Plasma pro-brain natriuretic peptides are strong biochemical markers in clinical cardiology

The cardiac natriuretic peptides constitute a family of peptides that regulate fluid homeostasis as well as vascular tonus and growth. Following the fundamental establishment of the heart as an endocrine organ in the early 1980's, the cardiac natriuretic peptides have today been identified as potent biochemical tools in diverse aspects of clinical cardiology including as diagnostic, therapeutic and prognostic markers of cardiac dysfunction as well as potential drug targets. In man, Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP) are mainly synthesised and secreted by the failing heart, whereas the closely related C-type Natriuretic Peptide (CNP) appears to be a local factor secreted by the endothelium and hence is not considered as a cardiac natriuretic peptide. With the ongoing development of sensitive immunoassays, increased plasma concentrations of ANP and BNP peptides have been associated to a variety of cardiac diseases--but their clinical usefulness as biochemical markers in congestive heart failure is the most promising. In contrast to the large quantity of clinical research on cardiac-derived peptides, the basic understanding of the molecular heterogeneity of these peptides is however still insufficient. Since much clinical work on peptides derived from the proBNP precursor has been published recently, this mini-review will focus on these novel peptides and their potential applications in the clinical setting.