Zusammenfassung.
Ein entscheidender Schritt für das Verständnis der Physiologie des Herz-Kreislaufsystems
und der Identifizierung des Herzens als endokrines Organ gelang DeBold et al. im Jahr
1981. Er zeigte, dass die Injektion eines Extraktes aus Vorhofgewebe eine Natriurese
und Blutdrucksenkung induziert. Diese Beobachtung führte zur Entdeckung einer Familie
von Peptiden, die sich in ihrer biochemischen Struktur nur wenig unterscheiden und
den Salz- und Wasserhaushalt des Organismus beeinflussen. Mitglieder dieser Peptidfamilie
sind atriales oder A-Typ-natriuretisches Peptid (ANP), B-Typ-natriuretisches Peptid
(BNP), C-Typ-natriuretisches Peptid (CNP) und Urodilatin (URO) mit unterschiedlichen
Hauptsyntheseorten im Herzen (ANP, BNP), dem Gehirn (BNP), dem Gefäßendothel (CNP)
und der Niere (URO). Die Erkenntnis, dass diese Peptide abgesehen von ihren Effekten
auf die Herz-Kreislauf- und Nierenfunktionen auch auf das endokrine System sowie die
Bronchialmuskulatur wirken, ging in den letzten Jahren mit einer intensiven Suche
nach therapeutischen Anwendungsmöglichkeiten einher. So untersuchten viele Arbeitsgruppen
die Wirkungen von ANP, BNP oder URO zur Behandlung des akuten Nierenversagens oder
der Herzinsuffizienz. Eine Bestätigung der in einer Fülle von Experimenten beobachteten
positiven Effekte durch prospektive, placebokontrollierte Studien mit hinreichend
großen Patientenzahlen steht allerdings bisher noch immer aus. Abgesehen von möglichen
therapeutischen Optionen könnten die Plasmaspiegel von ANP und insbesondere BNP Bedeutung
als diagnostisches Kriterium für den Schweregrad und die Prognose einer Herzinsuffizienz
bzw. einer Abstoßungsreaktion nach Herztransplantation erlangen.
Natriuretic Peptides: Physiological, Pathophysiological and Clinical Aspects.
A milestone was reached in cardiophysiology when in 1981 DeBold demonstrated that
the heart functions as an endocrine gland by injecting an extract of atrial muscle
into rats, resulting in an induction of natriuresis and a drop in blood pressure.
This observation then led to the discovery of a family of related peptides with slightly
different amino acid compositions working in concert to achieve the maintenance of
sodium and volume homeostasis. The natriuretic peptide family consists of atrial natriuretic
peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP),
and Urodilatin (URO) with their tissue-specific distribution including the heart (ANP,
BNP), brain (ANP, BNP, CNP), endothelial cells (CNP), and kidney (URO). These peptides
were thought to be primarily involved in cardiovascular and renal functions but have
now proven to play a role in other physiological systems. In view of their known biological
effects, therapeutic efficacy from administration of ANP, BNP or URO might be anticipated,
for example in acute renal failure or congestive heart failure. A number of clinical
trials suggest that application of these peptides may represent a new pharmacological
tool in the treatment or prevention of these diseases, but the clinical benefit still
needs to be shown in large controlled studies. In addition to therapeutic options
it is possible that plasma concentrations of ANP and BNP could play a role as diagnostic
and prognostic markers of cardiac dysfunction.
Schlüsselwörter:
Natriuretische Peptide - akutes Nierenversagen - Herzinsuffizienz - Herztransplantation
Key words:
Natriuretic peptides - Renal failure - Congestive heart failure - Heart transplantation
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Dr. med. Peter Michels
Zentrum für Anaesthesiologie, Rettungs- und Intensivmedizin
Georg-August-Universität Göttingen
Robert Koch-Straße 40
37070 Göttingen
eMail: peter.michels@dgai.de
