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Adrenomedullin's Clinical Promise: From Vasodilation to Sepsis Biomarker to Potential Drug

RPEP-008882004Bunton, David C; Petrie, Mark C; Hillier, Chris; Johnston, Fiona; McMurray, John J V
ReviewStrong evidence
The takeaway

Adrenomedullin has transitioned from a laboratory curiosity to a clinically relevant peptide with roles as a sepsis biomarker, heart failure prognostic marker, and potential therapeutic agent for cardiovascular and renal diseases.

Biomarker AND therapy

AM measures disease severity (biomarker) and improves it when administered (therapy) — rare dual utility from a single peptide

What the researchers found

Adrenomedullin has clinical relevance as both a biomarker (predicting outcomes in sepsis, HF, ACS) and a potential therapeutic (improving hemodynamics, protecting kidneys, reducing inflammation) — a dual biomarker-therapy peptide.

Why it matters

AM is rare — a peptide that both MEASURES disease severity and TREATS the disease. This dual role streamlines clinical development from biomarker to therapy.

How the study worked

Comprehensive review of adrenomedullin clinical studies covering biomarker applications (sepsis, HF, ACS prognosis) and therapeutic trials (hemodynamic improvement, renal protection).

What this study cannot tell us

Review from 2004. Clinical therapeutic trials were mostly small. The optimal therapeutic dose and formulation were not established.

How to read the evidence

Strong evidence from a comprehensive review integrating biomarker and therapeutic clinical data.

When this study was published

Published in 2004. MR-proADM is now an established clinical sepsis biomarker, and AM-targeting therapy (adrecizumab) is in clinical trials.

The bigger picture

The biomarker-to-therapy paradigm (measure it to predict disease, give it to treat disease) is exemplified by AM and natriuretic peptides. This approach accelerates clinical translation.

Questions still open

  • Will AM-based therapy achieve clinical approval?
  • Can MR-proADM (the clinical biomarker) guide AM therapeutic dosing?
  • Would AM infusion improve sepsis survival in a large trial?

Common questions

Can adrenomedullin both predict and treat disease?
Yes — elevated AM levels predict poor outcomes in sepsis and heart failure (biomarker), and giving AM improves hemodynamics and protects kidneys (therapy). It's rare for one peptide to serve both roles.
Is AM testing available?
MR-proADM (a stable AM fragment) is clinically available as a sepsis biomarker. AM-targeting therapy is in clinical trials.

Read the original research

The clinical relevance of adrenomedullin: a promising profile?

Pharmacology & therapeutics, 103(3), 179-201

View on PubMed ↗

Citation

Bunton, David C; Petrie, Mark C; Hillier, Chris; Johnston, Fiona; McMurray, John J V. (2004). The clinical relevance of adrenomedullin: a promising profile?. Pharmacology & therapeutics, 103(3), 179-201.