ANP-28 (Atrial Natriuretic Peptide)
/ Endogenous 28-residue atrial natriuretic peptide; NPR-A receptor agonistALIAS · ANP · Atrial natriuretic peptide · ANP-28 · alpha-ANP · Carperitide (Japan)
Terms in this page you can click for a plain-English popup: , , , , , , , .
Tier 3 for the native peptide in the US (not FDA-approved). Carperitide, a recombinant form of human ANP-28, has been approved in Japan since 1995 for acute decompensated heart failure - making this peptide tier-1 in Japan but tier-3 in the US regulatory frame. The Open Assay tier reflects the US perspective.
ANP-28 is a 28-residue peptide hormone synthesised primarily in atrial cardiomyocytes and released in response to atrial wall stretch. The mature peptide contains an intramolecular disulfide bond (Cys7-Cys23) that forms the 17-residue ring required for receptor engagement. ANP signals through the natriuretic peptide receptor A (NPR-A, also called GC-A), a single-pass membrane-bound guanylyl cyclase that produces cyclic GMP on activation.
Cyclic-GMP signalling drives the canonical natriuretic, diuretic, and vasodilator effects: increased glomerular filtration rate, suppression of sodium reabsorption in the inner medullary collecting duct, vasodilation of resistance arteries, and inhibition of the renin-angiotensin-aldosterone and sympathetic nervous systems. A second receptor, NPR-C (the clearance receptor), binds ANP without producing intracellular cyclic GMP and primarily mediates peptide removal from circulation.
In acute decompensated heart failure, intravenous ANP / carperitide reduces cardiac filling pressures, improves dyspnoea, and antagonises the maladaptive neurohormonal axis - mechanistic basis for the Japanese approval of carperitide.
No FDA-approved native ANP product in the US. Carperitide (recombinant human ANP) has been approved in Japan since 1995 for acute decompensated heart failure based on Japanese trials and registry data (PROTECT-AHF and others). Western post-approval observational data have been mixed, with concerns about hypotension and renal effects in select populations. Nesiritide (recombinant BNP-32) is the closest US analog and has its own evidence trajectory documented on the BNP-32 page.
Hypotension is the principal dose-limiting effect of ANP / carperitide infusion. Japanese post-marketing surveillance has reported transient blood-pressure reduction, headache, and bradycardia; long-term outcome data from Japanese registries have been observational rather than randomised. The native peptide has a very short plasma half-life (~2-3 minutes) requiring continuous infusion.
Regulatory status
- FDA status:
- Not FDA-approved
Japanese carperitide use is widespread in acute decompensated heart failure but the supporting controlled-trial evidence is modest by Western standards - the US nesiritide trajectory (ASCEND-HF showing no clinical benefit at the doses studied) led to caution about extrapolating from Japanese clinical practice.
Native ANP-28 is not interchangeable with nesiritide (BNP-32) - both engage NPR-A but differ in receptor selectivity ratios, half-life, and clinical-trial portfolios.