Molecular and physiological effects of nesiritide.
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.


OBJECTIVE
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.


CONCLUSIONS
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.
Reichert
S
S
University of British Columbia, Vancouver, British Columbia.
Ignaszewski
A
A
D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006439:Hemodynamics / Q000187:drug effects; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008967:Molecular Biology; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects* / Q000502:physiology
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain