Title Značaj i uloga natriuretičkih peptida u kardiovaskularnim bolestima Title (english) Importance and role of natriuretic peptides in cardiovascular diseases Author Iva Klobučar Mentor Vesna Degoricija (mentor)Committee member Anton Šmalcelj (predsjednik povjerenstva)Committee member Jasenka Markeljević (član povjerenstva)Committee member Vesna Degoricija (član povjerenstva)Granter University of Zagreb Defense date and country 2015-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract U obitelj natriuretičkih peptida pripadaju atrijski natriuretički peptid (ANP), B-tip natriuretički peptid (BNP), C-tip natriuretički peptid (CNP), „dendroaspis“ natriuretički peptid (DNP), urodilatin, urogvanilin i gvanilin. U ovom radu pozornost je usmjerena na ANP i BNP. Natriuretičke peptide ANP i BNP izlučuju miociti srca, a u manjoj se količini izlučuju i u drugim organima. Podražaj koji izaziva izlučivanje natriuretičkih peptida je istezanje miocita srca povećanim volumenom krvi u atrijima i ventrikulima. Natriuretički peptidi djeluju na bubreg, gdje povećavaju izlučivanje natrija i vode. Imaju dilatacijski učinak na arterije i vene. Također inhibitorno djeluju na sustav renin-angiotenzin-aldosteron i simpatički živčani sustav. Ukupni cilj njihovog djelovanja je smanjiti volumen cirkulirajuće krvi i perifernu vaskularnu rezistenciju, što smanjuje i istezanje miocita srca. Koncentracija natriuretičkih peptida u krvi povećana je u kardiovaskularnim bolestima. Mjerenje koncentracije natriuretičkih peptida ima dijagnostičku važnost u razlučivanju dispneje kardijalnog uzroka od drugih oblika dispneje. Koncentracija natriuretičkih peptida u krvi povezana je s napredovanjem i prognozom zatajenja srca, valvularnih bolesti srca, kao i prognozom bolesnika nakon infarkta miokarda. Predlaže se i prilagodba terapije zatajenja srca prema razini natriuretičkih peptida. Novija istraživanja dokazuju vrijednost mjerenja natriuretičkih peptida u općoj populaciji jer su njihove više, ali još uvijek normalne vrijednosti, povezane s povećanim rizikom za razvoj kardiovaskularnih bolesti. Na isti se način mogu probirati i ljudi koji već boluju od bolesti srca i krvnih žila, ali
nemaju simptome. Natriuretički peptidi imaju ulogu i u liječenju zatajenja srca i hipertenzije. Rekombinantne molekule humanih natriuretičkih peptida u nekim su zemljama odobrene za primjenu. Lijekovi koji inhibiraju neutralnu endopeptidazu, enzim koji razgrađuje natriuretičke peptide, u kombinaciji s inhibitorima angiotenzin-konvertirajućeg enzima ili antagonistima AT1 receptora za angiotenzin II (engl. AT1 receptor blockers - ARBs) proučavaju se u studijama i uspoređuju sa standardnom terapijom zatajenja srca i hipertenzije. U tijeku su istraživanja lijeka LCZ696, kombiniranog inhibitora neutralne endopeptidaze i ARBs, koji uz odličan antihipertenzivni učinak ne pokazuje izražene nuspojave svojih prethodnika.
Abstract (english) Members of the natriuretic peptide family are atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), C-type natriuretic peptide (CNP), dendroaspis natriuretic peptide (DNP), urodilatin, uroguanylin and guanylin. The main subjects of this paper are ANP and BNP. ANP and BNP are released from cardiomyocytes, and also in smaller amounts from other organs. Myocardial stretching, caused by increased blood volume in heart chambers, is the main stimulus for natriuretic peptide release. Natriuretic peptides increase renal sodium and water excretion. They also dilate arteries and veins. Natriuretic peptides antagonize renin-angiotensin-aldosterone system and sympathetic nervous system. Their main goal is to decrease blood volume and peripheral vascular resistance, what helps to reduce myocardial stretching. In cardiovascular diseases there is a high concentration of natriuretic peptides in blood. Measurement of natriuretic peptide concentration in
blood helps physicians to distinguish cardiac and noncardiac dyspnea and to make the right diagnosis. Natriuretic peptide concentration in blood is related to the progression and prognosis of heart failure, valvular heart disease and also to the prognosis after myocardial infarction. Some authors recommend natriuretic peptide-guided treatment of heart failure.
The latest studies show the value of the natriuretic peptide concentration measurement in general population. Higher concentrations, but still under the threshold, are connected to the increased cardiovascular risk. This test would also be useful to find those who already have cardiovascular disease, but are still asymptomatic. Natiuretic peptides also have a role in treatment of heart failure and hypertension. Recombinant human natriuretic peptides have already been approved for use in some countries. Drugs which inhibit neutral endopeptidase, the natriuretic peptide-degrading enzyme, combined with
angiotensin-converting enzyme inhibitors (ACEi) or AT1 receptor blockers (ARBs), are studied and compared to standard heart failure and hypertension treatment. Research about new drug LCZ696, the combined inhibitor of neutral endopeptidase and ARBs, is in progress. LCZ696 has great antihypertensive effect without side effects related to the use of other neutral endopeptidase inhibitors.
Keywords
natriuretički peptidi
BNP
kardiovaskularne bolesti
zatajenje srca
inhibitori neutralne endopeptidaze
Keywords (english)
natriuretic peptides
BNP
cardiovascular diseases
heart failure
neutral endopeptidase inhibitors
Language croatian URN:NBN urn:nbn:hr:105:435663 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2016-11-25 11:18:48
