Skip to main content

Advertisement

SpringerLink
Log in

Ularitide in Acute Heart Failure

  • Heart Failure (F Peacock and L Zhang, Section Editors)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review article will summarize the currently available data for ularitide in acute decompensated heart failure (ADHF).

Recent Findings

Hospitalization for ADHF represents a key prognostic event in the time course of many patients with HF. It is associated with a high risk for rehospitalization (~ 50% at 6 months) and 1-year mortality rate (~ 30%).

Summary

There is an unmet need for agents that will improve symptoms and outcomes for clinical outcomes in ADHF. Several agents with vasodilating properties have been studied in this population, but there is limited data demonstrating definitive efficacy of currently available therapies. Ularitide is a synthetic form of urodilatin, a natriuretic peptide produced in the distal renal tubule cells.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. https://doi.org/10.1016/j.jacc.2013.05.019.

    Article  PubMed  Google Scholar 

  2. Allen LA, O’Connor CM. Management of acute decompensated heart failure. CMAJ: Can Med Assoc J. 2007;176(6):797–805.

    Article  Google Scholar 

  3. Ignarro LJ. After 130 years, the molecular mechanism of action of nitroglycerin is revealed. Proc Natl Acad Sci U S A. 2002;99(12):7816–7. https://doi.org/10.1073/pnas.132271799.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Aziz EF, Kukin M, Javed F, Pratap B, Sabharwal MS, Tormey D, et al. Effect of adding nitroglycerin to early diuretic therapy on the morbidity and mortality of patients with chronic kidney disease presenting with acute decompensated heart failure. Hospital practice (1995). 2011;39(1):126–32. https://doi.org/10.3810/hp.2011.02.382.

    Article  Google Scholar 

  5. • Singh A, Laribi S, Teerlink JR, Mebazaa A. Agents with vasodilator properties in acute heart failure. Eur Heart J. 2017;38(5):317–25. Review of the agents with vasodilator properties in the treatment of acute decompensated heart failure. https://doi.org/10.1093/eurheartj/ehv755.

    Article  PubMed  Google Scholar 

  6. Schulz-Knappe P, Forssmann K, Herbst F, Hock D, Pipkorn R, Forssmann WG. Isolation and structural analysis of “urodilatin”, a new peptide of the cardiodilatin-(ANP)-family, extracted from human urine. Klin Wochenschr. 1988;66(17):752–9. https://doi.org/10.1007/BF01726570.

    Article  CAS  PubMed  Google Scholar 

  7. Forssmann WG, Richter R, Meyer M. The endocrine heart and natriuretic peptides: histochemistry, cell biology, and functional aspects of the renal urodilatin system. Histochem Cell Biol. 1998;110(4):335–57.

    Article  CAS  PubMed  Google Scholar 

  8. Goetz K, Drummer C, Zhu JL, Leadley R, Fiedler F, Gerzer R. Evidence that urodilatin, rather than ANP, regulates renal sodium excretion. J Am Soc Nephrol. 1990;1(6):867–74.

    CAS  PubMed  Google Scholar 

  9. Mitrovic V, Hernandez AF, Meyer M, Gheorghiade M. Role of guanylate cyclase modulators in decompensated heart failure. Heart Fail Rev. 2009;14(4):309–19. https://doi.org/10.1007/s10741-009-9149-7.

    Article  CAS  PubMed  Google Scholar 

  10. Gagelmann M, Hock D, Forssmann WG. Urodilatin (CDD/ANP-95-126) is not biologically inactivated by a peptidase from dog kidney cortex membranes in contrast to atrial natriuretic peptide/cardiodilatin (alpha-hANP/CDD-99-126). FEBS Lett. 1988;233(2):249–54. https://doi.org/10.1016/0014-5793(88)80436-8.

    Article  CAS  PubMed  Google Scholar 

  11. Anker SD, Ponikowski P, Mitrovic V, Peacock WF, Filippatos G. Ularitide for the treatment of acute decompensated heart failure: from preclinical to clinical studies. Eur Heart J. 2015;36(12):715–23. https://doi.org/10.1093/eurheartj/ehu484.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Abassi ZA, Powell JR, Golomb E, Keiser HR. Renal and systemic effects of urodilatin in rats with high-output heart failure. Am J Phys. 1992;262(4 Pt 2):F615–21.

    CAS  Google Scholar 

  13. Villarreal D, Freeman RH, Johnson RA. Renal effects of ANF (95-126), a new atrial peptide analogue, in dogs with experimental heart failure. Am J Hypertens. 1991;4(6):508–15. https://doi.org/10.1093/ajh/4.6.508.

    Article  CAS  PubMed  Google Scholar 

  14. Kentsch M, Ludwig D, Drummer C, Gerzer R, Müller-Esch G. Haemodynamic and renal effects of urodilatin in healthy volunteers. Eur J Clin Investig. 1992;22(5):319–25. https://doi.org/10.1111/j.1365-2362.1992.tb01469.x.

    Article  CAS  Google Scholar 

  15. Carstens J, Jensen KT, Pedersen EB. Metabolism and action of urodilatin infusion in healthy volunteers. Clin Pharmacol Ther. 1998;64(1):73–86. https://doi.org/10.1016/S0009-9236(98)90025-X.

    Article  CAS  PubMed  Google Scholar 

  16. Kentsch M, Ludwig D, Drummer C, Gerzer R, Müller-Esch G. Haemodynamic and renal effects of urodilatin bolus injections in patients with congestive heart failure. Eur J Clin Investig. 1992;22(10):662–9. https://doi.org/10.1111/j.1365-2362.1992.tb01427.x.

    Article  CAS  Google Scholar 

  17. Elsner D, Muders F, Müntze A, Kromer EP, Forssmann WG, Riegger GA. Efficacy of prolonged infusion of urodilatin [ANP-(95-126)] in patients with congestive heart failure. Am Heart J. 1995;129(4):766–73. https://doi.org/10.1016/0002-8703(95)90328-3.

    Article  CAS  PubMed  Google Scholar 

  18. Mitrovic V, Lüss H, Nitsche K, Forssmann K, Maronde E, Fricke K, et al. Effects of the renal natriuretic peptide urodilatin (ularitide) in patients with decompensated chronic heart failure: a double-blind, placebo-controlled, ascending-dose trial. Am Heart J. 2005;150(6):1239. https://doi.org/10.1016/j.ahj.2005.01.022.

    Article  PubMed  Google Scholar 

  19. Mitrovic V, Seferovic PM, Simeunovic D, Ristic AD, Miric M, Moiseyev VS, et al. Haemodynamic and clinical effects of ularitide in decompensated heart failure. Eur Heart J. 2006;27(23):2823–32. https://doi.org/10.1093/eurheartj/ehl337.

    Article  CAS  PubMed  Google Scholar 

  20. Lüss H, Mitrovic V, Seferovic PM, Simeunovic D, Ristić AD, Moiseyev VS, et al. Renal effects of ularitide in patients with decompensated heart failure. Am Heart J. 2008;155(6):1012.e1–8. https://doi.org/10.1016/j.ahj.2008.02.011.

    Article  Google Scholar 

  21. •• Packer M, O’Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD, et al. Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med. 2017;376(20):1956–64. Trial showing effect of ularitide on cardiovascular mortality in patients with acute decompnesated heart failure.

    Article  CAS  PubMed  Google Scholar 

  22. •• Teerlink JR, Voors AA, Ponikowski P, Pang PS, Greenberg BH, Filippatos G, et al. Serelaxin in addition to standard therapy in acute heart failure: rationale and design of the RELAX-AHF-2 study. Eur J Heart Fail. 2017;19(6):800–9. Describes design of the RELAX-AHF-2 trial.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32–43. https://doi.org/10.1056/NEJMoa1100171.

    Article  PubMed  Google Scholar 

  24. •• Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. 2013;381(9860):29–39. Important trial of outcomes of serelaxin in heart failure patients. https://doi.org/10.1016/S0140-6736(12)61855-8.

    Article  CAS  PubMed  Google Scholar 

  25. Serelaxin fails to meet primary endpoints in phase 3 RELAX-AHF-2 trial [press release]. 2017.

Download references

Author information

Authors and Affiliations

  1. Section of Cardiology, Michael E. DeBakey VA Medical Center, 111B, 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Tina Shah & Anita Deswal

  2. Section of Cardiology, Baylor College of Medicine, Houston, TX, USA

    Tina Shah & Anita Deswal

  3. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    June Kampangkaew & Ryle Przybylowicz

Authors
  1. Tina Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. June Kampangkaew
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryle Przybylowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anita Deswal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tina Shah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shah, T., Kampangkaew, J., Przybylowicz, R. et al. Ularitide in Acute Heart Failure. Curr Emerg Hosp Med Rep 6, 17–23 (2018). https://doi.org/10.1007/s40138-018-0150-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-018-0150-0

Keywords

Search

Navigation