Cardiac natriuretic peptides

• Published in: Nature reviews cardiology 2020-11, Vol.17 (11), p.698-717
• Main Authors: Goetze, Jens P., Bruneau, Benoit G., Ramos, Hugo R., Ogawa, Tsuneo, de Bold, Mercedes Kuroski, de Bold, Adolfo J.
• Format: Article
• Language: English
• Subjects: 692/163/2743; 692/53/2421; 692/53/2422; 692/699/75/230; Animals; Atrial Appendage - cytology; Atrial Fibrillation - metabolism; Atrial Natriuretic Factor - genetics; Atrial Natriuretic Factor - metabolism; Atrial Natriuretic Factor - physiology; Atrial Remodeling; Biological markers; Biomarkers; Biomarkers - metabolism; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular disease; Care and treatment; Cyclic GMP - metabolism; Development and progression; Diabetes Mellitus - metabolism; Fibrosis; Gene Expression Regulation, Developmental; Genetic aspects; Health aspects; Heart; Heart Atria - cytology; Heart diseases; Heart Failure - metabolism; Humans; Hypertension - metabolism; Identification and classification; Lipid Metabolism - physiology; Medicine; Medicine & Public Health; Metabolic Syndrome - metabolism; Mice; Myocardium - metabolism; Myocardium - pathology; Myocytes, Cardiac - metabolism; Natriuretic Peptide, Brain - genetics; Natriuretic Peptide, Brain - metabolism; Natriuretic Peptide, Brain - physiology; Natriuretic peptides; Obesity - metabolism; Peptide Fragments - metabolism; Peptides; Physiology; Prognosis; Protein Processing, Post-Translational; Pulmonary Arterial Hypertension - metabolism; Receptors, Guanylate Cyclase-Coupled - metabolism; Review Article; Secretory Vesicles - metabolism; Ventricular Remodeling; Water-Electrolyte Balance - physiology
• ISSN: 1759-5002; 1759-5010
• DOI: 10.1038/s41569-020-0381-0

Investigations into the mixed muscle–secretory phenotype of cardiomyocytes from the atrial appendages of the heart led to the discovery that these cells produce, in a regulated manner, two polypeptide hormones — the natriuretic peptides — referred to as atrial natriuretic factor or atrial natriuretic peptide (ANP) and brain or B-type natriuretic peptide (BNP), thereby demonstrating an endocrine function for the heart. Studies on the gene encoding ANP ( NPPA ) initiated the field of modern research into gene regulation in the cardiovascular system. Additionally, ANP and BNP were found to be the natural ligands for cell membrane-bound guanylyl cyclase receptors that mediate the effects of natriuretic peptides through the generation of intracellular cGMP, which interacts with specific enzymes and ion channels. Natriuretic peptides have many physiological actions and participate in numerous pathophysiological processes. Important clinical entities associated with natriuretic peptide research include heart failure, obesity and systemic hypertension. Plasma levels of natriuretic peptides have proven to be powerful diagnostic and prognostic biomarkers of heart disease. Development of pharmacological agents that are based on natriuretic peptides is an area of active research, with vast potential benefits for the treatment of cardiovascular disease. The heart is an endocrine organ, producing atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in a regulated manner. In this Review, the authors discuss the physiological regulation and actions of the cardiac natriuretic peptides and their clinical use as powerful diagnostic and prognostic biomarkers of heart disease. Key points The dual contractile–secretory phenotype of atrial (appendage) cardiomyocytes underlies the regulated secretion of two natriuretic peptide (NP) hormones: atrial NP and B-type NP. Investigation into the genes encoding NPs has provided valuable insights into gene regulation in the cardiovascular system. NPs are ligands for receptors that are membrane-bound guanylyl cyclases, thereby signalling through increases in intracellular levels of cGMP, which in turn interact with cGMP-dependent enzymes and ion channels in many cell types. In addition to their roles in water and electrolyte balance, NPs participate in seemingly unrelated processes, such as immune response and lipid metabolism. Plasma levels of NPs are useful clinical indicators in the diagnosis and prognosis of cardiovasc