Discoveries of the cardiac
natriuretic peptides ANP, BNP, and CNP along with studies of their function and regulation in health and disease, have led to breakthroughs in the understanding and clinical management of
heart failure. Analysis of the
ANP and BNP promoters and patterns of expression uncovered a set of key regulators and pathways that converge onto these sensitive markers of early myocyte differentiation and cardiac stress. Among the most studied are the
transcription factors GATA4, TBX5, and NKX2-5, which are central to cardiac development and mutations of which are associated with
congenital heart disease. In clinical practice, plasma
natriuretic peptides levels have been used as quantitative
biomarkers of
heart failure and proved to be highly effective for the diagnosis of
heart failure, for risk-stratification of patients and guided
therapy, as well as for screening for subclinical cardiac stress. Emerging studies are revealing the cardioprotective attributes of these
peptides and may offer new therapeutic venues for
myocardial infarction and
heart failure. Clinical trials have documented the benefits and risks of the use of synthetic
ANP (
Anaritide) and BNP (
Nesiritide) for treating
heart failure,
renal failure, and
hypertension. This review summarizes the function and regulation of cardiac
natriuretic peptides and the translation of the basic biochemical discoveries into clinical practice both at the diagnostic and therapeutic level.