Adrenomedullina e peptidi correlati: dalla fisiologia alla diagnostica

AUTORI

ABSTRACT

Adrenomedullin and related peptides: from physiology to diagnostics

Adrenomedullin (ADM) and related peptides have important physiologic effects on cardiovascular system, including a potent and powerful hypotensive activity caused by dilatation of resistance vessels. Other roles are played in endocrine and nervous systems. The plasma concentrations of ADM are increased in several cardiac diseases, raising the possibility of a role as a biomarker of heart failure. The actions of ADM are generally protective and beneficial to organs and tissues (e.g., vasodilation, natriuresis and anti-inflammation) and suggest that increased ADM expression or activity could act as a compensatory response to end-organ injury. The investigations on the possible applications of ADM in clinical studies have increased since the introduction of an assay measuring mid-regional proadrenomedullin (MR-proADM), a peptide derived from proadrenomedullin characterized by a high stability in plasma. Recent studies suggest that MRproADM could be a marker of adverse prognostic effects after myocardial infarction or during acute cardiac dyspnea. Recently, our group showed that MR-proADM is a powerful prognostic marker in AL (light-chain) amyloidosis, which may not only reflect cardiac dysfunction, but also widespread systemic disease, and can be combined with cardiac troponin for detecting patients at risk of early death. However, further studies are required in order to recommend the assay of MR-proADM in the clinical laboratory; in particular, there is a lack of information about: 1) kinetics of MRproADM release after acute events and 2) the specific contribution given by MR-proADM assay in addition to the wellestablished determination of natriuretic peptides.

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