
Evaluation of renal sodium handling in heart failure with preserved ejection fraction: A pilot study.Physiol Rep. 2024 May;12(9):e16033. doi: 10.14814/phy2.16033. Physiol Rep. 2024. PMID: 38740564 Free PMC article.
-
The impact of serum BNP on retinal perfusion assessed by an AI-based denoising optical coherence tomography angiography in CHD patients.Heliyon. 2024 Apr 12;10(8):e29305. doi: 10.1016/j.heliyon.2024.e29305. eCollection 2024 Apr 30. Heliyon. 2024. PMID: 38655359 Free PMC article.
-
Circulating galectin-3 level association with cardiovascular risk factors during peritoneal dialysis.Clin Exp Nephrol. 2024 Apr 20. doi: 10.1007/s10157-024-02498-3. Online ahead of print. Clin Exp Nephrol. 2024. PMID: 38643287
-
Evaluating biomarkers for contrast-induced nephropathy following coronary interventions: an umbrella review on meta-analyses.Eur J Med Res. 2024 Apr 1;29(1):210. doi: 10.1186/s40001-024-01782-y. Eur J Med Res. 2024. PMID: 38561791 Free PMC article. Review.
References
-
- Francis G.S., Benedict C., Johnstone D.E., Kirlin P.C., Nicklas J., Liang C.S., Kubo S.H., Rudin-Toretsky E., Yusuf S. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD) Circulation. 1990;82:1724–1729. doi: 10.1161/01.CIR.82.5.1724. - DOI - PubMed
-
- Francis G.S., McDonald K.M., Cohn J.N. Neurohormonal activation in preclinical heart failure: remodeling and the potential for intervention. Circulation. 1993;87(Suppl. IV):IV-90–96. - PubMed
-
- Volpe M., Tritto C., De Luca N., Mele A.F., Lembo G., Rubattu S., Romano M., De Campora P., Enea I., Ricciardelli B., et al. Failure of atrial natriuretic factor to increase with saline load in patients with dilated cardiomyopathy and mild heart failure. J. Clin. Invest. 1991;88:1481–1489. doi: 10.1172/JCI115458. - DOI - PMC - PubMed
-
- Magri P., Rao M.A., Cangianiello S., Bellizzi V., Russo R., Mele A.F., Andreucci M., Memoli B., De Nicola L., Volpe M. Early impairment of renal hemodynamic reserve in patients with asymptomatic heart failure is restored by angiotensin II antagonism. Circulation. 1998;98:2849–2854. doi: 10.1161/01.CIR.98.25.2849. - DOI - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous