SUMMARY
Experimental and clinical studies from recent decades provided evidence supporting the hypothesis that the heart’s endocrine function is part of the neurohumoral network.
The natriuretic peptide system consists of hormones generated by the myocardium having similar cardioprotective effects involved in cardiovascular homeostasis. During hemodynamic overload, particularly in heart failure (HF), the natriuretic peptide (NP) production significantly increases. At first, NPs were considered as diagnostic and prognostic markers in HF. However, the deeper understanding of NPs’ physiological effects revealed their therapeutic potential. Previously, pharmacological interventions in HF focused on curbing the excessive neurohumoral activation by inhibition of the renin-angiotensin-aldosterone system and sympathetic nervous system and subsequently their vasoconstrictive, proinflammatory and proproliferative effects. Recently, the attention turned to increasing NP bioavailability coming with diuretic, vasodilative, antiproliferative and anti-inflammatory effects. After a decade of disappointing results of clinical trials with HF, dual inhibition of neprilysin (an enzyme degrading NPs) and angiotensin II type 1 receptor brought about a significant morbidity and mortality benefit in HF. To understand the mechanism of cardiovascular benefit by the new drug class ARNi (angiotensin receptor–neprilysin inhibitors), a knowledge of physiology and pathophysiology of NPs is required. This review presents an insight into the physiology of formation, effects and degradation of NPs and conveys their therapeutic potential.
Key words: natriuretic peptide system, neprilysin, ARNi, heart failure.
Lek Obz, 2021, 70 (7 – 8): 264 – 270
Peter STANKO 1, Tomáš BAKA 1, Kristína REPOVÁ 1, Silvia AZIRIOVÁ 1, Kristína KRAJČÍROVIČOVÁ 1, Fedor ŠIMKO 1,2,3
1 Ústav patologickej fyziológie, Lekárska fakulta, Univerzita Komenského v Bratislave, prednosta prof. MUDr. F. Šimko, CSc., FESC
2 III. interná klinika, Lekárska fakulta a Univerzitná nemocnica, Univerzita Komenského v Bratislave, prednosta
doc. MUDr. V. Mojto, CSc., MHA
3 Ústav experimentálnej endokrinológie, Biomedicínske centrum, Slovenská akadémia vied v Bratislave, vedecká riaditeľka RNDr. D. Gašperíková, DrSc.
Cite:
STANKO P., BAKA T., REPOVÁ K., AZIRIOVÁ S., KRAJČÍROVIČOVÁ K., ŠIMKO F.: Natriuretic peptide system – the heart’s endocrine function: pathophysiological background of clinical implications. Lek Obz, 2021, 70 (7 – 8): 264 – 270
