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Urodilatin: A better natriuretic peptide?

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Abstract

The kidney natriuretic peptide urodilatin (ie, ularitide) decreases pulmonary capillary wedge pressure (PCWP) but does not cause diuresis in persons with congestive heart failure (CHF). Thirty-three percent of patients with CHF treated with 30 ng/kg/min ularitide develop hypotension with systolic blood pressures below 90 mmHg. Nesiritide and atrial natriuretic peptide lower PCWP and cause hypotension. They do not produce diuresis or natriuresis in patients with CHF. The best natriuretic peptide for treating CHF is the cardiac hormone vessel dilator which decreases PCWP and decreases systemic and pulmonary vascular resistance while simultaneously increasing cardiac output and cardiac index. What makes the vessel dilator markedly better than atrial natriuretic peptide, nesiritide, and ularitide for treatment of CHF is that it enhances sodium excretion fivefold and causes a fivefold enhanced diuresis in patients with CHF with its biologic effects lasting over 6 hours compared with less than 30 minutes for the above peptides.

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References and Recommended Reading

  1. Schulz-Knappe P, Forssmann K, Herbst F, et al.: Isolation and structural analysis of urodilatin, a new peptide of the cardiodilatin-(ANP)-family, extracted from human urine. Klin Wochenuschr 1988, 66:752–759.

    Article  CAS  Google Scholar 

  2. Vesely DL: Atrial natriuretic peptide prohormone gene expression: hormones and diseases that upregulate its expression. IUBMB Life 2002, 53:153–159.

    PubMed  CAS  Google Scholar 

  3. Vesely DL: Natriuretic hormones. In The Kidney: Physiology and Pathophysiology, edn 4. Edited by Alpern RJ, Hebert SC. San Diego: Elsevier/Academic Press; 2007:947–977.

    Google Scholar 

  4. Vesely BA, Eichelbaum EJ, Alli AA, et al.: Urodilatin and four cardiac hormones decrease human renal carcinoma cell number. Eur J Clin Invest 2006, 36:810–819.

    Article  PubMed  CAS  Google Scholar 

  5. Vesely DL, Norris JS, Walters JM, et al.: Atrial natriuretic prohormone peptides 1–30, 31–67, and 79–98 vasodilate the aorta. Biochem Biophys Res Commun 1987, 148:1540–1548.

    Article  PubMed  CAS  Google Scholar 

  6. Martin DR, Pevahouse JB, Trigg DJ, et al.: Three peptides from the ANF prohormone NH2-terminus are natriuretic and/or kaliuretic. Am J Physiol 1990, 258:F1401–F1408.

    PubMed  CAS  Google Scholar 

  7. Gunning ME, Brady HR, Otuechere G, et al.: Atrial natriuretic peptide (31–67) inhibits Na transport in rabbit inner medullary collecting duct cells: role of prostaglandin E2. J Clin Invest 1992, 89:1411–1417.

    Article  PubMed  CAS  Google Scholar 

  8. Benjamin BA, Peterson TV: Effects of proANF (31–67) on sodium excretion in conscious monkeys. Am J Physiol 1995, 269:R1351–R1355.

    PubMed  CAS  Google Scholar 

  9. Zeidel ML: Regulation of collecting duct Na+ reabsorption by ANP 31–67. Clin Exp Pharmacol Physiol 1995, 22:121–124.

    Article  PubMed  CAS  Google Scholar 

  10. Villarreal D, Reams GP, Taraben A, Freeman RH: Hemodynamic and renal effects of proANF 31–67 in hypertensive rats. Proc Soc Exp Biol Med 1990, 221:166–170.

    Article  Google Scholar 

  11. Dietz JR, Scott DY, Landon CS, Nazian SJ: Evidence supporting a physiological role for proANP (1–30) in the regulation of renal excretion. Am J Physiol 2001, 280:R1510–R1517.

    CAS  Google Scholar 

  12. Vesely DL, Douglass MA, Dietz Jr, et al.: Three peptides from the atrial natriuretic factor prohormone amino terminus lower blood pressure and produce diuresis, natriuresis and/or kaliuresis in humans. Circulation 1994, 90:1129–1140.

    PubMed  CAS  Google Scholar 

  13. Vesely DL, Douglass MA, Dietz JR, et al.: Negative feedback of atrial natriuretic peptides. J Clin Endocrinol Metab 1994, 78:1128–1134.

    Article  PubMed  CAS  Google Scholar 

  14. Vesely DL, Dietz JR, Parks JR, et al.: Vessel dilator enhances sodium and water excretion and has beneficial hemodynamic effects in persons with congestive heart failure. Circulation 1998, 98:323–329.

    PubMed  CAS  Google Scholar 

  15. Vesely DL, Dietz JR, Parks JR, et al.: Comparison of vessel dilator and long acting natriuretic peptide in the treatment of congestive heart failure. Am Heart J 1999, 138:652–632.

    Article  Google Scholar 

  16. Nasser A, Dietz JR, Siddique M, et al.: Effects of kaliuretic peptide on sodium and water excretion in persons with congestive heart failure. Am J Cardiol 2001, 88:23–29.

    Article  PubMed  CAS  Google Scholar 

  17. Barr CS, Rhodes P, Struthers AD: C-Type natriuretic peptide. Peptides 1996, 17:1243–1251.

    Article  PubMed  CAS  Google Scholar 

  18. Lainchbury J, Richards AM, Nicholls MG: Brain natriuretic peptide in heart failure. In Atrial Natriuretic Peptides. Edited by Vesely DL. Trivandrum, India: Research Signpost; 1997:151–158.

    Google Scholar 

  19. Winters CJ, Sallman AL, Baker BJ, et al.: The N-terminus and a 4000 molecular weight peptide from the mid portion of the N-terminus of the atrial natriuretic factor prohormone each circulate in human and increase in congestive heart failure. Circulation 1989, 80:438–449.

    PubMed  CAS  Google Scholar 

  20. Vesely DL, Norsk P, Winters CJ, et al.: Increased release of the N-terminal and C-terminal portions of the prohormone of atrial natriuretic factor during immersion-induced central hypervolemia in normal humans. Proc Soc Exp Biol Med 1989, 192:230–235.

    PubMed  CAS  Google Scholar 

  21. Hunter EFM, Kelly PA Prowse C, et al.: Analysis of peptides derived from pro atrial natriuretic peptide that circulate in man and increase in heart disease. Scand J Clin Lab Invest 1998, 58:205–216.

    Article  CAS  Google Scholar 

  22. Franz M, Woloszczuk W, Horl WH: N-terminal fragments of the proatrial natriuretic peptide in patients before and after hemodialysis treatment. Kidney Int 2000, 58:374–378.

    Article  PubMed  CAS  Google Scholar 

  23. De Palo EF, Woloszczuk W, Meneghetti M, et al.: Circulating immunoreactive proANP (1–30) and proANP (31–67) in sedentary subjects and athletes. Clin Chem 2000, 46:843–847.

    PubMed  Google Scholar 

  24. Franz M, Woloszczuk W, Horl WH: Plasma concentration and urinary excretion of N-terminal proatrial natriuretic peptides in patients with kidney diseases. Kidney Int 2001, 59:1928–1934.

    Article  PubMed  CAS  Google Scholar 

  25. Vesely DL, Overton RM, Blankenship M, et al.: Atrial natriuretic peptide increases urodilatin in the circulation. Am J Nephrol 1998, 18:204–213.

    Article  PubMed  CAS  Google Scholar 

  26. Suga SI, Nakao K, Hosoda K, et al.: Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide. Endocrinology 1992, 130:229–239.

    Article  PubMed  CAS  Google Scholar 

  27. Heim JM, Kiefersauer S, Fulle HJ, Gerzer R: Urodilatin and beta-ANP: Binding properties and activation of particulate guanylate cyclase. Biochem Biophys Res Commun 1989, 163:37–41.

    Article  PubMed  CAS  Google Scholar 

  28. Saxenhofer H, Fitzgibbon WR, Paul RV: Urodilatin: Binding properties and stimulation of cGMP generation in rat kidney cells. Am J Physiol 1993, 264:F267–F273.

    PubMed  CAS  Google Scholar 

  29. Valentin JP, Sechi LA, Qiu C, et al.: Urodilatin binds to and activates renal receptors for atrial natriuretic peptide. Hypertension 1993, 21:432–438.

    PubMed  CAS  Google Scholar 

  30. Ritter D, Chao J, Needleman P, et al.: Localization, synthetic regulation, and biology of renal atriopeptin-like prohormone. Am J Physiol 1992, 263:F503–F509.

    PubMed  CAS  Google Scholar 

  31. Ramirez G, Saba SR, Dietz JR, Vesely DL: Immunocytochemical localization of proANF 1–30, proANF 31–67, and atrial natriuretic factor in the kidney. Kidney Int 1992, 41:334–341.

    Article  PubMed  CAS  Google Scholar 

  32. Greenwald JE, Needelman P, Wilkins MR, Schreiner GF: Renal synthesis of atriopeptin-like protein in physiology and pathophysiology. Am J Physiol 1991, 260:F602–F607.

    PubMed  CAS  Google Scholar 

  33. Poulos JE, Gower WR Jr, Sullebarger JT, et al.: Congestive heart failure: Increased cardiac and extracardiac atrial natriuretic peptide gene expression. Cardiovasc Res 1996, 32:909–919.

    Article  PubMed  CAS  Google Scholar 

  34. Shin SJ, Lee YJ, Tan MS, et al.: Increased atrial natriuretic peptide mRNA expression in the kidney of diabetic rats. Kidney Int 1997, 51:1100–1105.

    Article  PubMed  CAS  Google Scholar 

  35. Totsune K, Mackenzie HS, Totsune H, et al.: Upregulation of atrial natriuretic peptide gene expression in remnant kidney of rats with reduced renal mass. J Am Soc Nephrol 1998, 9:1613–1617.

    PubMed  CAS  Google Scholar 

  36. Mitrovic V, Lüss H, Nitsche 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, 150:1239.

    Article  PubMed  Google Scholar 

  37. Kentsch M, Drummer C, Gerzer R, et al.: Severe hypotension and bradycardia after continuous intravenous infusion of urodilatin (ANP 95–126) in a patient with congestive heart failure. Eur J Clin Invest 1995, 25:281–283.

    Article  PubMed  CAS  Google Scholar 

  38. Mitrovic V, Seferovic PM, Simeunovic D, et al.: Haemodynamic and clinical effects of ularitide in decompensated heart failure. Eur Heart J 2006, 27:2823–2832.

    Article  PubMed  CAS  Google Scholar 

  39. Carstens J, Jensen KT, Pedersen EB: Metabolism and action of urodilatin infusion in healthy volunteers. Clin Pharmacol Ther 1998, 64:73–86.

    Article  PubMed  CAS  Google Scholar 

  40. Vesely DL: Which of the cardiac natriuretic peptides is the most effective for the treatment of congestive heart failure, renal failure, and cancer? Clin Exp Pharmacol Physiol 2006, 33:169–176.

    Article  PubMed  CAS  Google Scholar 

  41. Sackner-Bernstein JD, Skopicki HA, Aaronson KD: Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 2005, 111:1487–1491.

    Article  PubMed  CAS  Google Scholar 

  42. Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K: Short-term risk of death after treatment with nesiritide for decompensated heart failure. A pooled analysis of randomized controlled trials. JAMA 2005, 293:1900–1905.

    Article  PubMed  CAS  Google Scholar 

  43. Scriven TA, Burnett JC Jr: Effects of synthetic atrial natriuretic peptide on renal function and renin release in acute experimental heart failure. Circulation 1985, 72:892–897.

    PubMed  CAS  Google Scholar 

  44. Cody RJ, Atlas SA, Laragh JH, et al.: Atrial natriuretic factor in normal subjects and heart failure patients. Plasma levels and renal, hormonal and hemodynamic responses to peptide infusion. J Clin Invest 1986, 78:1362–1374.

    Article  PubMed  CAS  Google Scholar 

  45. Chiou S, Vesely DL: Kaliuretic peptide: the most potent inhibitor of Na+-K+-ATPase of the atrial natriuretic peptides. Endocrinology 1995, 136:2033–2039.

    Article  PubMed  CAS  Google Scholar 

  46. Vesely DL: Natriuretic peptides and acute renal failure. Am J Physiol 2003, 285:F167–F177.

    CAS  Google Scholar 

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Authors and Affiliations

  1. USF Cardiac Hormone Center and Professor of Medicine, Molecular Pharmacology, and Physiology, James A. Haley Veterans Medical Center, 13000 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA

    David L. Vesely

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  1. David L. Vesely
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Correspondence to David L. Vesely.

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Vesely, D.L. Urodilatin: A better natriuretic peptide?. Curr Heart Fail Rep 4, 147–152 (2007). https://doi.org/10.1007/s11897-007-0033-2

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