C-type Natriuretic Peptide (CNP)
Overview
C-type natriuretic peptide is a 22-amino acid member of the natriuretic peptide family that selectively activates natriuretic peptide receptor B (NPR-B). Unlike ANP and BNP, CNP is produced primarily in vascular endothelium and functions as a paracrine regulator of vascular tone and endothelial permeability with minimal direct renal effects. CNP also plays important roles in bone growth and chondrocyte proliferation through cyclic GMP signaling.
Key Research Findings
Vosoritide, an analogue of CNP, received FDA approval in 2021 for achondroplasia based on the phase 3 trial showing increased growth velocity in pediatric patients (NEJM, 2020). Cardiovascular applications of CNP remain investigational, with preclinical studies demonstrating anti-fibrotic and anti-remodeling properties in models of vascular and cardiac disease.
Endogenous
Research Phase
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Eptifibatide (Integrilin)
FDA ApprovedA synthetic cyclic heptapeptide modeled after the KGD (Lys-Gly-Asp) disintegrin sequence found in the venom of the southeastern pygmy rattlesnake (Sistrurus miliarius barbouri). Eptifibatide is a potent, reversible glycoprotein IIb/IIIa receptor antagonist that blocks the final common pathway of platelet aggregation by preventing fibrinogen and von Willebrand factor binding to activated platelets.
Nesiritide (Natrecor)
FDA ApprovedA recombinant form of human B-type natriuretic peptide (BNP), a 32-amino acid peptide naturally produced by ventricular cardiomyocytes in response to volume overload and wall stress. Nesiritide binds natriuretic peptide receptor A (NPR-A), activating guanylyl cyclase and increasing intracellular cGMP to produce venous, arterial, and coronary vasodilation, natriuresis, and suppression of the renin-angiotensin-aldosterone and sympathetic nervous systems.
Angiotensin II (Giapreza)
FDA ApprovedA synthetic form of the endogenous octapeptide angiotensin II, the primary effector of the renin-angiotensin system. Angiotensin II acts on AT1 receptors on vascular smooth muscle to produce potent vasoconstriction, and on the adrenal cortex to stimulate aldosterone release. Exogenous administration raises blood pressure in vasodilatory shock refractory to conventional vasopressors by restoring vascular tone through a mechanism complementary to catecholamine vasopressors.
Serelaxin (Relaxin-2)
InvestigationalSerelaxin is a recombinant form of human relaxin-2, a naturally occurring peptide hormone composed of two chains linked by disulfide bonds. It acts via the relaxin family peptide receptor 1 (RXFP1) to promote vasodilation, inhibit fibrosis, and modulate hemodynamics. The therapeutic rationale targets acute heart failure by improving renal perfusion and reducing vascular resistance.