Adrenomedullin rises during trauma, infection, and sepsis as both a pro-inflammatory responder and an anti-inflammatory protector, with its dual nature making it both a biomarker and potential therapeutic target.
Dual natureADM is both a disease fighter (anti-inflammatory) and a disease contributor (vasodilation causing hypotension) — which role dominates depends on timing
What the researchers found
Adrenomedullin acts as both a pro-inflammatory stress responder and an anti-inflammatory tissue protector during disease, with its dual nature and temporal dynamics determining whether it helps or harms at each stage.
Why it matters
ADM's dual nature means simple antagonism or augmentation could backfire. Therapy must be timed and targeted to the specific phase and aspect of ADM's function — a precision medicine challenge.
How the study worked
Comprehensive review of adrenomedullin in trauma, infection, and sepsis, covering gene regulation, tissue expression, systemic effects, and interaction with inflammatory mediators.
What this study cannot tell us
Review synthesizing complex and sometimes contradictory data. The optimal therapeutic strategy for ADM modulation was not clearly defined.
How to read the evidence
Moderate evidence from a comprehensive review integrating molecular, cellular, and systemic ADM data across multiple disease states.
When this study was published
Published in 2002. ADM's dual role has been confirmed, and the biomarker MR-proADM is now used clinically for sepsis risk stratification.
The bigger picture
Many inflammatory mediators have dual roles — protective and harmful depending on context. ADM exemplifies this complexity and the need for precision timing in therapeutic intervention.
Questions still open
- When should ADM be boosted versus blocked?
- Can ADM's anti-inflammatory effects be separated from its cardiovascular effects?
- Is ADM monitoring useful for timing therapeutic interventions?
Common questions
Is adrenomedullin good or bad in disease?
How do doctors use this information?
Read the original research
Adrenomedullin has multiple roles in disease stress: development and remission of the inflammatory response.
Microscopy research and technique, 57(2), 120-9
Citation
Elsasser, Ted H; Kahl, Stas. (2002). Adrenomedullin has multiple roles in disease stress: development and remission of the inflammatory response.. Microscopy research and technique, 57(2), 120-9.