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Review
. 2008 Jul;24 Suppl B(Suppl B):15B-8B.
doi: 10.1016/s0828-282x(08)71024-9.

Molecular and physiological effects of nesiritide

S Reichert  1 , A Ignaszewski
Affiliations
Review

Molecular and physiological effects of nesiritide

S Reichert et al. Can J Cardiol. 2008 Jul.

Abstract
in English, French

Background: Nesiritide (Natrecor, Janssen-Ortho Inc, Canada), or recombinant human B-type natriurtic peptide (BNP), is a molecule identical in structure to endogenous BNP-32. This peptide is secreted from cardiac myocytes in response to volume and pressure overload. While high levels of circulating BNP are measured by commercially available assays during acute decompensated heart failure (ADHF), the detection of alternate, potentially more active, but undermeasured forms of BNP needs to be considered.

Aim: The present review summarizes the molecular and physiological effects of nesiritide in the setting of hospitalized patients with ADHF. In particular, an overview of the molecular structure and circulating isoforms of BNP is given, followed by a discussion of the vasodilatory, renal, antagonistic neurohormonal, pulmonary, anti-inflammatory and cardiac remodelling effects of recombinant human BNP.

Summary: Nesiritide has beneficial effects in the treatment of ADHF that go beyond the traditional goals of reducing pulmonary capillary wedge pressure, preload and afterload, and relieving symptoms of dyspnea. Therefore, the unique pharmacological profile of this medication provides an additional treatment option for Canadian patients with ADHF.

HISTORIQUE :: Le nésiritide (Natrecor, Janssen-Ortho Inc., Canada), un peptide natriurétique de type B recombinant (PNB), est une molécule à la structure identique à celle du PNB-32 endogène. Cet peptide est sécrété par les myocytes cardiaques en réponse à une surcharge de volume et de pression. Bien que des taux élevés de PNB circulants soient mesurés au moyen de titrages commerciaux pendant une insuffisance cardiaque aiguë décompensée (ICAD), le dépistage d’autres formes de besoins de PNB, peut-être plus actifs, mais trop peu mesurés, doit être envisagé.

OBJECTIF :: La présente analyse résume les effets moléculaires et physiologiques du nésiritide chez des patients hospitalisés atteints d’ICAD. Notamment, les auteurs présentent un aperçu de la structure moléculaire et des isoformes circulants des PNB et exposent les effets de remodelage vasodilatateur, rénal, neuro-hormonal antagoniste, pulmonaire, anti-inflammatoire et cardiaque des PNB humains recombinants.

RÉSUMÉ :: Le nésiritide a des effets bénéfiques dans le traitement de l’ICAD, lesquels dépassent les objectifs classiques de réduction de la pression capillaire bloquée, de la précharge et de la postcharge et du soulagement des symptômes de dyspnée. Ainsi, le profil pharmacologique unique de ce médicament en fait une nouvelle possibilité de traitement pour les patients canadiens atteints d’ICAD.

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Figures

Figure 1)
Figure 1)
Summary diagram of the physiological effects of nesiritide. BNP B-type natriuretic peptide
See this image and copyright information in PMC

References

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