Scholarly article on topic 'Metabolic actions of natriuretic peptides and therapeutic potential in the metabolic syndrome'

Metabolic actions of natriuretic peptides and therapeutic potential in the metabolic syndrome Academic research paper on "Basic medicine"

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Abstract of research paper on Basic medicine, author of scientific article — Nina Schlueter, Anita de Sterke, Diana M. Willmes, Joachim Spranger, Jens Jordan, et al.

Abstract Natriuretic peptides (NPs) are a group of peptide-hormones mainly secreted from the heart, signaling via c-GMP coupled receptors. NP are well known for their renal and cardiovascular actions, reducing arterial blood pressure as well as sodium reabsorption. Novel physiological functions have been discovered in recent years, including activation of lipolysis, lipid oxidation, and mitochondrial respiration. Together, these responses promote white adipose tissue browning, increase muscular oxidative capacity, particularly during physical exercise, and protect against diet-induced obesity and insulin resistance. Exaggerated NP release is a common finding in congestive heart failure. In contrast, NP deficiency is observed in obesity and in type-2 diabetes, pointing to an involvement of NP in the pathophysiology of metabolic disease. Based upon these findings, the NP system holds the potential to be amenable to therapeutical intervention against pandemic diseases such as obesity, insulin resistance, and arterial hypertension. Various therapeutic approaches are currently under development. This paper reviews the current knowledge on the metabolic effects of the NP system and discusses potential therapeutic applications.

Academic research paper on topic "Metabolic actions of natriuretic peptides and therapeutic potential in the metabolic syndrome"

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JPT-06681; No of Pages 16

Pharmacology & Therapeutics xxx (2014) xxx-xxx

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Pharmacology & Therapeutics

journal homepage: www.elsevier.com/locate/pharmthera

Associate editor: G. Eisenhofer

Metabolic actions of natriuretic peptides and therapeutic potential in the metabolic syndrome

Nina Schlueter a, Anita de Sterke a, Diana M. Willmes a, Joachim Spranger a, Jens Jordan b, Andreas L. Birkenfeld a'*

a Department of Endocrinology, Diabetes and Nutrition, Center for Cardiovascular Research, Charité, University School of Medicine, Berlin, Germany b Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany

article info abstract

Natriuretic peptides (NPs) are a group of peptide-hormones mainly secreted from the heart, signaling via c-GMP coupled receptors. NP are well known for their renal and cardiovascular actions, reducing arterial blood pressure as well as sodium reabsorption. Novel physiological functions have been discovered in recent years, including activation of lipolysis, lipid oxidation, and mitochondrial respiration. Together, these responses promote white adipose tissue browning, increase muscular oxidative capacity, particularly during physical exercise, and protect against diet-induced obesity and insulin resistance. Exaggerated NP release is a common finding in congestive heart failure. In contrast, NP deficiency is observed in obesity and in type-2 diabetes, pointing to an involvement of NP in the pathophysiology of metabolic disease. Based upon these findings, the NP system holds the potential to be amenable to therapeutical intervention against pandemic diseases such as obesity, insulin resistance, and arterial hypertension. Various therapeutic approaches are currently under development. This paper reviews the current knowledge on the metabolic effects of the NP system and discusses potential therapeutic applications.

© 2014 Elsevier Inc. All rights reserved.

Keywords: Natriuretic peptides ANP BNP

Insulin resistance

Diabetes

Obesity

Contents

1. Introduction................................................0

2. The natriuretic peptide system.......................................0

3. Cardiovascular effects of natriuretic peptides.................................0

4. Metabolic effects of natriuretic peptides...................................0

5. Natriuretic peptides in human cardiometabolic disease............................0

6. Therapeutic potential of natriuretic peptides in metabolic syndrome and its components.............0

7. Novel pharmacologic approaches......................................0

8. Conclusion................................................0

Conflict of interest...............................................0

Acknowledgment................................................0

References...................................................0

Abbreviations: ACE, angiotensin converting enzyme; AMPK, adenosine monophosphate-activated protein kinase; ANP, atrial natriuretic peptide; ATGL, adipose triglyceride lipase; ATP, adenosine triphosphate; BAT, brown adipose tissue; BMI, body mass index; BNP, brain-type natriuretic peptide; cAMP, cyclic adenosine monophosphate; cGK-I, protein kinase G; cGMP, cyclic guanosine monophosphate; CHF, chronic heart failure; CNP, C-type natriuretic peptide; DAG, diacylglycerol; DNP, dendroaspis natriuretic peptide; FFA, free fatty acid; GC, guanylyl cyclase; GFR, glomerular filtration rate; GLP-1R,glucagon-likepeptide-1 receptor; HDL, high density lipoprotein; HFD, high fat diet; HMW, high molecular weight; HSL, hormone sensitive lipase; IgG, immunoglobulin G; LDL, low density lipoprotein; LVH, left ventricular hypertrophy; MR-pro-ANP, mid-regional pro-atrial natriuretic peptide; NEP, neutral endopeptidase; NP, natriuretic peptides; NPRA, natriuretic peptide receptor A; NPRB, natriuretic peptide receptor B; NPRC, natriuretic peptide receptor C; NPY, neuropeptide Y; NRF, nuclear respiratory factor; NT-proANP, N-terminal prohormone of atrial natriuretic peptide; NT-pro-BNP, N-terminal prohormone of brain natriuretic peptide; NYHA, New York Heart Association; p38 MAPK, p38 mitogen activated protein kinase; PDE3B, phosphodiesterase 3B; PDE5, phosphodiesterase 5; PEG, polyethylene glycol; PGC-1 a, prolifator-activated receptor y coactivator 1 a; PKA, protein kinase A; PKC, protein kinase C; PPAR-8, peroxisome proliferator activated receptor 8; RAAS, renin-angiotensin-aldosterone-system; SAT, subcutaneous adipose tissue; T2DM, type 2 diabetes mellitus; UCP1, uncoupling protein 1; UCP 3, uncoupling protein 3; VAT, visceral adipose tissue; WAT, white adipose tissue.

* Corresponding author at: Department of Endocrinology, Diabetes and Nutrition, Center for Cardiovascular Research, Hessische Str. 3-4,10115 Berlin, Germany. Tel.: +49 30 450 514 333; fax: +49 30 450 514 930.

E-mail address: andreas.birkenfeld@charite.de (A.L. Birkenfeld).

http://dx.doi.org/10.10167j.pharmthera.2014.04.007 0163-7258/© 2014 Elsevier Inc. All rights reserved.

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1. Introduction

Natriuretic peptides (NP) are primarily known for their cardiovascular and renal actions. Moreover, NP or their fragments are widely applied as cardiovascular biomarkers in epidemiological studies and in the clinical routine setting. In particular, NP are important in the diagnostic workup of heart failure patients (Maisel et al., 2002). However, during the last decade, NPs have been shown to exert a variety of metabolic effects. The purpose of the present review is to give an overview of the current knowledge of the metabolic properties of NP and to summarize therapeutic options that arise from these findings in the treatment of the metabolic syndrome and its components.

2. The natriuretic peptide system

2.1. Components and receptor tissue distribution

The endocrine properties of the heart were first discovered by deBold in 1981 when intravenous infusion of a crude atrial myocardial extract into rats led to a potent natriuretic and diuretic effect (deBold et al., 1981). Twenty-five years earlier, granules resembling endocrine glands had been discovered in atrial myocardium using electron microscopy (Kisch, 1956). Three years after the ground-breaking discovery by deBold, the structure of the underlying peptide was identified and designated 'atrial natriuretic peptide' (ANP) (Kangawaet al., 1984a, 1984b, 1984c). Within the following years, a number of structurally and functionally related peptides have been identified to comprise the NP-hormone family.

To date three members of the NP family, atrial natriuretic peptide (ANP), brain-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP), are considered to play a role in metabolic regulation. All three natriuretic peptides are secreted as pro-hormones and cleaved by proteases to reach their final, biologically active form. The three peptides have a 17-amino acid ring structure in common, formed by a disulfide bond between two cysteinyl residues. In humans, the amino acid sequence of the ring structure is highly preserved within the three peptides, differing by a few amino acid molecules, only. Both, ANP and BNP feature peptide specific amino- and carboxy-terminal extensions, while CNP lacks the carboxy-terminal appendage (Nishikimi et al., 2011). ANP is predominantly released from atrial myocardium where it is produced as a preprohormone and stored as a proANP in intracellular granules (Nakao et al., 1992). The biologically active aANP is a 28-amino acid peptide cleaved from proANP by the serine-protease corin during secretion (Yan et al., 2000). Brain-type natriuretic peptide was first discovered in porcine brain (Sudoh et al., 1988). Today, BNP is known to be primarily secreted by ventricular myocardium (Nannipieri et al., 2002). Similar to ANP, BNP is produced as preproBNP which is then cleaved to proBNP. Eventually conversion of proBNP to active, 32-amino acid BNP is mediated by the endoprotease furin at the trans-Golgi network (Nakayama, 1997). Lacking the carboxy-terminal extension, CNP is the shortest member of the NP family, comprising 22-amino acid residues, only (Nishikimi et al., 2011). It was initially identified in porcine brain (Sudoh et al., 1990). CNP is predominantly present in vascular endothelial cells and in the central nervous system (Komatsu et al., 1991; Heublein et al., 1992; Stingo et al., 1992; Suga et al., 1992). Further members of the NP family are urodilatin, which has been isolated from urine, and Dendroaspis Natriuretic Peptide (DNP) from the venom of green mamba snakes (Dendroaspis angusticeps) (Mitsuishi et al., 2008; You & Laychock, 2011). Urodilatin and DNP have not been well studied upon metabolic effects in humans and, thus, shall not be further discussed in this review.

Circulating ANP and BNP concentrations may differ between healthy men and women (Vasan et al., 2002; Clerico et al., 2005; Lam et al., 2011). NPs increase progressively throughout adolescence in girls, and reach about 2-fold higher levels in normal cycling women compared to men at the same age (Maffei et al., 2001; Clerico et al., 2002), in

some but not all studies. The ANP-precursor gene, NPPR, interacts with estradiol receptor-a (ER-a) (Mahmoodzadeh et al., 2012). Moreover, estrogen administration in postmenopausal women increases circulating ANP levels (Maffei et al., 2001). Besides regulating NP transcription and secretion, estrogens also seem to affect NP-receptor expression. Estradiol augments Natriuretic peptide receptor A (NPRA) expression levels, while stabilizing or reducing Natriuretic peptide receptor C (NPRC) transcription levels, in a tissue and setting dependent manner in mice (Belo et al., 2008). Possibly, sex dependent NP regulation contributes to the well-known differences in cardiovascular risk, sympathovagal balance and redistribution of body fat between women and men, as explained in detail below.

22. Natriuretic peptide signaling cascade

NPs exert their effects via NP receptors in a classical endocrine manner. Three subtypes of NP receptors have been described. Natriuretic peptide receptors A and B (NPRA and NPRB) are guanylyl cyclase (GC) coupled transmembrane receptors (Waldman et al., 1984; Song et al., 1988). Ligand binding to NPRA and -B activates the cytosolic GC receptor domain increasing intracellular levels of the second messenger cGMP. NPRC, the third NP receptor subtype, does not have GC activity, facilitating NP internalization and degradation, instead (Maack et al., 1987). Therefore, NPRC is sometimes referred to as clearance receptor. Additionally, NP are cleared by the neural endopeptidase neprilysin (NEP) (alternative names: atriopeptidase, common acute lymphocytic leukemia antigen (CALLA), enkephalinase, neutral endopeptidase 24.11) (Kenny etal., 1993).

The diverse effects of the NP system are determined by NP receptor distribution and receptor-ligand-affinity and are depicted in part in Fig. 1. NPRA is regarded as the main effector receptor for ANP and BNP (Suga et al., 1992). NPRA is abundantly expressed in vascular smooth muscle and endothelial cells, adipose tissue as well as in kidney, adrenal gland, liver and brain and to a lesser extent in the heart (Sarzani et al., 1996; Bryan et al., 2006). NPRB is structurally similar to NPRA but is rather activated by CNP in a paracrine fashion (Koller et al., 1991; Suga, Nakao, Hosoda, et al., 1992). NPRB is expressed by chondrocytes, where it appears to play a crucial role in enchondral ossification during long bone growth (Yasoda et al., 1998). Disruption of the CNP/NPRB-sig-naling in mice leads to dwarfism (Chusho et al., 2001; Tsuji & Kunieda, 2005), while CNP overexpression is associated with bone overgrowth (Kake et al., 2009). Apart from bone, NPRB is highly expressed in brain, lung, heart, ovary tissue fibroblasts and vascular smooth muscle cells (Schulz et al., 1989; Nagase et al., 1997). The NP clearance receptor C is mainly present in adipose tissue and kidney (Nagase et al., 1997). NPRC is involved in degradation of all three types of natriuretic peptides with highest affinity to ANP and lowest affinity to BNP (Suga et al., 1992).

3. Cardiovascular effects of natriuretic peptides

The beneficial effects of NPs on systemic blood pressure and cardiac remodeling have been investigated thoroughly. The present review focuses on the metabolic properties of the NP system and the resulting therapeutic implications. However cardiovascular disease and metabolic disorders are tightly linked. Therefore the various mechanisms involved in NP mediated blood pressure regulation will be outlined briefly.

As ligands for the same receptor, ANP and BNP appear to maintain similar regulatory actions on blood pressure and cardiac remodeling. However, ANP and BNP markedly differ in plasma half-life times, with BNP having an approximately sevenfold longer half-life period (21 min) than ANP (3 min) (Astrup et al., 1985). The difference in half-life might be explained by faster clearance of ANP due to a greater NPRC affinity compared to BNP.

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Central nervous system

¿sympathetic nervous system Regulation of food intake?

Fig. 1. Target organs of the natriuretic peptide system. Released by the heart in response to cardiac wall stress, natriuretic peptides act on vascular system, kidneys and brain. In order to reduce blood pressure and the resulting cardiac burden, NPs reduce vascular tone, enhance renal sodium and water excretion, inhibit the renin-angiotensin-aldosterone system (RAAS) and attenuate central nervous sympathetic nervous system activity. Moreover, natriuretic peptides exert metabolic effects in a numerous organs. In human adipose tissue, NPs enhance lipolysis as well as the secretion of the insulin sensitizing adipokine adiponectin, while leptin release is suppressed. At the same time, natriuretic peptides enhance mitochondrial biogenesis and oxidative capacity in skeletal muscle and adipose tissue. In white adipose tissue (WAT) mitochondrial biogenesis leads to browning of adipocytes, enhancing energy expenditure and heat production. Natriuretic peptides might also improve pancreatic insulin secretion. All these mechanisms might play together to control whole body energy homeostasis. ANP atrial natriuretic peptide; BNP brain natriuretic peptide; HSL hormone sensitive lipase.

Both, ANP and BNP reduce systemic vascular tone in a dose dependent manner (Protter et al., 1996; van der Zander et al., 1999). Mice with endothelium restricted NPRA deletion feature arterial hypertension with a paradoxically normal vasodilatory response to ANP (Sabrane et al., 2005). Endothelial NPRA appears to affect endothelial permeability, thus, regulating fluid shifts between the interstitial and intravascular compartment (Sabrane et al., 2005). Cardiomyocyte restricted NPRA disruption in mice is associated with five times higher ANP concentrations compared to wild type and comes along with markedly reduced blood pressure levels (Holtwick et al., 2003). Heart specific NPRA disruption was also associated with pressure independent cardiac hypertrophy, confirming anti-cardiohypertrophic properties of NP (Tamura et al., 2000; Kishimoto et al., 2001; Holtwick et al., 2003). Moreover, NPs acutely reduce plasma volume in part by enhancing na-triuresis (Yoshimura et al., 1991). ANP augments glomerular filtration rate (GFR) through escalation of glomerular capillary pressure and expansion of mesangial cell filtration surface (Fried et al., 1986; Marin-Grez et al., 1986). Additionally, NPs inhibit water and sodium re-uptake in the proximal tubule and the collecting duct (Sonnenberg et al., 1986; Harris et al., 1987).

In addition to the direct cardiovascular and renal effects, NPs inhibit the renin-angiotensin-aldosterone-system (RAAS) by suppressing renal renin release (Burnett et al., 1984; Johnson et al., 1988; Shi et al., 2001). Besides peripheral regulatory effects on blood pressure, NPs modulate sympathetic activity in the central nervous system (Floras, 1990; Schroeder et al., 2006). CNP does not seem to have a significant effect on renal sodium and water excretion (Pham et al., 1997). However, CNP is considered to cause vascular smooth muscle relaxation and inhibition of smooth muscle proliferation in a paracrine manner

(Furuya et al., 1990; Furuya et al., 1991). Yet, CNP-/- mice do not develop severe arterial hypertension, indicating that CNP might not play an important role in blood pressure and fluid homeostasis (reviewed by Schulz) (Schulz, 2005).

4. Metabolic effects of natriuretic peptides

4.1. Natriuretic peptide activated lipolysis

The regulation of lipolysis in adipose tissue has been thoroughly investigated (Lafontan & Langin, 2009; Ahmadian et al., 2010; Zechner et al., 2012). For many years, catecholamines were considered to be the major physiological lipolytic agent. Catecholamines induce lipolysis via stimulation of adipocyte adrenergic (3-receptors and subsequent cAMP dependent activation of hormone sensitive lipase (HSL) (Stralfors & Belfrage, 1983; Stralfors et al., 1984; Egan et al., 1992). The exact mechanism of adipose triglyceride lipase (ATGL) activation in the process, hydrolyzing the first fatty acid from triacylglycerols, is still a matter of research (Zechner et al., 2012). Insulin is the major endogenous inhibitor of catecholamine dependent lipolysis (Coppack et al., 1989; Jensen et al., 1989). Insulin abolishes adipose tissue lipolysis via phosphodiesterase 3B (PDE3B) activation which subsequently leads to cAMP degradation and deactivation of PKA (Choi et al., 2006).

A decade ago, NP entered the 'lipolytic arena'. Potent lipolytic properties of natriuretic peptides were first described by Sengenes et al. (2000). The authors observed that all three subtypes of the NP family promote li-polysis in human adipose tissue, with ANP being the most potent activator of lipolysis, followed by BNP and CNP in descending order (pEC50: ANP 9.82 ± 0.20; BNP 8.33 ± 0.08; CNP 7.75 ± 0.58 [-log EC50]).

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Lipolytic NP actions appear to be limited to primates owing to higher NPRC expression in other mammalian adipocytes (Sengenès et al., 2002). Indeed; NPRC deletion fully restored the lipolytic properties of natriuretic peptides in mice (Bordicchia et al., 2012).

Unlike catecholamines, NPs resort to a cGMP dependent, protein kinase G activating, pathway. NP driven activation of protein kinase G (GK-I) promotes perilipin A and hormone sensitive lipase ( HSL) mediated triglyceride degradation (Sengenès et al., 2000, 2003; Birkenfeld et al., 2005). Relying on different pathways, the lipolytic actions of NP's and catecholamines in humans seem to be completely independent (Galitzky et al., 2001 ; Birkenfeld et al., 2006). Simultaneous stimulation with ANP and ß-adrenergic agonists such as isoproterenol results in additive potentiation of the lipolytic effects in human adipocytes (Moro et al., 2004).

Remarkably, insulin does not seem to have a direct antilipolytic effect on the cGMP/GK-I dependent lipolytic pathway (Moro et al., 2004; Moro et al., 2005).

However, insulin might attenuate NP mediated lipolysis indirectly by reducing circulating NP levels. Furthermore, insulin may reduce NPRA expression while reciprocally enhancing NPRC expression in white adipose tissue in rodents (Nakatsuji et al., 2010; Pivovarova et al., 2012). In fact, short-term insulin infusions reduced circulating NT-pro-BNP and MR-pro-ANP levels in humans (Halbirk et al., 2010; Pivovarova et al., 2012) and interventions increasing insulin sensitivity increase MR-pro-ANP levels (Rudovich et al., 2012).

Besides direct activation of lipolysis, other relevant effects on adipose tissue have been described. Sarzani et al. hypothesized that ANP may attenuate human adipocyte growth (Sarzani et al., 2007). However, this issue needs further study to fully delineate the effect of NPs in adipogenesis. Moreover, Moro and colleagues showed that ANP inhibits the release of pro-inflammatory cytokines and chemokines from human adipocytes and adipose tissue macrophages (Moro et al.,

2007). The mechanism could be beneficial because chronic, low grade inflammation contributes to obesity-associated insulin resistance and cardiovascular disease.

42. Natriuretic peptides enhance lipid oxidation and mitochondrial respiration

NP induced lipolysis acutely increases free fatty acid (FFA) availability in human subjects (Galitzky et al., 2001 ; Birkenfeld et al., 2005,2006, 2011a). Apparently, these fatty acids serve as substrates for oxidative tissues such as skeletal muscle, liver, and 'beige' and brown adipose tissue. Moreover, studies in humans and mice indicate that NPs enhance lipid oxidation in adipose tissue, skeletal muscle and liver, allowing these tissues to fuel fatty acids into the ß-oxidation pathway at an increased rate.

We observed that short term intravenous administration of ANP acutely increases lipid oxidation (Birkenfeld et al., 2005, 2012) and postprandial energy expenditure in healthy men (Birkenfeld et al.,

2008). In the latter study, circulating beta-hydroxybutyrate increased markedly, indicating that hepatic lipid oxidation at least in part contributed to the acute response. Molecular mechanisms might include distinct pathways. First, FFAs from acute ß-adrenergic receptor mediated lipolysis seem to increase mitochondrial respiration and lipid oxidation by an effect on uncoupling protein 3 (UCP3) activity in skeletal muscle (Hoeks et al., 2003). The mechanism might also be applicable to the NP system. Second, apart from acute lipid oxidation enhancement (Birkenfeld et al., 2008), ANP and BNP induce skeletal muscle mitochon-drial biogenesis, respiration and lipid oxidation in human cells and in rodents, in vitro and in vivo (Miyashita et al., 2009). Chronic overexpression of BNP and GK-I each led to increased muscle mitochondrial content, oxidative capacity and lipid oxidation in mice. Enhanced oxidative metabolism was associated with protection from high fat diet (HFD) induced obesity and insulin resistance. Heterozygous GC-A knockout was associated with increased susceptibility to weight

gain and insulin resistance in mice (Miyashita et al., 2009). The mechanism driving improvements in mitochondrial biogenesis and lipid oxidation in skeletal muscle included the induction of peroxisome proliferator-activated receptor y coactivator (PGC)-1a and peroxisome proliferator-activated receptor (PPAR)-S genes, two master regulators of mitochondrial biogenesis in skeletal muscle (Miyashita et al., 2009).

In human myotubes, we showed that ANP and BNP, as well as cGMP analogs, induced PGC-1 a, mitochondrial respiration and lipid oxidation (Engeli, et al., 2012). Furthermore, NPRA expression was associated with PGC-1a expression in skeletal muscle of healthy physically trained human subjects. Supporting evidence comes from cell culture studies showing that cGMP restores glucose and insulin induced mitochondrial dysfunction in cultured C2C12 myotubes (Mitsuishi et al., 2008). In the same vein, nitric oxide signals via cGMP to mediate the induction of PGC-1 a and mitochondrial biogenesis in various murine tissues (Nisoli et al., 2003). Activation of PGC-1a enhances activity of PPARs, nuclear receptors with transcriptional activity on genes involved in lipid oxidation and mitochondrial function (Puigserver et al., 1999; Schupp & Lazar, 2010). Moreover, mitochondrial biogenesis requires expression of nuclear encoded mitochondrial genes that are under the control of several transcription factors including the nuclear respiratory factors (NRFs) (Kelly & Scarpulla, 2004). PGC-1a is a key regulator of NRF-1 and 2, which control a network that includes respiratory chain subunits and parts of mitochondrial DNA transcription machinery (Kelly & Scarpulla, 2004). Importantly, PGC-1a also induces mitochon-drial UCP1 in adipose tissue and UCP3 in skeletal muscle through interaction with PPARy (Puigserver et al., 1999). Intriguingly, ANP and BNP not only induced PGC-1a expression in human myotubes, but also an array of downstream target genes, such as NRF1, UCP-3 and complexes I and IV of the respiratory chain (Engeli, et al., 2012). Together, these data suggest, that NPs induced lipid oxidation and mitochondrial respiration in skeletal muscle is induced through a cGMP driven, GK-I mediated effect on PGC-1a, inducing transcription of downstream targets, such as NRF-1 and UCP3, probably via PPARa and/or PPARS. The signaling cascade is depicted in Fig. 2. An unresolved question is.

In white and 'beige' (brite) adipose tissue, NPs mediate similar effects (see below). In these tissues, activation of p38 mitogen activated protein kinase (p38 MAPK) by GK-I might play a role (Bordicchia et al., 2012). Moreover, Souza et al. showed that ANP induces mitochondrial biogenesis and up-regulates expression of mitochondrial genes involved in fatty acid transport and oxidation in human adipocytes via NPRA by GK-I dependent activation of AMP-activated protein kinase (AMPK) (Souza et al., 2011), a master energy sensor acting as a nod in intracellular energy metabolism. AMPK induces PGC-1a via direct phosphorylation to increase transcriptional activity of PGC-1a (Jäger et al., 2007). AMPK is generally induced via an increased ratio of AMP to ATP, or calcium via distinct kinases. More studies are clearly needed to put the pieces together. Identification of the initial molecular mechanisms involved in NP enhanced mitochondrial respiration may lead to novel targets for the treatment of metabolic disease.

4.3. Natriuretic peptides and browning of white adipose tissue

Recently, the significance of mitochondrial metabolism in adipose tissue has been revisited by showing that brown adipose tissue mass and function is more relevant in humans than previously appreciated. Moreover, adipocytes in human white adipose tissues can switch from white to brown and vice versa ('brite' or 'beige' adipose tissue) (Cypess et al., 2009). Fat is mainly stored in white adipose tissue (WAT). Brown adipose tissue (BAT) is another fat reservoir, which in contrast to WAT is able to generate heat and maintain body temperature. Brown adipocytes are located in the BAT and smaller populations were identified within WAT. BAT evolved in mammals to dissipate large amounts of biochemical energy in form of heat for defending the cold (Smith & Roberts, 1964). Upon cold exposure, BAT is activated by central nervous mechanisms through the sympathetic nervous system.

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Fig. 2. Natriuretic peptide induced effects in skeletal muscle. ANP and BNP binding to the natriuretic peptide receptor A (NPRA) kicks of cGMP formation at the intracellular guanylyl cyclase receptor domain. Rising intracellular cGMP levels induce expression of PGC1a downstream genes. Moreover free fatty acids from adipocyte lipolysis serve as additional ligands for the transcriptional regulator of mitochondrial biogenesis PPAR8. Thus, natriuretic peptides increase muscle mitochondrial content and mitochondrial lipid oxidation. SNS sympathetic nervous system; ANP atrial natriuretic peptide; BNP brain type natriuretic peptide; NPRA natriuretic peptide receptor A; GTP guanosine triphosphate; cGMP cyclic guanosine monophosphate; GC-A guanylyl cyclase A; PGC1a Peroxisome proliferator-activated receptor gamma coactivator 1-alpha; OXPHOS oxidative phosphorylation; ADP adenosine diphosphate; ATP adenosine triphosphate AMPK AMP-activated protein kinase; FATP fatty acid transport protein; CD36 cluster of differentiation 36 (=fatty acid translocase), green arrow indicates activation, induction, red arrow indicates decrease, inhibition. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

The thermogenic response in brown adipocytes is mediated by uniquely enriched mitochondria expressing UCP1 in the inner membrane (Ricquier & Kader, 1976; Heaton et al., 1978; Lin & Klingenberg, 1980; Ricquier et al., 1983). UCP1 allows brown adipocytes to dissipate the electrochemical gradient that is normally used to drive ATP synthesis (Klingenberg, 1999). However, the thermogenic response cannot solely be explained by UCP1, since the expression of several genes involved in energy metabolism is increased in experimental animals to a cold environment (Stralfors & Belfrage, 1983; Egan et al., 1992). Bordicchia et al. recently demonstrated the importance of NPRA and NPRB in BAT (Bordicchia et al., 2012).

Adrenergic stimulation increases energy dissipation in BAT, probably reducing body weight in obese individuals (Astrup et al., 1985; Finer et al., 2000). However, adrenergic compounds have the potential to increase stroke and myocardial infarction risk, likely through influences on heart rate and blood pressure (Haller & Benowitz, 2000; Torp-Pedersen et al., 2007). Catecholamines raise intracellular cAMP, directly activating PKA (cAMP dependent protein kinase), which phos-phorylates HSL and kinases of the p38 MAPK pathway (Cao et al., 2001, 2004). p38 MAPK inhibition attenuates adrenergically mediated UCP1 expression (Cao et al., 2004). Bordicchia et al. demonstrated that mice, lacking the negative regulator of NP activity NPRC-/—, have reduced WAT and lipid accumulation in BAT with enhanced expression of thermogenic genes in both tissues (Bordicchia et al., 2012). Treatment of a human derived adipocyte cell line with ANP results in GK-I dependent induction of thermogenic and mitochondrial genes, leading to an uncoupling of respiration (Bordicchia et al., 2012). NPs elicited the response by increasing p38 MAPK signaling and phosphorylation of ATF2, directly increasing UCP1 transcription in brown adipocytes (Bordicchia et al., 2012). BNP treatment in mice enhanced energy

expenditure and increased thermogenic protein levels in BAT and WAT (Bordicchia et al., 2012). With cold exposure, circulating NP levels and BAT NPRA expression increases while NPRC expression decreases (Bordicchia et al., 2012). Similarly, forced PKG expression in primary adipocytes induces a strong increase in UCP-1 and activates a brown-like thermogenic program. Treatment of mice with the phosphodiesterase 5 inhibitor sildenafil elicited a similar response (Pfeifer etal., 2013). Together, these studies show that similarly to skeletal muscle, the NP system induces a thermogenic program in adipose tissue. A schematic representation is given in Fig. 3. By these means, the NP axis seems to be involved in the physiological BAT adaptation to changes in environmental temperature. (Carey & Kingwell, 2013; Schulz & Tseng, 2013).

4.4. Natriuretic peptide interactions with adipokines

Besides a direct activating effect on lipolysis and lipid oxidation, NPs also seem to have a regulatory sway on certain adipokines involved in energy metabolism. ANP acutely increases systemic levels of total and high molecular weight (HMW) adiponectin, an insulin sensitizing adipokine, in human subjects (Tanaka et al., 2008; Birkenfeld et al., 2012). These findings are in accordance with a number of observational studies showing positive associations between circulating NP and adiponectin levels, as for example in heart failure patients (Kistorp et al., 2005; Hara et al., 2011; Azizi Ghanbari et al., 2013). Leptin may be another NP regulated adipokine. ANP reduces leptin release from human adipocytes (Fain et al., 2003). These findings are supported in vivo by a recent clinical investigation in heart failure patients. Melenovsky and coworkers observed a significant inverse relationship between systemic BNP levels and plasma concentrations of the anorex-igenic adipokine leptin in heart failure patients (Melenovsky et al.,

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Mitochondrial biogenesis Î energy expenditure Î heat production „WAT browning"

Insulin-receptor

ß-adrenoreceptor Catecholamines

Insulin

Fig. 3. NP related effects in human adipocytes. ANP and BNP induce a cGMP dependent pathway via stimulation of natriuretic peptide receptor A Increased intracellular cGMP levels activate cGMP dependent protein kinase G which induces lipolysis through phosphorylation of hormone sensitive lipase. At the same time, enhances mitochondrial biogenesis via activation of AMPK and p38-MAPK, leading to browning of white adipose tissue. Unlike catecholamine induced lipolysis, the cGMP dependent lipolytic pathway is independent of the antilipolytic effects of insulin. ANP atrial natriuretic peptide; BNP brain type natriuretic peptide; NPRA natriuretic peptide receptor A; NPRC natriuretic peptide receptor C; GCA guanylyl cyclase A; GTP guanosine triphosphate; cGMP cyclic guanosine monophosphate; PKG protein kinase G; ATP adenosine triphosphate; AC adenylyl cyclase; cAMP cyclic adenosine monophosphate; PKA protein kinase A; HSL hormone sensitive lipase; ATGL adipocyte triglyceride lipase; AMPK AMP-activated protein kinase; p38-MAPK mitogen-activated protein kinase; AKT protein kinase B.

2013). To date, the mechanism and significance of NP adipokine release is still incompletely understood. In conditions with decreased NP levels, such as in obesity, the mechanism might contribute to metabolic disease (Wang, 2012).

4.5. Natriuretic Peptides, insulin secretion and glucose homeostasis

A number of studies suggest that NP directly and indirectly affect glucose metabolism. We and others observed increased insulin levels during ANP infusion in human subjects (Uehlinger et al., 1986; Birkenfeld et al., 2005, 2008). The effect might be explained by a direct modulating effect on (3-cell function or, less likely in the acute setting, on (3-cell mass (Ropero et al., 2010). ANP directly enhanced glucose-stimulated insulin secretion in cultured islets. In addition, ANP induced (3-cell growth in isolated rat pancreatic islets (You & Laychock, 2009), whereas significantly smaller islets with reduced (3-cell mass are found in knockout mice. Thus, ANP might increase glucose uptake via stimulation of pancreatic insulin release.

Second, ANP might alter insulin sensitivity through adiponectin. Interestingly, ANP infusion in ten fasting, healthy young men slightly increased circulating glucose levels (Birkenfeld et al., 2005). This effect might be explained by the acute effect of ANP on lipid mobilization, acutely increasing the flux of fatty acids to metabolic, insulin responsive organs and thereby inducing insulin resistance (Nowotny et al., 2013;

Birkenfeld & Shulman, 2014), an effect that can be outbalanced in the long-term by increased usage of these fatty acids in (3-oxidation. The notion that lipid mobilization enhances the distribution of fatty acids to ec-topic organs inducing insulin resistance, is supported by the fact that short-term infusion of BNP, in a manner not increasing fatty acid levels, lowered circulating glucose concentrations slightly during the initial phase of an intravenous glucose tolerance test, together with reduced insulin secretion. In this case, the effect could be mediated by the increase in peripheral vasodilation (Heinisch et al., 2012) and through improved glucose transport across the capillary wall into the interstitial space (Jensen et al., 1998). Together, these studies suggest that NP might enhance insulin-stimulated glucose disposition. Whether or not NPs directly affect insulin signaling deserves to be studied in more detail.

Hepatic and skeletal muscle lipid content is strongly associated with insulin resistance (Samuel & Shulman, 2012; Birkenfeld & Shulman, 2014). In liver and skeletal muscle, insulin resistance develops when there is an imbalance between supply and utilization of intracellular lipid leading to net accumulation of bioactive lipid species, such as intracellular diacylglycerol (DAG hypothesis) (Birkenfeld & Shulman, 2014). In obesity and metabolic syndrome, this lipid accumulation is primarily achieved by excessive caloric intake exceeding the capacity of hepatocytes and myocytes to metabolize or export fatty acids refining or uncoupling mitochondrial respiration and enhancing lipid oxidation

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have been proved to improve insulin sensitivity (Lee et al., 2010; Thielecke et al., 2010; Birkenfeld et al., 2011b, 2011c; Kumashiro et al., 2013; Perry et al., 2013; Neuschafer-Rube et al., 2014).

NPs could ameliorate lipid-induced insulin resistance through improvements in hepatic (Birkenfeld et al., 2008) and muscular (Engeli et al., 2012) lipid oxidation. In line with the notion, NPs preserve mito-chondrial function and insulin sensitivity in high fat feeding in mice (Miyashita et al., 2009). Cross sectional studies support the hypothesis that NPs protect from the development of T2D and are explained in detail below. Investigation of the effect of BNP on insulin sensitivity in individuals with impaired glucose tolerance or frank diabetes in men would be of interest now that data on healthy participants are available.

4.6. Natriuretic peptides in food intake and satiety

As mentioned above, NPRB, the CNP receptor, is predominantly found in the brain. Therefore it has been suggested that CNP might play a role in the central regulation of energy metabolism and food intake. The hypothesis is supported by a recent study testing intra-cerebroventricular application of different CNP variants in mice. The intervention substantially decreased food intake after a 48 h-fast and nocturnal food intake, whereas intraperitoneal CNP injection did not alter feeding behavior. Anorexigenic effects of CNP are evoked by melanocortin system activation as well as suppression of orexigenic mediators such as ghrelin and neuropeptide Y (NPY) (Yamada-Goto et al., 2013). In human subjects, short-term BNP infusion suppress hunger, perhaps by decreasing total and acetylated ghrelin concentrations (Vila et al., 2012). However, regulation of food intake is complex and NP influence on hunger and satiety is a still emerging research field. To date, it is unknown whether BNP's anorexigenic effects are mediated by stimulation of hypothalamic AMP-activated protein kinase (AMPK) through ghrelin, or another regulator of hypothalamic AMPK activity.

Insulin, glucose and certain fatty acids might be involved in the regulation of satiety through BNP (Jens Jordan & Birkenfeld, 2012). Additionally, high BNP levels are associated with suppressed levels of the anorexigenic adipokine leptin in heart failure patients, suggesting a regulatory effect of the NP system on leptin release. An increase in food intake may ensue (Melenovsky et al., 2013). Clearly, the effect of NP on leptin release warrants careful clinical studies to better understand the importance of NP on adipokines such as leptin.

A summary of the metabolic actions and phenotypes of NP animal models and human polymorphisms is given in Table 1.

5. Natriuretic peptides in human cardiometabolic disease

5.1. Natriuretic peptides in obesity

During the last years, numerous studies demonstrated an inverse relationship between circulating NP levels and bodyweight (Wang et al., 2004; Das et al., 2005; Olsen et al., 2005; Sugisawa et al., 2010; Khan et al., 2011; Cannone et al., 2013). This correlation can also be observed in chronic heart failure patients, despite increased NP levels, due to cardiac wall stress (Stavrakis et al., 2013).

Increased NP levels due to a genetic C( —55)A polymorphism of the NPRC are associated with lower prevalence of obesity and abdominal adiposity compared to individuals with intact NPRC (Sarzani et al., 2004). Another genetic polymorphism, in the ANP-promoter region, is associated with higher ANP levels and a favorable cardiometabolic phenotype including lower BMI and blood pressure as well as lower prevalence of obesity and metabolic syndrome (Newton-Cheh et al., 2009; Cannone et al., 2011; Arora et al., 2013; Cannone et al., 2013).

However, some studies show discordant results, indicating that there is no or even a positive correlation between BMI and systemic NP concentrations (Grandi et al., 2004; Abdulle et al., 2007). Elevated

Table 1

Metabolic phenotypes.

Genetic variation

NP related effect

Phenotype

Publication

NPRC-/- mice

BNP-Tg mice

cGK-Tg mice

GC-A+/- mice

BNP promoter T-381C polymorphism (humans) rs5068 (humans)

NPRC polymorphism C( -55)A

Neprilysin-/— mice

î ANP î BNP î cGMP

I cGMP-signaling î BNP

î ANP = BNP

î ANP

î bone metabolism, delayed enchondral ossification î long bone growth | blood pressure î urine excretion | WAT mass î energy expenditure | body weight

| visceral and subcutaneous fat mass | diet-induced ectopic fat accumulation î glucose tolerance î muscle mitochondrial content î lipid oxidation rate | body weight

| visceral and subcutaneous fat mass | diet-induced ectopic fat accumulation î glucose tolerance î muscle mitochondrial content î lipid oxidation rate î body weight î fat mass | glucose tolerance | blood glucose levels | T2DM-risk

| blood pressure | BMI and prevalence of obesity

| blood pressure | BMI and prevalence of obesity î body weight î insulin resistance | HDL, î VLDL

Jaubert et al., 1999 Matsukawa et al., 1999 Bordicchia et al., 2012

Miyashita et al., 2009

Miyashita et al., 2009

Miyashita et al., 2009

Meirhaeghe et al., 2007 Choquet et al., 2009

Newton-Cheh et al., 2009 Arora et al., 2013 Cannone et al., 2011,2013 Sarzani et al., 1999,2004

Becker et al., 2010

Correlations between natriuretic peptide system related genetic and cardiometabolic phenotypes Tg transgenic; cGK cGMP dependent protein kinase G; GC-A guanylyl-cyclase; WAT white adipose tissue; T2DM type 2 diabetes mellitus; HDL high-density lipoprotein; VLDL very low- density lipoprotein | increase; | decrease; = no change.

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NT-proBNP levels comparable to heart failure patients with NYHA-stage I have been reported in morbidly obese patients (BMI > 40 kg/m2). However, the authors relate their findings to the enormous cardiac burden secondary to morbid obesity (Hermann-Arnhof et al., 2005). Yet, it is widely agreed obesity is a state of a 'NP'. Differences in sample handling and analytical techniques could contribute to the variability (Buckley et al., 1999; Nowatzke & Cole, 2003; Belenky et al., 2004).

In lean, healthy subjects cardiac NP release is acutely enhanced by physical exercise (Moro et al., 2004a; Scharhag et al., 2005; Frassl et al., 2008; Knebel et al., 2009; Tian et al., 2012; Baker et al., 2013). In marathon runners NT-proBNP increased directly after the run while BNP showed a delayed reaction (Frassl et al., 2008). Interestingly both hormones show a sustained increase during the first 24 h after prolonged running with a delayed return to basal levels more than 24 h after the run (Frassl et al., 2008; Tian et al., 2012).

In contrast to lean subjects, circulating NP levels are suppressed and acute NP responses are blunted in obese individuals (Koppo et al., 2010) but can be restored by long-term physical training (C. Moro et al., 2005; Chen-Tournoux et al., 2010; Changchien et al., 2011; Abrahamsson et al., 2013; Martin et al., 2013). Investigation of a total of 7770 subjects who participated in the Framingham Heart Study and the Malmo Diabetes and Cancer Study revealed that obesity and insulin resistance are associated with markedly reduced plasma NP levels (Khan et al., 2011). Clinically relevant hypercortisolism comes along with central adiposity and the full range of metabolic syndrome symptoms. Despite the metabolic phenotype, NP levels seem to be increased in subjects with hypercortisolism (Yamaji et al., 1988; Tabarin et al., 1990). Elevated NP levels might be attributed to cardiovascular diseases, a major determinant of mortality in hypercortisolism (Mancini et al., 2004; Toja et al., 2012; Shibusawa et al., 2013). Interestingly, NP response appears to be blunted in hypercortisolism, despite elevated NP levels (Sala et al., 2001). However, the role of NP in clinically relevant hypercortisolism is still a controversial issue and alterations in NP

receptor distribution and signaling due to hypercortisolism deserve further investigation.

So far, several potential reasons for the relative NP deficiency in human metabolic disease have been considered. Increased NP degradation could be one possible cause of decreased NP plasma levels in obese individuals. As mentioned before, natriuretic peptides are cleared by neutral endopeptidase neprilysin and NPRC (Maack et al., 1987; Kenny et al., 1993). NPRA and NPRC have been identified in human adipose tissue in abundance, implying that adipose tissue is not just a target organ for NP but also maintains a regulatory influence on circulating NP levels (Sarzani et al., 1996; Nakatsuji et al., 2010; Pivovarova et al., 2012). NPRC is increased in adipose tissue of obese hypertensive patients compared to non-obese and normotensive individuals (Dessi-Fulgheri et al., 1997). Moreover; hyperinsulinemia induces NPRC expression in human adipocytes (Nakatsuji et al., 2010) and monocytes (Pivovarova et al., 2012). Additionally, neprilysin, the NP degrading endopeptidase, is expressed in human adipose tissue and at increased levels in obesity (Standeven et al., 2011). Taken together these findings militate for an accelerated NP clearance due to a shift in the NPRA/NPRC ratio towards NPRC and increased neprilysin levels in human metabolic disease, emerging to a vicious cycle of NP suppression, obesity and insulin resistance (Fig. 4).

In line with the notion, caloric restriction and weight loss can restore BNP levels in humans (Chainani-Wu et al., 2010) and NP signaling in rodents by decreasing adipose tissue NPRC expression (Sarzani et al., 1995). This effect might in parts be attributed to reduced hyperinsulinemia (Chainani-Wu et al., 2010).

Apart from their general association with lower body fat mass, NPs may favorably affect adipose tissue distribution. Increased NP levels are associated with reductions in visceral adipose tissue (VAT) and in ectopic, intra-organ fat deposition such as intrahepatic lipid accumulation (Sarzani et al., 2004; Cheng etal., 2011; Neeland etal., 2013). One possible explanation is increased susceptibility to NP mediated lipolysis in VAT due to increased NP receptor expression in VAT compared to

NP plasma levels

Î Adipose tissue NPRC-expression

f Obesity Ectopic lipid accumulation

\ Insulin-resistance Mitochondrial function

Hyperinsulinemia Hyperglycemia

Fig. 4. Obesity is associated with impaired NP release and increased expression of the NP degrading receptor NPRC, leading to a significant reduction of systemic NP levels. NP deficiency contributes to insulin resistance and mitochondrial dysfunction which in turn lead to hyperglycemia and increased insulin levels resulting in further weight gain. Thus, obesity, insulin resistance and natriuretic peptide deficiency emerge to a viscous cycle.

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subcutaneous adipose tissue (SAT) (Pivovarova et al., 2012). Another possible explanation is that SAT generally exhibits less lipolytic activity than VAT (Arner, 1995).

There are also indications of an impaired cardiac NP release in metabolic diseases. In obese individuals, reduced saline load-induced NP responses were observed as early as 20 years ago (Licata et al., 1994). More recently, a number of studies demonstrated that circulating levels of NT-proANP and NT-proBNP are reduced in obesity, too. As mentioned above, NT-proANP and NT-proBNP are side-products of NP release. These peptides are cleaved of the amino-terminus of the inactive prohormones to produce biologically active ANP and BNP (Yan et al., 2000). The aminoterminal cleavage products of ANP and BNP are structurally distinct from the biologically active peptides making NPRC mediated degradation unlikely (Minami et al., 2004; Das et al., 2005). Mizuno et al. recently observed that differences between BNP levels measured in the aortic root and BNP levels in the coronary sinus are negatively correlated with BMI, supporting the hypothesis of an impaired myocardial NP release in obese individuals (Mizuno et al., 2013). Others observed correlations between NP plasma levels and lean body mass rather than fat mass (Das et al., 2005; Asferg et al., 2013a, 2013b). Interestingly; lower NP levels were strongly related to high glucose and insulin levels independent of body composition and adipose tissue distribution (Asferg et al., 2013a, 2013b).

5.2. Natriuretic peptides in insulin resistance and diabetes

A potential connection between plasma glucose and insulin levels and the natriuretic peptide system has been observed in several studies. Acute hyperglycemia induces a rapid rise of ANP levels in response to hyperglycemia induced sodium and fluid retention (Clark et al., 1993; Böhlen et al., 1994; McKenna et al., 2000). On the other hand, low BNP levels are associated with insulin resistance and type 2 diabetes (T2D) (Kroon et al., 2012). This correlation can be partially explained by the association of T2D and obesity. However; statistical correction for BMI does not abolish the correlation between NP-levels and diabetes onset. Data from the Women's Health Study revealed that individuals with NT-proBNP levels near the upper limit of normal have significantly lower incidence of diabetes (Everett et al., 2013).

Large cross-sectional studies confirm the relationship between low NP concentrations and high glucose and insulin levels, as well as high plasma cholesterol and triglyceride concentrations (Olsen et al., 2005; Wang et al., 2007). Data from a total of 7770 participants in the Framingham Heart Study and the Malmö Diet and Cancer Study revealed that lower NP levels are associated with higher susceptibility to insulin resistance in both lean and obese individuals (Khan et al., 2011). Moreover, in the cohort of the longitudinal Malmö Diet and Cancer Study low NP concentrations were clearly predictive of new-onset diabetes as well as blood glucose level progression over the study period (Magnusson et al., 2012). Correspondingly, increased NP levels seem to be protective against insulin resistance (Neeland et al., 2013) and T2D (Pfister et al., 2011; Cannone et al., 2013; Everett et al., 2013). Along these lines, Heinisch et al. observed that BNP infusion during intravenous glucose tolerance testing lowers blood glucose concentrations transiently by increasing glucose distribution volume in healthy men (Heinisch et al., 2012). These findings suggest that NPs might be protective against T2D due to a direct, insulin-independent anti-hyperglycemic effect, and by increasing lipid oxidation rates and pertaining mitochondrial function as outlines before. Vice versa, NP deficiency contributes and aggravates at least in part metabolic disease, such as insulin resistance and diabetes on the long run.

Another interesting link has recently been discovered between glucagon-like peptide-1 receptor (GLP-1R) agonists and natriuretic peptide release. GLP-1R agonists are a group of antidiabetic drugs that enhance insulin secretion and suppress glucagon release (Drucker & Nauck, 2006). In addition, GLP-1 receptor agonists promote satiety and weight loss while decreasing blood pressure (Ussher & Drucker,

2012). Heart rate tends to increase with GLP-1R agonist treatment. The mechanism of the cardiovascular side effects is still incompletely understood. However, Kim et al. recently demonstrated that the GLP-1R agonist liraglutide induces cardiac ANP release in mice, leading to enhanced natriuresis and vasodilatation (Kim et al., 2013).

53. Natriuretic peptides in cardiovascular diseases

Another facet of metabolic diseases is the link between obesity and arterial hypertension. Obese individuals have a two- to threefold higher prevalence of arterial hypertension compared to lean subjects (Stamler etal., 1978). Although many aspects of obesity related arterial hypertension have been intensively studied during the last years, not all mechanisms are well understood (Aneja et al., 2004; Jordan & Engeli, 2012). In lean healthy individuals, administration of sodium load or vasopressors induces myocardial NP release and consequently enhances natriuresis (Uehlinger et al., 1987; Clinkingbeard et al., 1990; Bruun et al., 2000; Park et al., 2013). The response is impaired in obese individuals (Asferg et al., 2013a, 2013b). Possibly, obesity promotes hypertension partly through reduced direct vascular and renal NP responses as well as impaired NP-mediated RAAS inhibition (Burnett et al., 1984; Shi et al., 2001). NP deficiency might contribute to the development of obesity related hypertension directly through reduced vasodilatation (Protter et al., 1996; van der Zander et al., 1999) and enhanced sodium and water reabsorption (Sonnenberg et al., 1986; Harris et al., 1987; Yoshimura et al., 1991), as well as decreased suppression of the renin-angiotensin-aldosterone-system (RAAS). All of these mechanisms are considered major contributing factors in obese, hypertensive patients (Kurukulasuriya et al., 2011).

Moreover, enhanced sympathetic nervous system activity has been implied in the development of obesity related arterial hypertension. NP have been shown to attenuate muscle sympathetic nerve activity (Floras, 1990,1995), in part by blocking ganglionic neurotransmission (Floras, 1995), thereby attenuating the reflex sympathetic response to baroreceptor deactivation (Floras, 1990). Brunner-La Rocca et al. demonstrated an inhibitory effect on systemic and cardiac sympathetic nervous system activity for BNP at physiological levels (Brunner-La Rocca et al., 2001). Thus, insufficient NP-response might contribute to enhanced sympathetic nervous system activity in the setting of obesity.

Ethnic differences have been reported in the prevalence of cardio-metabolic disease, with a higher prevalence in subjects with African (Taylor et al., 2010; Liu et al., 2013) or Hispanic ancestry (Guzman, 2012) compared to Caucasians. The reasons for these ethnic variances remain elusive. Lifestyle and socioeconomic status are considered to play a major role, however; interracial differences are preserved in Africans and Caucasians with comparable socioeconomic status (Sampson et al., 2014). One possible mechanism might be the inadequately higher RAAS-activity in individuals of African origin (Flack et al., 2010). Interestingly, significant ethnic differences were also found in NT-proBNP levels with the highest levels found in non-Hispanic whites, followed by Hispanics, Chinese and African-Americans in decreasing order (Choi et al., 2012). Due to their metabolic effects and modulatory impact on RAAS activity (Burnett et al., 1984; Johnson et al., 1988; Shi et al., 2001), it seems intriguing to speculate that ethnic differences in developing hypertension and metabolic disease might in part be mediated by variances in circulating NP levels and the resulting change in modulation of the RAAS. However, the issue is still poorly understood and further investigation is needed to elucidate the meaning of interracial differences in the NP system.

Apart from their impact on blood pressure regulation, NPs also seem to have a beneficial effect cardiac remodeling in essential hypertension, reducing left ventricular hypertrophy (LVH) (Rubattu et al., 2006). Conversely, conditions associated with NP deficiency result in an increased risk for cardiac hypertrophy in hypertensive patients. Rubattu et al. demonstrated that hypertensive patients with metabolic syndrome have lower ANP and NT-proBNP levels, higher cardiac mass and higher

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prevalence of LV hypertrophy compared to hypertensive subjects without metabolic syndrome (Rubattu et al., 2007).

All in all, these findings suggest that lower NP levels are associated with obesity and increased risk of metabolic and cardiovascular disease, while higher NP levels come along with a more favorable cardiometa-bolic phenotype.

5.4. Natriuretic peptides in heart failure and cardiac cachexia

Severe chronic heart failure (CHF) is associated with metabolic alterations and cardiac cachexia. A number of immunological and neurohormonal processes are involved in the genesis of heart failure-induced cachexia, reviewed in (von Haehling et al., 2007; Martins et al., 2013). The pathophysiology of cardiac cachexia is multifactorial, resulting from several factors interacting in a complex system with metabolic, immune and neurohormonal consequences, probably triggered to protect the heart from damage (Martins et al., 2013). Systemic NP levels are elevated in CHF due to cardiac wall stress resulting from increased end diastolic pressure. BNP and NT-proBNP have been well established as diagnostic and prognostic markers for heart failure patients (Cowie et al., 2003; Rothenburger et al., 2004; Januzzi et al., 2005; Fonarow et al., 2007). With respect to their lipolytic properties and activation of oxidative metabolism natriuretic peptides might contribute to weight loss and cachexia in heart failure (McCord et al., 2004; McEntegart et al., 2007 ; Polak et al., 2011 ) and evidence has been given in numerous studies that high NP levels are associated with cardiac cachexia (Horwich et al., 2001; Lavie et al., 2003; Melenovsky et al., 2013; Stavrakis et al., 2013). However, through improvements in muscular oxidative function, NP could also counteract the muscle fiber type switch in heart failure patients. Patients with chronic heart failure feature relative reductions in oxidative type 1 muscle fibers, which further limits aerobic exercise capacity.

These mechanisms are only plausible when NP mediated metabolic responses do not desensitize due to chronic NP excess in heart failure. We have addressed the question whether or not the ex vivo lipolytic response to ANP is attenuated in isolated adipocytes from patients with severely impaired left ventricular function in part through changes in the NP receptor expression. We observed that the adipose tissue NP system does not desensitize in heart failure patients, as evidenced by a preserved lipolytic response to ANP (Birkenfeld et al., 2011a). The finding has been confirmed in different clinical settings (Polak et al., 2011; Szabo et al., 2013). Whether metabolic responses to NP are also preserved in skeletal muscle is unknown.

6. Therapeutic potential of natriuretic

peptides in metabolic syndrome and its components

6.1. Cardiovascular disease

Recombinant NP analogs such as Carperitide (synthetic ANP) or Nesiritide (synthetic BNP) have been approved for intravenous treatment of acutely decompensated heart failure in Japan and the US. However, the short plasma half life (Astrup et al., 1985), the need for intravenous or subcutaneous infusion, and adverse events such as relevant hypotension requiring drug discontinuation limit the clinical utility (Suwa et al., 2005; Suzuki et al., 2013).

In the past, the recombinant BNP analog Nesiritide was widely used for the treatment of acute decompensated heart failure in the US. However, standard dose Nesiritide treatment increased mortality and worsened renal function (Sackner-Bernstein et al., 2005a, 2005b). Thus far, there is no evidence for a significant benefit of Nesiritide treatment in heart failure from placebo-controlled clinical trials (Yancy et al., 2008; O'Connor et al., 2011; Topol, 2011). Perhaps, Nesiritide may have a neutral or even protective influence on renal function when applied in non-hypotensive doses (Chen et al., 2007; Mentzeretal., 2007; Witteles

et al., 2007). In patients with congestive heart failure and reduced renal function, the effect seems to be neutral (H.H. Chen et al., 2013).

More recently, Nesiritide has been tested in pulmonary hypertension patients. Nesiritide infusion reduced pulmonary artery and right ventricular pressures in these patients (Michaels et al., 2005; T. Chen et al., 2013).

Another option to augment the NP system is to block NP clearance. In animal models inhibition of the NP degrading neutral endopeptidase neprilysin increased NP plasma levels and promoted diuresis (Good et al., 1995). In clinical trials, monotherapy with neutral endopeptidase inhibitors showed poor results, so far. Acute and chronic effects on cardiac output, vascular tone and blood pressure were minor (Northridge etal., 1989; Bevanetal., 1992). Although neprilysin inhibitors in general are well tolerated, long-term treatment with high doses of certain neprilysin inhibitors, was associated with severe adverse events such as severe aplastic anemia and angioedema (Cleland & Swedberg, 1998).

Combined neprilysin and RAAS inhibition may overcome the limited efficacy of neprilysin inhibitor monotherapy but is not without risks. Recent in vivo data from animal models indicate that dual inhibition of the RAAS and augmentation of the NP system might decelerate tachycardia-induced left ventricular hypertrophy and chronic heart failure progression (Birner et al., 2012). Yet, the dual vasopeptidase inhibitor Omapatrilat that blocked ACE and neprilysin had to be withdrawn from the market owing to an excessive angioedema risk. More recently, a large scale trial with 1328 mild to moderately hypertensive patients confirmed that dual inhibition of angiotensin II subtype 1 receptors and neprilysin with LCZ696 decreases blood pressure more than angiotensin II subtype 1 receptor blockade alone (Ruilope et al., 2010). LCZ696 is an unusual compound comprised of the angiotensin II subtype 1 receptor blocker Valsartan tied to a neprilysin inhibitor through an ester bond. The treatment is in late stage clinical development for the treatment of heart failure and arterial hypertension.

Besides direct NP agonistic or augmenting strategies, other pharmacological strategies yield at downstream mediators of the NPRA dependent pathway. Phosphodiesterase 5 (PDE5) inhibition selectively blocks cyclic GMP degradation (Omori & Kotera, 2007), NPRA's and NPRB's second messenger (Waldman et al., 1984; Song et al., 1988). So far, phosphodiesterase inhibitors have been approved for the treatment of pulmonary hypertension (Galie et al., 2009) as well as demand actuated medication for the treatment of erectile dysfunction. In general, PDE5-inhibitors are well tolerated when contraindications such as use of nitrates in coronary heart disease are heeded (Bruzziches et al., 2013). Sildenafil is a highly selective PDE-5 inhibitor augmenting cGMP signaling (Glossmann et al., 1999). Sildenafil treatment may slow down disease progression in early, asymptomatic diabetic cardiomyopathy (Giannetta et al., 2012) and improve left ventricular function in heart failure (Guazzi et al., 2011).

Novel strategies exploiting desirable cardiovascular effects of NPs for the prevention and treatment of cardiovascular diseases are a matter of ongoing preclinical and clinical research. Thus far, the ideal way to clinically manipulate the NP system has not been found.

6.2. Metabolic disease

The that NP could therapeutic strategy in obesity, the metabolic syndrome, or T2D has been recently entertained (Costello-Boerrigter, 2013). Indeed, by improving lipid mobilization, oxidative metabolism, and blood pressure, NPs address a root cause of these disorders. Regular physical training can restore circulating NP concentrations and NP effectiveness in obese individuals (Moro et al., 2005) in addition to the known beneficial effects on improving weight loss, insulin sensitivity, and cardiovascular risk (Goodpaster et al., 2003; Houmard et al., 2004). Endurance training also improves skeletal muscle oxidative capacity (Pruchnic et al., 2004). Recent experimental data suggest that the positive effects of physical training are at least in part caused by exercise-induced NP elevation in rodents (Mitsuishi et al., 2008;

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Engeli et al., 2012). As mentioned above, in a murine model, increased BNP levels were protective against diet induced obesity and insulin resistance (Miyashita et al., 2009) and large cross sectional studies confirm these data in human subjects (Sarzani et al., 2004). Moreover, higher NP levels were also associated with a more favorable lipid profile comprising lower circulating LDL and higher HDL concentrations (Pervanidou et al., 2009; Wang et al., 2013). These findings suggest that NPs might be protective against dyslipidemia, which conveys increased cardiovascular risk in obesity and T2DM.

Dual ACE and neprilysin inhibition improved insulin sensitivity in diabetic rats (Wang et al., 2003). The authors related the effect to increased bradykinin levels and stimulation of the bradykinin receptor B2. Regrettably, natriuretic peptide levels were not measured. Also, other dual vasopeptidase inhibitors may improve microvascular circulation including endoneurial blood flow, which genesis of diabetic polyneuropathy (Davidson et al., 2007; Oltman et al., 2009).

Downstream mediators of the NPRA pathway may also provide treatment targets. Natriuretic peptides are considered to facilitate their metabolic effects mainly via cGMP dependent GK-I activation. (Sengenès et al., 2003; Mitsuishi et al., 2008; Miyashita et al., 2009). Thus, activation of GK-I by other means is likely to have a similar impact on energy homeostasis (Miyashita et al., 2009; Mitschke et al., 2013). A well-known pharmacological target is phosphodiesterase-5 that degrades cyclic GMP. In murine models, long-term treatment with the PDE-5 inhibitor Sildenafil improves skeletal muscle metabolic index, diet-induced insulin resistance and weight-gain (Ayala et al., 2007; Rizzo et al., 2010; Handa et al., 2013). These findings are consistent with the idea that augmented cGMP signaling rescues mitochondrial function and promotes mitochondrial biogenesis.

Given their effects on mitochondrial metabolism, on lipid and glucose metabolism, and on arterial blood pressure, NPs provide a particularly promising target for the treatment of obesity and its related diseases. To date, many anti-obesity drugs were withdrawn from the market due to their unfavorable cardiovascular profile. In contrast, NP system manipulation is a promising approach to simultaneously address common cardiovascular and metabolic conditions.

7. Novel pharmacologic approaches

New strategies are needed to make the NP amenable for more chronic treatments. CD-NP is a novel, chimeric NP analog that is ligand to both natriuretic peptide receptors A and B and is more resistant to proteolytic degradation compared to ANP and BNP. CD-NP is a fusion product of CNP and the carboxyterminus of dendroaspis natriuretic peptide (DNP) from the venom of the green mamba snake. Due to its DNP-carboxyterminal tail CD-NP has a 13-, 4-, and threefold increased half-life compared to ANP, BNP and CNP respectively (Dickey & Potter, 2011). CD-NP was designed to generate a peptide that combines "the cardiac unloading, antiproliferative, antifibrotic, and minimal hypotensive properties of CNP with the renal-enhancing actions of DNP" (McKie et al., 2010) and minimal adverse side effects. First data in humans confirms significant natriuretic and diuretic effects as well as RAAS suppressing properties with only slight changes in arterial blood pressure (Lee et al., 2009). Recently, long-term subcutaneous treatment with CD-NP was found to significantly attenuate left ventricular fibrosis in rats with unilateral nephrectomy-induced cardiac fibrosis (Martin et al., 2013). Current approaches yield at CD-NP-eluting patches that can be applied locally for the treatment of localized myocardial fibrosis, as for example after myocardial infarction (Ng et al., 2013).

Another novel natriuretic peptide receptor-A (NPR-A) agonist PL-3994 (Hept-cyclo(Cys-His-Phe-d-Ala-Gly-Arg-d-Nle-Asp-Arg-Ile-Ser-Cys)-Tyr-[Arg mimetic]-NH(2)), has been designed and proven high affinity to NPRA. PL-3994 induces a sustained cGMP generation in NPRAs. Interestingly, PL-3994 has been reported to be resistant to degradation by human neutral endopeptidase. Thus, PL-3994 might have a profile

predictive of longer clinical activity than other related peptides (Edelson et al., 2013).

Pegylation, the covalent binding of poly(ethylene glycol) (PEG) to peptides and proteins, is another approach to prolong substance release and to delay degradation (Roberts et al., 2002; Veronese & Pasut, 2005; Werle & Bernkop-Schnürch, 2006). Nesher et al. reversibly pegylated ANP and thereby achieved prolonged elevation of ANP plasma levels and blood pressure reduction in hypertensive rats (Nesher et al., 2007). More recently; ANP has been fused to the Fc-domain of immunoglobulin G (IgG) reaching plasma half-times approximately 2 orders of magnitude longer than unfused ANP (Mezo et al., 2012). However, Fc-ANP was significantly weaker than the unconjugated peptide.

Recently, the Wang lab described miRNA-425 (miR-425) as a novel negative regulator of ANP expression. miR-425 is expressed in human atria and ventricles and silenced NPPA mRNA in an allele-specific manner (Arora et al., 2013). Possibly, miR-425 antagonists could be designed to increase ANP levels in order to treat disorders of salt overload, including hypertension and heart failure and metabolic disease.

8. Conclusion

Natriuretic peptides are well known for their renal and cardiovascular effects. They are widely used as prognostic biomarkers in heart failure and a number of therapeutic strategies aim to exploit the hypotensive, natriuretic and antihypertrophic properties of the NP system. Metabolic and cardiovascular diseases are closely linked and constitute a major public health issue in industrialized countries. A growing body of evidence indicates that NPs might be a crucial piece of the puzzle linking the heart to energy metabolism. In paradigm, the heart can be regarded a sensor chaperoning whole body lipid and glucose metabolism. Connecting cardiovascular and energy metabolism, the NP system provides a bouquet of options for pharmacological intervention. To date, recombinant peptides and inhibitors of the degradation process of NP are the most promising molecules in this regard. Moreover, mi-RNA 425 has recently shown to be a regulator of ANP and as such, might be a suitable target to increase ANP concentrations. Time will show, if it will be possible to.

Conflict of interest

We do not have any actual or potential conflict of interest including any financial, personal or other relationships with individuals or organizations within three years of initiating the work that could inappropriately influence, or be perceived to influence, the study design or data Interpretation of our work.

Acknowledgment

ALB was supported by a grant from the German Research Foundation (BI1292/4-1 and BI1292/5-1), the German Hypertension League and the Deusches Zentrum für Herz-Kreislaufforschung (DZHK).JS was supported by the Deusches Zentrum für Herz-Kreislaufforschung (DZHK), the German Research Foundation (KFO218/2) and ICEMED (Helmholtz-Alliance).

References

Abdulle, A.M., Nagelkerke, N. J.D., Adem, A., Abouchacra, S., Pathan, J. Y., Al-Rukhaimi, M., et al. (2007). Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population. J Hum Hypertens 21, 647-653. Abrahamsson, N., Engström, B., Sundbom, M., & Karlsson, F. A. (2013). Gastric bypass

surgery elevates NT-ProBNP levels. Obes Surg 23,1421-1426. Ahmadian, M., Wang, Y., & Sul, H. S. (2010). Lipolysis in adipocytes. IntJBiochem Cell Biol 42, 555-559.

Aneja, A., El-Atat, F., McFarlane, S. I., & Sowers, J.R (2004). Hypertension and obesity.

Recent Prog Horm Res 59,196-205. Arner, P. (1995). Differences in lipolysis between human subcutaneous and omental adipose tissues. Ann Med 27,435-438.

ARTICLE IN PRESS

12 N. Schlueter et al. / Pharmacology & Therapeutics xxx (2014) xxx-xxx

Arora, P., Wu, C., Khan, A.M., Bloch, D. B., Davis-Dusenbery, B. N., Ghorbani, A., et al. (2013). Atrial natriuretic peptide is negatively regulated by microRNA-425. J Clin Invest 123, 3378-3382.

Asferg, C. L., Nielsen, S. r. J., Andersen, U. B., Linneberg, A., Moller, D.V., Hedley, P. L., et al. (2013a). Metabolic rather than body composition measurements are associated with lower serum natriuretic peptide concentrations in normal weight and obese men. Am J Hypertens 27, 620-627.

Asferg, C. L., Nielsen, J., S.r., Andersen, U. B., Linneberg, A., Moller, D. V., Hedley, P. L., et al. (2013b). Relative atrial natriuretic peptide deficiency and inadequate renin and angiotensin ii suppression in obese hypertensive men. Hypertension 62,147-153.

Astrup, A., Lundsgaard, C., Madsen, J., & Christensen, N. J. (1985). Enhanced thermogenic responsiveness during chronic ephedrine treatment in man. Am J Clin Nutr42,83-94.

Ayala, J. E., Bracy, D. P., Julien, B.M., Rottman, J. N., Fueger, P. T., & Wasserman, D. H.

(2007). Chronic treatment with sildenafil improves energy balance and insulin action in high fat-fed conscious mice. Diabetes 56,1025-1033.

Azizi Ghanbari, A., Dörr, R., Spitzer, S., Stumpf, J., Britz, A., Amann-Zalan, I., et al. (2013). Adiponectin in coronary heart disease and newly diagnosed impaired glucose tolerance. Diab Vasc Dis Res 10,452-458.

Baker, P., Davies, S. L., Larkin,J., Moult, D., Benton, S., Roberts, A., et al. (2013). Changes to the cardiac biomarkers of non-elite athletes completing the 2009 London Marathon. EmergMed J. PMID:23513235.

Becker, M., Siems, W. -E., Kluge, R., Gembardt, F., Schultheiss, H. -P., Schirner, M., et al. (2010). New Function for an Old Enzyme: NEP Deficient Mice Develop Late-Onset Obesity. PLoS ONE 5, e12793.

Belenky, A., Smith, A., Zhang, B., Lin, S., Despres, N., Wu, A. H. B., et al. (2004). The effect of class-specific protease inhibitors on the stabilization of B-type natriuretic peptide in human plasma. Clin ChimActa 340,163-172.

Belo, N. O., Sairam, M. R., & dos Reis, A.M. (2008). Impairment of the natriuretic peptide system in follitropin receptor knockout mice and reversal by estradiol: implications for obesity-associated hypertension in menopause. Endocrinology 149,1399-1406.

Bevan, E. G., Connell, J. M., Doyle, J., Carmichael, H. A., Davies, D. L., Lorimer, A.R., et al. (1992). Candoxatril, a neutral endopeptidase inhibitor: efficacy and tolerability in essential hypertension. J Hypertens 10,607-613.

Birkenfeld, A. L., Adams, F., Schroeder, C., Engeli, S., & Jordan, J. (2011). Metabolic actions could confound advantageous effects of combined angiotensin II receptor and neprilysin inhibition. Hypertension 57, e4-e5.

Birkenfeld, A. L., Boschmann, M., Engeli, S., Moro, C., Arafat, A.M., Luft, F. C., et al. (2012). Atrial natriuretic peptide and adiponectin interactions in man. PLoS One 7, e43238.

Birkenfeld, A. L., Boschmann, M., Moro, C., Adams, F., Heusser, K., Franke, G., et al. (2005). Lipid mobilization with physiological atrial natriuretic peptide concentrations in humans. J Clin Endocrinol Metab 90,3622-3628.

Birkenfeld, A. L., Boschmann, M., Moro, C., Adams, F., Heusser, K., Tank, J., et al. (2006). ß-Adrenergic and atrial natriuretic peptide interactions on human cardiovascular and metabolic regulation. J Clin Endocrinol Metab 91, 5069-5075.

Birkenfeld, A. L., Budziarek, P., Boschmann, M., Moro, C., Adams, F., Franke, G., et al.

(2008). Atrial natriuretic peptide induces postprandial lipid oxidation in humans. Diabetes 57, 3199-3204.

Birkenfeld, A. L., Lee, H. Y., Guebre-Egziabher, F., Alves, T. C., Jurczak, M. J., Jornayvaz, F. R., et al. (2011). Deletion of the mammalian INDY homolog mimics aspects of dietary restriction and protects against adiposity and insulin resistance in mice. Cell Metab 14,184-195.

Birkenfeld, A. L., Lee, H. Y., Majumdar, S., Jurczak M. J., Camporez, J. P., Jornayvaz, F. R., et al. (2011). Influence of the hepatic eukaryotic initiation factor 2alpha (eIF2alpha) endoplasmic reticulum (ER) stress response pathway on insulin-mediated ER stress and hepatic and peripheral glucose metabolism. J Biol Chem 286, 36163-36170.

Birkenfeld, A. L., & Shulman, G. I. (2014). Non alcoholic fatty liver disease, hepatic insulin resistance and type 2 diabetes. Hepatology 59, 713-723.

Birner, C., Ulucan, C., Bratfisch, M., Götz, T., Dietl, A., Schweda, F., et al. (2012). Antihypertrophic effects of combined inhibition of the renin-angiotensin system (RAS) and neutral endopeptidase (NEP) in progressive, tachycardia-induced experimental heart failure. Naunyn Schmiedebergs Arch Pharmacol 385,1117-1125.

Böhlen, L., Ferrari, P., Papiri, M., Allemann, Y., Shaw, S., & Wiedmann, P. (1994). Atrial na-triuretic factor increases in response to an acute glucose load. J Hypertens 12, 803-807.

Bordicchia, M., Liu, D., Amri, E. Z., Ailhaud, G., Dessi-Fulgheri, P., Zhang, C., et al. (2012). Cardiac natriuretic peptides act via p38 MAPK to induce the brown fat thermogenic program in mouse and human adipocytes. J Clin Invest 122,1022-1036.

Brunner-La Rocca, H. P., Kaye, D.M., Woods, R L., Hastings, J., & Esler, M.D. (2001). Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects. J Am Coll Cardiol 37,1221-1227.

Bruun, N. E., Dige-Pedersen, H., & Skott, P. (2000). Normal responses of atrial natriuretic factor and renal tubular function to sodium loading in hypertension-prone humans. Blood Press 9,206-213.

Bruzziches, R., Francomano, D., Gareri, P., Lenzi, A., & Aversa, A. (2013). An update on pharmacological treatment of erectile dysfunction with phosphodiesterase type 5 inhibitors. Expert Opin Pharmacother 14,1333-1344.

Bryan, P.M., Smirnov, D., Smolenski, A., Feil, S., Feil, R., Hofmann, F., et al. (2006). A sensitive method for determining the phosphorylation status of natriuretic peptide receptors: cGK-Ialpha does not regulate NpR-A Biochemistry 45,1295-1303.

Buckley, M. G., Marcus, N. J., & Yacoub, M. H. (1999). Cardiac peptide stability, aprotinin and room temperature: importance for assessing cardiac function in clinical practice. Clin Sci 97, 689-695.

Burnett, J. C., Granger, J. P., & Opgenorth, T. J. (1984). Effects of synthetic atrial natri-uretic factor on renal function and renin release. Am J Physiol Renal Physiol 247, F863-F866.

Moro, C. d., Polak, J., Richterova, B., Sengenes, C., Pelikanova, T., Galitzky, J., et al.

(2005). Differential regulation of atrial natriuretic peptides and adrenergic receptor dependent lipolytic pathways in human adipose tissue. Metabolism 54, 122-131.

Cannone, V., Boerrigter, G., Cataliotti, A., Costello-Boerrigter, L. C., Olson, T. M., McKie, P.M., et al. (2011). A genetic variant of the atrial natriuretic peptide gene is associated with cardiometabolic protection in the general community. J Am Coll Cardiol 58, 629-636.

Cannone, V., Cefalu', A.B., Noto, D., Scott, C. G., Bailey, K. R., Cavera, G., et al. (2013). The atrial natriuretic peptide genetic variant rs5068 is associated with a favorable cardiometabolic phenotype in a Mediterranean population. Diabetes Care 36, 2850-2856.

Cao, W., Daniel, K. W., Robidoux, J., Puigserver, P., Medvedev, A. V., Bai, X., et al. (2004). p38 mitogen-activated protein kinase is the central regulator of cyclic AMP-dependent transcription of the brown fat uncoupling protein 1 gene. Mol Cell Biol 24, 3057-3067.

Cao, W., Medvedev, A. V., Daniel, K. W., & Collins, S. (2001). beta-Adrenergic activation of p38 MAP kinase in adipocytes: cAMP induction of the uncoupling protein 1 (UCP1) gene requires p38 MAP kinase. J Biol Chem 276,27077-27082.

Carey, A. L., & Kingwell, B.A. (2013). Brown adipose tissue in humans: therapeutic potential to combat obesity. Pharmacol Ther 140, 26-33.

Chainani-Wu, N., Weidner, G., Purnell, D.M., Frenda, S., Merritt-Worden, T., Kemp, C., et al. (2010). Relation of B-type natriuretic peptide levels to body mass index after comprehensive lifestyle changes. Am J Cardiol 105,1570-1576.

Changchien, E., Ahmed, S., Betti, F., Higa,J., Kiely, K., Hernandez-Boussard, T., etal. (2011). B-type natriuretic peptide increases after gastric bypass surgery and correlates with weight loss. Surg Endosc 25, 2338-2343.

Chen, H. H., Anstrom, K. J., Givertz, M. M., Stevenson, L. W., Semigran, M. J., Goldsmith, S. R., et al. (2013). Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA 310, 2533-2543.

Chen, T., Jiang, N., Wang, L., Guo, Z., Han, J., Jing, S., et al. (2013). The significance of natriuretic peptide in treatment of pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg 47,1362-1367.

Chen, H. H., Sundt, T. M., Cook, D. J., Heublein, D.M., & Burnett, J. C. (2007). Low dose nesiritide and the preservation of renal function in patients with renal dysfunction undergoing cardiopulmonary-bypass surgery: a double-blind placebo-controlled pilot study. Circulation 116,1-134-I-138.

Cheng, S., Fox, C. S., Larson, M. G., Massaro, J. M., McCabe, E. L., Khan, A.M., et al. (2011). Relation of visceral adiposity to circulating natriuretic peptides in ambulatory individuals. Am J Cardiol 108, 979-984.

Chen-Tournoux, A., Khan, A.M., Baggish, A. L., Castro, V. M., Semigran, M. J., McCabe, E. L., et al. (2010). Effect of weight loss after weight loss surgery on plasma N-terminal pro-B-type natriuretic peptide levels. Am J Cardiol 106,1450-1455.

Choi, E. -Y., Bahrami, H., Wu, C. O., Greenland, P., Cushman, M., Daniels, L. B., etal. (2012). N-terminal pro-B-type natriuretic peptide, left ventricular mass, and incident heart failure: multi-ethnic study of atherosclerosis. Circ Heart Fail 5, 727-734.

Choi, Y. H., Park, S., Hockman, S., Zmuda-Trzebiatowska, E., Svennelid, F., Haluzik, M., et al.

(2006). Alterations in regulation of energy homeostasis in cyclic nucleotide phospho-diesterase 3B-null mice. J Clin Invest 116, 3240-3251.

Choquet, H. I. n, Cavalcanti-Proen^a, C., Lecoeur, C. c., Dina, C., Cauchi, S. p., Vaxillaire, M., et al. (2009). The T-381C SNP in BNP gene may be modestly associated with type 2 diabetes: an updated meta-analysis in 49 279 subjects. Human Molecular Genetics 18, 2495-2501.

Chusho, H., Tamura, N., Ogawa, Y., Yasoda, A., Suda, M., Miyazawa, T., et al. (2001). Dwarfism and early death in mice lacking C-type natriuretic peptide. Proc Natl Acad Sci USA 98, 4016-4021.

Clark, B.A., Sclater, A., Epstein, F. H., & Elahi, D. (1993). Effect of glucose, insulin, and hy-pertonicity on atrial natriuretic peptide levels in man. Metabolism 42, 224-228.

Cleland, J. G. F., & Swedberg, K. (1998). Lack of efficacy of neutral endopeptidase inhibitor ecadotril in heart failure. Lancet 351,1657-1658.

Clerico, A., Recchia, F. A., Passino, C., & Emdin, M. (2005). Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications. Am J Physiol Heart Circ Physiol 290, H17-H29.

Clerico, A., Ry Silvia, D., Maffei, S., Prontera, C., Emdin, M., & Giannessi, D. (2002). The circulating levels of cardiac natriuretic hormones in healthy adults: effects of age and sex. Clin Chem Lab Med 40, 371.

Clinkingbeard, C., Sessions, C., & Shenker, Y. (1990). The physiological role of atrial natriuretic hormone in the regulation of aldosterone and salt and water metabolism. J Clin Endocrinol Metab 70,582-589.

Coppack S., Frayn, K., Humphreys, S., Dhar, H., & Hockaday, T. (1989). Effects of insulin on human adipose tissue metabolism in vivo. Clin Sci (Lond) 77, 663-670.

Costello-Boerrigter, L. C. (2013). Cardiac natriuretic peptides: contributors to cardiac cachexia or possible anti-obesity agents or both? Diabetes 61,2403-2404.

Cowie, M. R., Jourdain, P., Maisel, A., Dahlstrom, U., Follath, F., Isnard, R., et al. (2003). Clinical applications of B-type natriuretic peptide (BNP) testing. Eur Heart J 24, 1710-1718.

Cypess, A.M., Lehman, S., Williams, G., Tal, I., Rodman, D., Goldfine, A.B., et al. (2009). Identification and importance of brown adipose tissue in adult humans. N Engl J Med 360, 1509-1517.

Das, S. R., Drazner, M. H., Dries, D. L., Vega, G. L., Stanek H. G., Abdullah, S. M., et al. (2005). Impact of body mass and body composition on circulating levels of natriuretic peptides: results from the Dallas Heart Study. Circulation 112, 2163-2168.

Davidson, E. P., Kleinschmidt, T. L., Oltman, C. L., Lund, D.D., & Yorek, M.A. (2007). Treatment of streptozotocin-induced diabetic rats with AVE7688, a vasopeptidase inhibitor: effect on vascular and neural disease. Diabetes 56, 355-362.

ARTICLE IN PRESS

N. Schlueter et al. / Pharmacology & Therapeutics xxx (2014) xxx-xxx 13

deBold, A. J., Borenstein, H. B., Veress, A. T., & Sonnenberg, H. (1981). A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Life Sci 28, 89-94.

Dessi-Fulgheri, P., Sarzani, R., Tamburrini, P., Moraca, A., Espinosa, E., Cola, G., et al. (1997). Plasma atrial natriuretic peptide and natriuretic peptide receptor gene expression in adipose tissue of normotensive and hypertensive obese patients. J Hypertens 15,

1695-1698.

Dickey, D.M., & Potter, L. R (2011). Dendroaspis natriuretic peptide and the designer natriuretic peptide, CD-NP, are resistant to proteolytic inactivation. J Mol Cell Cardiol 51,67-71.

Drucker, D. J., & Nauck, MA (2006). The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet 368,

1696-1705.

Edelson, J.D., Makhlina, M., Silvester, K. R., Vengurlekar, S. S., Chen, X., Zhang, J., et al. (2013). In vitro and in vivo pharmacological profile of PL-3994, a novel cyclic peptide (Hept-cyclo(Cys-His-Phe-d-Ala-Gly-Arg-d-Nle-Asp-Arg-Ile-Ser-Cys)-Tyr-[Arg mimetic]-NH(2)) natriuretic peptide receptor-A agonist that is resistant to neutral endopeptidase and acts as a bronchodilator. Pulm Pharmacol Ther 26,229-238. Egan, J. J., Greenberg, A. S., Chang, M. K., Wek, S. A., Moos, M. C., & Londos, C. (1992). Mechanism of hormone-stimulated lipolysis in adipocytes: translocation of hormone-sensitive lipase to the lipid storage droplet. Proc Natl Acad Sci U S A 89, 8537-8541.

Engeli, S., Birkenfeld, A. L., Badin, P. -M., Bourlier, V., Louche, K., Viguerie, N., et al. (2012). Natriuretic peptides enhance the oxidative capacity of human skeletal muscle. J Clin Invest 122, 4675-4679. Everett, B.M., Cook, N. R., Chasman, D. I., Magnone, M. C., Bobadilla, M., Rifai, N., et al. (2013). Prospective evaluation of B-type natriuretic peptide concentrations and the risk of type 2 diabetes in women. Clin Chem 59, 557-565. Fain, J. N., Kanu, A., Bahouth, S. W., Cowan, G. S. M., Jr., & Lloyd Hiler, M. (2003). Inhibition of leptin release by atrial natriuretic peptide (ANP) in human adipocytes. Biochem Pharmacol 65,1883-1888. Finer, N., Bloom, S. R., Frost, G. S., Banks, L. M., & Griffiths, J. (2000). Sibutramine is effective for weight loss and diabetic control in obesity with type 2 diabetes: a randomised, double-blind, placebo-controlled study. Diabetes Obes Metab 2,105-112. Flack, J. M., Sica, D. A., Bakris, G., Brown, A. L., Ferdinand, K. C., Grimm, R H., et al. (2010). Management of high blood pressure in blacks: an update of the international society on hypertension in blacks consensus statement. Hypertension 56, 780-800. Floras, J. S. (1990). Sympathoinhibitory effects of atrial natriuretic factor in normal

humans. Circulation 81,1860. Floras, J. S. (1995). Inhibitory effect of atrial natriuretic factor on sympathetic ganglionic

neurotransmission in humans. Am J Physiol 269, R406-R412. Fonarow, G. C., Peacock, W. F., Phillips, C. O., Givertz, M. M., & Lopatin, M. (2007). Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 49,1943-1950. Frassl, W., Kowoll, R., Katz, N., Speth, M., Stangl, A., Brechtel, L., et al. (2008). Cardiac markers (BNP, NT-pro-BNP, troponin I, troponin T, in female amateur runners before and up until three days after a marathon. Clin Lab 54, 81-87. Fried, T., McCoy, R., Osgood, R., & Stein, J. (1986). Effect of atriopeptin II on determinants of glomerular filtration rate in the in vitro perfused dog glomerulus. Am J Physiol 250, 1119-1122.

Furuya, M., Takehisa, M., Minamitake, Y., Kitajima, Y., Hayashi, Y., Ohnuma, N., et al. (1990). Novel natriuretic peptide, CNP, potently stimulates cyclic GMP production in rat cultured vascular smooth muscle cells. Biochem Biophys Res Commun 170, 201-208.

Furuya, M., Yoshida, M., Hayashi, Y., Ohnuma, N., Minamino, N., Kangawa, K., et al. (1991). C-Type natriuretic peptide is a growth inhibitor of rat vascular smooth muscle cells. Biochem Biophys Res Commun 177,927-931. Galie, N., Hoeper, M. M., Humbert, M., Torbicki, A., Vachiery, J. -L., Barbera, J. A., et al. (2009). Guidelines for the diagnosis and treatment of pulmonary hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30, 2493-2537. Galitzky, J., Sengenes, C., Thalamas, C., Marques, M.A., Senard, J. -M., Lafontan, M., et al. (2001). The lipid-mobilizing effect of atrial natriuretic peptide is unrelated to sympathetic nervous system activation or obesity in young men. J Lipid Res 42, 536-544.

Giannetta, E., Isidori, A.M., Galea, N., Carbone, I., Mandosi, E., Vizza, C. D., et al. (2012). Chronic inhibition of cGMP phosphodiesterase 5A improves diabetic cardiomyopa-thy: a randomized, controlled clinical trial using magnetic resonance imaging with myocardial tagging. Circulation 125, 2323-2333. Glossmann, H., Petrischor, G. n., & Bartsch, G. (1999). Molecular mechanisms of the effects

of sildenafil (VIAGRA®). Exp Gerontol 34, 305-318. Good, J. M., Peters, M., Wilkins, M., Jackson, N., Oakley, C. M., & Cleland, J. G. F. (1995). Renal response to candoxatrilat in patients with heart failure. J Am Coll Cardiol 25, 1273-1281.

Goodpaster, B. H., Katsiaras, A., & Kelley, D. E. (2003). Enhanced fat oxidation through physical activity is associated with improvements in insulin sensitivity in obesity. Diabetes 52, 2191-2197. Grandi, A.M., Laurita, E., Selva, E., Piantanida, E., Imperiale, D., Giovanella, L., et al. (2004). Natriuretic peptides as markers of preclinical cardiac disease in obesity. Eur J Clin Invest 34, 342-348.

Guazzi, M., Vicenzi, M., Arena, R., & Guazzi, M.D. (2011). PDE5 inhibition with sildenafil improves left ventricular diastolic function, cardiac geometry, and clinical status in patients with stable systolic heart failure: results of a 1-year, prospective, randomized, placebo-controlled study. Circ Heart Fail 4, 8-17.

Guzman, N. (2012). Epidemiology and management of hypertension in the hispanic population. Am J Cardiovasc Drugs 12,165-178.

Halbirk, M., Norrelund, H., Moller, N., Schmitz, O., Botker, H. E., & Wiggers, H. (2010). Short-term changes in circulating insulin and free fatty acids affect Nt-pro-BNP levels in heart failure patients. Int J Cardiol 144,140-142.

Haller, C. A., & Benowitz, N. L. (2000). Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 343,1833-1838.

Handa, P., Tateya, S., Rizzo, N. O., Cheng, A.M., Morgan-Stevenson, V., Han, C. -Y., et al. (2013). Reduced vascular nitric oxide-cGMP signaling contributes to adipose tissue inflammation during high-fat feeding. Arterioscler Thromb Vasc Biol 31, 2827-2835.

Hara, K., Uchida, T., Takebayashi, K., Sakai, Y., Inoue, T., Inukai, T., et al. (2011). Determinants of serum high molecular weight (HMW) adiponectin levels in patients with coronary artery disease: associations with cardio-renal-anemia syndrome. Intern Med 50, 2953-2960.

Harris, P. J., Thomas, D., & Morgan, T. O. (1987). Atrial natriuretic peptide inhibits angiotensin-stimulated proximal tubular sodium and water reabsorption. Nature 326, 697-698.

Heaton, G. M., Wagenvoord, R.J., Kemp, A., Jr., & Nicholls, D.G. (1978). Brown-adipose-tissue mitochondria: photoaffinity labelling of the regulatory site of energy dissipation. Eur J Biochem 82,515-521.

Heinisch, B. B., Vila, G., Resl, M., Riedl, M., Dieplinger, B., Mueller, T., et al. (2012). B-type natriuretic peptide (BNP) affects the initial response to intravenous glucose: a randomised placebo-controlled cross-over study in healthy men. Diabetologia 55, 1400-1405.

Hermann-Arnhof, K. -M., Hanusch-Enserer, U., Kaestenbauer, T., Publig, T., Dunky, A., Rosen, H. R., et al. (2005). N-terminal pro-B-type natriuretic peptide as an indicator of possible cardiovascular disease in severely obese individuals: comparison with patients in different stages of heart failure. Clin Chem 51,138-143.

Heublein, D.M., Clavell, A. L., Stingo, A. J., Lerman, A., Wold, L., & Burnett, J. C., Jr. (1992). C-type natriuretic peptide immunoreactivity in human breast vascular endothelial cells. Peptides 13,1017-1019.

Hoeks, J., van Baak, M.A., Hesselink, M. K. C., Hul, G. B., Vidal, H., Saris, W. H. M., et al. (2003). Effect of ß1- and ß2-adrenergic stimulation on energy expenditure, substrate oxidation, and UCP3 expression in humans. Am J Physiol Endocrinol Metab 285, E775-E782.

Holtwick, R., van Eickels, M., Skryabin, B. V., Baba, H. A., Bubikat, A., Begrow, F., et al.

(2003). Pressure-independent cardiac hypertrophy in mice with cardiomyocyte-restricted inactivation of the atrial natriuretic peptide receptor guanylyl cyclase-A. J Clin Invest 111,1399-1407.

Horwich, T. B., Fonarow, G. C., Hamilton, M.A., MacLellan, W. R., Woo, M.A., & Tillisch, J. H. (2001). The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 38, 789-795.

Houmard, J. A., Tanner, C. J., Slentz, C. A., Duscha, B.D., McCartney, J. S., & Kraus, W. E.

(2004). Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol 96,101-106.

Jäger, S., Handschin, C., St-Pierre, J., & Spiegelman, B.M. (2007). AMP-activated protein kinase (AMPK) action in skeletal muscle via direct phosphorylation of PGC-1a. Proc NatlAcadSci 104,12017-12022.

Januzzi, J. L., Jr., Camargo, C. A., Anwaruddin, S., Baggish, A. L., Chen, A. A., Krauser, D.G., et al. (2005). The N-terminal Pro-BNP Investigation of Dyspnea in the Emergency department (PRIDE) study. Am J Cardiol 95,948-954.

Jaubert, J., Jaubert, F., Martin, N., Washburn, L. L., Lee, B. K., Eicher, E. M., et al. (1999). Three new allelic mouse mutations that cause skeletal overgrowth involve the natri-uretic peptide receptor C gene (Npr3). Proceedings of the National Academy of Sciences 96,10278-10283.

Jensen, K. T., Carstens, J., & Pedersen, E. B. (1998). Effect of BNP on renal hemody-namics, tubular function and vasoactive hormones in humans. Am J Physiol 274, F63-F72.

Jensen, M., Caruso, M., Heiling, V., & Miles, J. (1989). Insulin regulation of lipolysis in non-diabetic and IDDM subjects. Diabetes 38,1595-1601.

Johnson, A., Lermioglu, F., Garg, U. C., Morgan-Boyd, R., & Hassid, A. (1988). A novel biological effect of atrial natriuretic hormone: inhibition of mesangial cell mitogenesis. Biochem Biophys Res Commun 152, 893-897.

Jordan, J., & Birkenfeld, A. L. (2012). Comment on: Vila et al. B-type natriuretic peptide modulates ghrelin, hunger, and satiety in healthy men. Diabetes 61, 2592-2596.

Jordan, J., & Engeli, S. (2012). Obesity, hypertension, and cardiovascular health: is there anything poor Cassandra tries to tell us? J Hypertens 30,1103-1105.

Kake, T., Kitamura, H., Adachi, Y., Yoshioka, T., Watanabe, T., Matsushita, H., et al. (2009). Chronically elevated plasma C-type natriuretic peptide level stimulates skeletal growth in transgenic mice. Am J Physiol Endocrinol Metab 297, E1339-E1348.

Kangawa, K., Fukuda, A., Kubota, I., Hayashi, Y., & Matsuo, H. (1984). Identification in rat atrial tissue of multiple forms of natriuretic polypeptides of about 3,000 daltons. Biochem Biophys Res Commun 121, 585-591.

Kangawa, K., Fukuda, A., Kubota, I., Hayashi, Y., Minamitake, Y., & Matsuo, H. (1984). Human atrial natriuretic polypeptides (hANP): purification, structure synthesis and biological activity. J Hypertens(Suppl. 2).

Kangawa, K., Fukuda, A., Minamino, N., & Matsuo, H. (1984). Purification and complete amino acid sequence of beta-rat atrial natriuretic polypeptide (ß-rANP) of 5,000 daltons. Biochem Biophys Res Commun 119, 933-940.

Kelly, D. P., & Scarpulla, R. C. (2004). Transcriptional regulatory circuits controlling mito-chondrial biogenesis and function. Genes & Development 18, 357-368.

Kenny, A. J., Bourne, A., & Ingram, J. (1993). Hydrolysis of human and pig brain natriuretic peptides, urodilatin, C-type natriuretic peptide and some C-receptor ligands by endopeptidase-24.11. Biochem J 1(291), 83-88.

ARTICLE IN PRESS

14 N. Schlueter et al. / Pharmacology & Therapeutics xxx (2014) xxx-xxx

Khan, A.M., Cheng, S., Magnusson, M., Larson, M. G., Newton-Cheh, C., McCabe, E. L., et al. (2011). Cardiac natriuretic peptides, obesity, and insulin resistance: evidence from two community-based studies. J Clin Endocrinol Metab 96, 3242-3249.

Kim, M., Platt, M. J., Shibasaki, T., Quaggin, S. E., Backx, P. H., Seino, S., et al. (2013). GLP-1 receptor activation and Epac2 link atrial natriuretic peptide secretion to control of blood pressure. Nat Med 19, 567-575.

Kisch, B. (1956). Electron microscopy of the atrium of the heart. I. Guinea pig. Exp Med Surg 14,99-112.

Kishimoto, I., Rossi, K., & Garbers, D. L. (2001). A genetic model provides evidence that the receptor for atrial natriuretic peptide (guanylyl cyclase-A) inhibits cardiac ventricular myocyte hypertrophy. Proc Natl Acad Sci 98, 2703-2706.

Kistorp, C., Faber, J., Galatius, S. r, Gustafsson, F., Frystyk, J., Flyvbjerg, A., et al. (2005). Plasma adiponectin, body mass index, and mortality in patients with chronic heart failure. Circulation 112,1756-1762.

Klingenberg, M. (1999). Uncoupling protein — a useful energy dissipator. J Bioenerg Biomembr 31,419-430.

Knebel, F., Schimke, I., Schroeckh, S., Peters, H., Eddicks, S., Schattke, S., et al. (2009). Myocardial function in older male amateur marathon runners: assessment by tissue Doppler echocardiography, speckle tracking, and cardiac biomarkers. J Am Soc Echocardiogr 22, 803-809.

Koller, K. J., Lowe, D.G., Bennett, G. L., Minamino, N., Kangawa, K., Matsuo, H., et al. (1991). Selective activation of the B natriuretic peptide receptor by C-type natriuretic peptide (CNP). Science 252,120-123.

Komatsu, Y., Nakao, K., Suga, S. -i, Ogawa, Y., Mukoyama, M., Arai, H., et al. (1991). C-type natriuretic peptide (CNP) in rats and humans. Endocrinology 129,1104-1106.

Koppo, K., Larrouy, D., Marques, M.A., Berlan, M., Bajzova, M., Polak,J., etal. (2010). Lipid mobilization in subcutaneous adipose tissue during exercise in lean and obese humans. Roles of insulin and natriuretic peptides. Am J Physiol Endocrinol Metab 299, E258-E265.

Kroon, M. H., van den Hurk, K., Alssema, M., Kamp, O., Stehouwer, C. D. A., Henry, R. M.A., et al. (2012). Prospective associations of B-type natriuretic peptide with markers of left ventricular function in individuals with and without type 2 diabetes: an 8-year follow-up of the Hoorn Study. Diabetes Care 35,2510-2514.

Kumashiro, N., Beddow, S. A., Vatner, D. F., Majumdar, S. K., Cantley, J. L., Guebre-Egziabher, F., et al. (2013). Targeting pyruvate carboxylase reduces gluconeogenesis and adiposity and improves insulin resistance. Diabetes 62,2183-2194.

Kurukulasuriya, L. R., Stas, S., Lastra, G., Manrique, C., & Sowers, J. R (2011). Hypertension in obesity. Med Clin North Am 95, 903-917.

Lafontan, M., & Langin, D. (2009). Lipolysis and lipid mobilization in human adipose tissue. Prog Lipid Res 48, 275-297.

Lam, C. S. P., Cheng, S., Choong, K., Larson, M. G., Murabito, J. M., Newton-Cheh, C., et al.

(2011). Influence of sex and hormone status on circulating natriuretic peptides. J Am Coll Cardiol 58, 618-626.

Lavie, C. J., Osman, A. F., Milani, R V., & Mehra, M. R (2003). Body composition and prognosis in chronic systolic heart failure: the obesity paradox. Am J Cardiol 91, 891-894.

Lee, C. Y. W., Chen, H. H., Lisy, O., Swan, S., Cannon, C., Lieu, H. D., et al. (2009). Pharma-codynamics pharmacodynamics of a novel designer natriuretic peptide, CD-NP, in a first-in-human clinical trial in healthy subjects. J Clin Pharmacol 49,668-673.

Lee, H. Y., Choi, C. S., Birkenfeld, A. L., Alves, T. C., Jornayvaz, F. R., Jurczak, M. J., et al. (2010). Targeted expression of catalase to mitochondria prevents age-associated reductions in mitochondrial function and insulin resistance. Cell Metab 12, 668-674.

Licata, G., Volpe, M., Scaglione, R., & Rubattu, S. (1994). Salt-regulating hormones in young normotensive obese subjects. Effects of saline load. Hypertension 23, 20-24.

Lin, C. S., & Klingenberg, M. (1980). Isolation of the uncoupling protein from brown adipose tissue mitochondria. FEBS Lett 113, 299-303.

Liu, J., Hickson, D. A., Musani, S. K., Talegawkar, S. A., Carithers, T. C., Tucker, K. L., et al. (2013). Dietary patterns, abdominal visceral adipose tissue, and cardiometabolic risk factors in African Americans: the Jackson heart study. Obesity (Silver Spring) 21, 644-651.

Maack T., Suzuki, M., Almeida, F. A., Nussenzveig, D., Scarborough, R M., McEnroe, G. A., et al. (1987). Physiological role of silent receptors of atrial natriuretic factor. Science 238, 675-678.

Maffei, S., Del Ry, S., Prontera, C., & Clerico, A. (2001). Increase in circulating levels of cardiac natriuretic peptides after hormone replacement therapy in postmenopausal women. Clin Sci 101,447-453.

Magnusson, M., Jujic, A., Hedblad, B., Engström, G., Persson, M., Struck, J., et al.

(2012). Low plasma level of atrial natriuretic peptide predicts development of diabetes: the Prospective Malmö Diet and Cancer Study. J Clin Endocrinol Metab 97, 638-645.

Mahmoodzadeh, S., Pham, T. H., Kuehne, A., Fielitz, B., Dworatzek, E., Kararigas, G., et al. (2012). 17beta-Estradiol-induced interaction of ERa with NPPA regulates gene expression in cardiomyocytes. Cardiovasc Res 96,411 -421.

Maisel, A. S., Krishnaswamy, P., Nowak, R. M., McCord, J., Hollander, J. E., Duc, P., et al. (2002). Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347,161-167.

Mancini, T., Kola, B., Mantero, F., Boscaro, M., & Arnaldi, G. (2004). High cardiovascular risk in patients with Cushing's syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol (Oxf) 61, 768-777.

Marin-Grez, M., Fleming, J. T., & Steinhausen, M. (1986). Atrial natriuretic peptide causes pre-glomerular vasodilatation and post-glomerular vasoconstriction in rat kidney. Nature 324, 473-476.

Martin, J., Bergeron, S., Pibarot, P., Bastien, M., Biertho, L., Lescelleur, O., et al. (2013). Impact of bariatric surgery on N-terminal fragment of the prohormone brain natriuretic peptide and left ventricular diastolic function. Can J Cardiol 29, 969-975.

Martins, T., Vitorino, R., Moreira-Goncalves, D., Amado, F., Duarte, J. A., & Ferreira, R (2013). Recent insights on the molecular mechanisms and therapeutic approaches for cardiac cachexia. Clin Biochem 47, 5-18.

Matsukawa, N., Grzesik, W. J., Takahashi, N., Pandey, K. N., Pang, S., Yamauchi, M., et al. (1999). The natriuretic peptide clearance receptor locally modulates the physiological effects of the natriuretic peptide system. PNAS 96, 7403-7408.

McCord, J., Mundy, B. J., Hudson, M. P., et al. (2004). Relationship between obesity and b-type natriuretic peptide levels. Arch Intern Med 164,2247-2252.

McEntegart, M. B., Awede, B., Petrie, M. C., Sattar, N., Dunn, F. G., MacFarlane, N. G., et al. (2007). Increase in serum adiponectin concentration in patients with heart failure and cachexia: relationship with leptin, other cytokines, and B-type natriuretic peptide. Eur Heart J 28, 829-835.

McKenna, K., Smith, D., Tormey, W., & Thompson, C. J. (2000). Acute hyperglycaemia causes elevation in plasma atrial natriuretic peptide concentrations in type 1 diabetes mellitus. DiabetMed 17,512-517.

McKie, P.M., Sangaralingham, S. J., & Burnett, J. C.J. (2010). CD-NP: an innovative designer natriuretic peptide activator of particulate guanylyl cyclase receptors for cardiorenal disease. Curr Heart Fail Rep 7, 93-99.

Melenovsky, V., Kotrc, M., Borlaug, B.A., Marek, T., Kovar, J., Malek I., et al. (2013). Relationships between right ventricular function, body composition, and prognosis in advanced heart failure. J Am Coll Cardiol 62,1660-1670.

Meirhaeghe, A., Sandhu, M. S., McCarthy, M. I., de Groote, P., Cottel, D., Arveiler, D., et al. (2007). Association between the T-381C polymorphism of the brain natriuretic peptide gene and risk of type 2 diabetes in human populations. Human Molecular Genetics 16,1343-1350.

Mentzer, R M., Jr., Oz, M. C., Sladen, R N., Graeve, A. H., Hebeler, R F., Jr., Luber, J. M., Jr., et al. (2007). Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA Trial. J Am Coll Cardiol 49, 716-726.

Mezo, AR, McDonnell, K. A., Low, S.C., Song, J., Reidy, T. J., Lu, Q., et al. (2012). Atrial natriuretic peptide-Fc, ANP-Fc, fusion proteins: semisynthesis, in vitro activity and pharmacokinetics in rats. Bioconjug Chem 23, 518-526.

Michaels, A.D., Chatterjee, K., & De Marco, T. (2005). Effects of intravenous nesiritide on pulmonary vascular hemodynamics in pulmonary hypertension. J Card Fail 11, 425-431.

Minami, J., Nishikimi, T., & Matsuoka, H. (2004). Plasma brain natriuretic peptide and N-terminal proatrial natriuretic peptide levels in obese patients: a cause or result of hypertension? Circulation 110, e76.

Mitschke, M. M., Hoffmann, L. S., Gnad, T., Scholz, D., Kruithoff, K., Mayer, P., et al. (2013). Increased cGMP promotes healthy expansion and browning of white adipose tissue. FASEBJ 27,1621-1630.

Mitsuishi, M., Miyashita, K., & Itoh, H. (2008). cGMP rescues mitochondrial dysfunction induced by glucose and insulin in myocytes. Biochem Biophys Res Commun 367, 840-845.

Miyashita, K., Itoh, H., Tsujimoto, H., Tamura, N., Fukunaga, Y., Sone, M., et al. (2009). Natriuretic peptides/cGMP/cGMP-dependent protein kinase cascades promote muscle mitochondrial biogenesis and prevent obesity. Diabetes 58,2880-2892.

Mizuno, Y., Harada, E., Katoh, D., Kashiwagi, Y., Morikawa, Y., Nakagawa, H., et al. (2013). Cardiac production of B-type natriuretic peptide is inversely related to the plasma level of free fatty acids in obese individuals — possible involvement of the insulin resistance. Endocr J 60,87-95.

Moro, C., Crampes, F., Sengenes, C., De Glisezinski, I., Galitzky, J., Thalamas, C., et al. (2004). Atrial natriuretic peptide contributes to the physiological control of lipid mobilization in humans. FASEB J 18, 908-910.

Moro, C., Galitzky, J., Sengenes, C., Crampes, F., Lafontan, M., & Berlan, M. (2004). Functional and pharmacological characterization of the natriuretic peptide-dependent lipolytic pathway in human fat cells. J Pharmacol Exp Ther 308, 984-992.

Moro, C., Klimcakova, E., Lolmède, K., Berlan, M., Lafontan, M., Stich, V., et al. (2007). Atrial natriuretic peptide inhibits the production of adipokines and cytokines linked to inflammation and insulin resistance in human subcutaneous adipose tissue. Diabetologia 50,1038-1047.

Moro, C., Pillard, F., De Glisezinski, I., Harant, I., Rivière, D., Stich, V., et al. (2005). Training enhances ANP lipid-mobilizing action in adipose tissue of overweight men. Med Sci Sports Exerc 37,1126-1132.

Nagase, M., Katafuchi, T., Hirose, S., & Fujita, T. (1997). Tissue distribution and localization of natriuretic peptide receptor subtypes in stroke prone spontaneously hypertensive rats. J Hypertens 15,1235-1243.

Nakao, K., Ogawa, Y., Suga, S., & Imura, H. (1992). Molecular biology and biochemistry of the natriuretic peptide system. I: natriuretic peptides. J Hypertens 10, 907-912.

Nakatsuji, H., Maeda, N., Hibuse, T., Hiuge, A., Hirata, A., Kuroda, Y., et al. (2010). Reciprocal regulation of natriuretic peptide receptors by insulin in adipose cells. Biochem Biophys Res Commun 392,100-105.

Nakayama, K. (1997). Furin: a mammalian subtilisin/Kex2p-like endoprotease involved in processing of a wide variety of precursor proteins. Biochem J 327,625-635.

Nannipieri, M., Seghieri, G., Catalano, C., Prontera, T., Baldi, S., & Ferrannini, E. (2002). Defective regulation and action of atrial natriuretic peptide in type 2 diabetes. Horm Metab Res 34,265-270.

Neeland, I. J., Winders, B. R., Ayers, C. R., Das, S. R., Chang, A. Y., Berry, J.D., et al. (2013). Higher natriuretic peptide levels associate with a favorable adipose tissue distribution profile. J Am Coll Cardiol 62, 752-760.

Nesher, M., Vachutinsky, Y., Fridkin, G., Schwarz, Y., Sasson, K., Fridkin, M., et al. (2007). Reversible pegylation prolongs the hypotensive effect of atrial natriuretic peptide. Bioconjug Chem 19, 342-348.

Neuschafer-Rube, F., Lieske, S., Kuna, M., Henkel, J., Perry, R. J., Erion, D.M., et al. (2014). The mammalian INDY homolog is induced by CREB in a rat model of type 2 diabetes. Diabetes 63,1048-1057.

ARTICLE IN PRESS

N. Schlueter et al. / Pharmacology & Therapeutics xxx (2014) xxx-xxx 15

Newton-Cheh, C., Larson, M. G., Vasan, R. S., Levy, D., Bloch, K. D., Surtí, A., et al. (2009). Association of common variants in NPPA and NPPB with circulating natriuretic peptides and blood pressure. Nat Genet 41, 348-353.

Ng, X. W., Huang, Y., Chen, H. H., Burnett, J. C., Jr., Boey, F. Y. C., & Venkatraman, S. S. (2013). Cenderitide-eluting film for potential cardiac patch applications. PLoS One 8, e68346.

Nishikimi, T., Kuwahara, K., & Nakao, K. (2011). Current biochemistry, molecular biology, and clinical relevance of natriuretic peptides. J Cardiol 57,131-140.

Nisoli, E., Clementi, E., Paolucci, C., Cozzi, V., Tonello, C., Sciorati, C., et al. (2003). Mitochondrial biogenesis in mammals: the role of endogenous nitric oxide. Sci AAAS 299, 896-899.

Northridge, D., Alabaster, C., Connell, J. C., Dilly, S., Lever, A., Jardine, A., et al. (1989). Effects of UK 69 578: a novel atriopeptidase inhibitor. Lancet 334,591-593.

Nowatzke, W. L., & Cole, T. G. (2003). Stability of N-terminal pro-brain natriuretic peptide after storage frozen for one year and after multiple freeze-thaw cycles. Clin Chem 49, 1560-1562.

Nowotny, B., Zahiragic, L., Krog, D., Nowotny, P.J., Herder, C., Carstensen, M., etal. (2013). Mechanisms underlying the onset of oral lipid-induced skeletal muscle insulin resistance in humans. Diabetes 62,2240-2248.

O'Connor, C. M., Starling, R C., Hernandez, A. F., Armstrong, P. W., Dickstein, K., Hasselblad, V., et al. (2011). Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 365, 32-43.

Olsen, M. H., Hansen, T. W., Christensen, M. K., Gustafsson, F., Rasmussen, S., Wachtell, K., et al. (2005). N-terminal pro brain natriuretic peptide is inversely related to metabolic cardiovascular risk factors and the metabolic syndrome. Hypertension 46, 660-666.

Oltman, C. L., Davidson, E. P., Coppey, L. J., Kleinschmidt, T. L., & Yorek, M.A. (2009). Treatment of Zucker diabetic fatty rats with AVE7688 improves vascular and neural dysfunction. Diabetes Obes Metab 11, 223-233.

Omori, K., & Kotera, J. (2007). Overview of PDEs and their regulation. Circ Res 100, 309-327.

Park, B.M., Oh, Y. -B., Gao, S., Cha, S. A., Kang, K. P., & Kim, S. H. (2013). Angiotensin III stimulates high stretch-induced ANP secretion via angiotensin type 2 receptor. Peptides 42,131-137.

Perry, R J., Kim, T., Zhang, X. -M., Lee, H. -Y., Pesta, D., Popov, V. B., et al. (2013). Reversal of hypertriglyceridemia, fatty liver disease, and insulin resistance by a liver-targeted mitochondrial uncoupler. Cell Metab 18, 740-748.

Pervanidou, P., Margeli, A., Akalestos, A., Sakka, S., Kanaka-Gantenbein, C., Papassotiriou, I., et al. (2009). Associations between circulating N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) and adiponectin concentrations depend on obesity level in female adolescents: gender dimorphic findings. Horm Metab Res 41, 829-833.

Pfeifer, A., Kilic, A., & Hoffmann, L. S. (2013). Regulation of metabolism by cGMP. Pharmacol Ther 140, 81-91.

Pfister, R., Sharp, S., Luben, R., Welsh, P., Barroso, I., Salomaa, V., et al. (2011). Mendelian randomization study of B-type natriuretic peptide and type 2 diabetes: evidence of causal association from population studies. PLoS Med 8, e1001112.

Pham, I., Sediame, S. d., Maistre, G. v., Roudot-Thoraval, F. o., Chabrier, P. -E., Carayon, A., et al. (1997). Renal and vascular effects of C-type and atrial natriuretic peptides in humans. Am J Physiol 273, R1457-R1464.

Pivovarova, O., Gögebakan, Ö., Klöting, N., Sparwasser, A., Weickert, M.O., Haddad, I., et al. (2012). Insulin up-regulates natriuretic peptide clearance receptor expression in the subcutaneous fat depot in obese subjects: a missing link between CVD risk and obesity? J Clin Endocrinol Metab 97, E731-E739.

Polak, J., Kotrc, M., Wedellova, Z., Jabor, A., Malek, I., Kautzner, J., et al. (2011). Lipolytic effects of B-type natriuretic peptide1 -32 in adipose tissue of heart failure patients compared with healthy controls. J Am Coll Cardiol 58,1119-1125.

Protter, A. A., Wallace, A.M., Ferraris, V. A., & Weishaar, R. E. (1996). Relaxant effect of human brain natriuretic peptide on human artery and vein tissue. Am J Hypertens 9, 432-436.

Pruchnic, R., Katsiaras, A., He, J., Kelley, D. E., Winters, C., & Goodpaster, B. H. (2004). Exercise training increases intramyocellular lipid and oxidative capacity in older adults. Am J Physiol Endocrinol Metab 287, E857-E862.

Puigserver, P., Adelmant, G., Wu, Z., Fan, M., Xu, J., O. M. B., et al. (1999). Activation of PPARgamma coactivator-1 through transcription factor docking. Sci AAAS 286, 1368-1371.

Ricquier, D., & Kader, J. C. (1976). Mitochondrial protein alteration in active brown fat: a sodium dodecyl sulfate-polyacrylamide gel electrophoretic study. Biochem Biophys Res Commun 73, 577-583.

Ricquier, D., Thibault, J., Bouillaud, F., & Kuster, Y. (1983). Molecular approach to thermo-genesis in brown adipose tissue. Cell-free translation of mRNA and characterization of the mitochondrial uncoupling protein. J Biol Chem 258, 6675-6677.

Rizzo, N. O., Maloney, E., Pham, M., Luttrell, I., Wessells, H., Tateya, S., et al. (2010). Reduced NO-cGMP signaling contributes to vascular inflammation and insulin resistance induced by high-fat feeding. Arterioscler Thromb Vasc Biol 30, 758-765.

Roberts, M. J., Bentley, M.D., & Harris, J. M. (2002). Chemistry for peptide and protein PEGylation. Adv Drug Deliv Rev 54,459-476.

Ropero, A.B., Soriano, S., Tudurí, E., Marroquí, L., Téllez, N., Gassner, B., et al. (2010). The atrial natriuretic peptide and guanylyl cyclase-a system modulates pancreatic beta-cell function. Endocrinology 151, 3665-3674.

Rothenburger, M., Wichter, T., Schmid, C., Stypmann, J. r, Tjan, T. D. T., Berendes, E., et al. (2004). Aminoterminal pro type B natriuretic peptide as a predictive and prognostic marker in patients with chronic heart failure. J Heart Lung Transplant 23,1189-1197.

Rubattu, S., Bigatti, G., Evangelista, A., Lanzani, C., Stanzione, R., Zagato, L., et al. (2006). Association of atrial natriuretic peptide and type A natriuretic peptide receptor

gene polymorphisms with left ventricular mass in human essential hypertension. J Am Coll Cardiol 48, 499-505.

Rubattu, S., Sciarretta, S., Ciavarella, G. M., Venturelli, V., D. P. P., Tocci, G., et al. (2007). Reduced levels of N-terminal-proatrial natriuretic peptide in hypertensive patients with metabolic syndrome and their relationship with left ventricular mass. J Hypertens 25, 833-839.

Rudovich, N., Pivovarova, O., Traberth, A., Sparwasser, A., Weickert, M.O., Bernigau, W., et al. (2012). Acarbose treatment enhances mid-regional pro-atrial natriuretic peptide concentrations in non-diabetic individuals: further evidence for a common cardiometabolic pathway? Diabetologia 55, 3392-3395.

Ruilope, L. M., Dukat, A., Böhm, M., Lacourciere, Y., Gong, J., & Lefkowitz, M. P. (2010). Blood-pressure reduction with LCZ696, a novel dual-acting inhibitor of the angioten-sin II receptor and neprilysin: a randomised, double-blind, placebo-controlled, active comparator study. Lancet 375,1255-1266.

Sabrane, K., Kruse, M. N., Fabritz, L., Zetsche, B., Mitko, D., Skryabin, B. V., et al. (2005). Vascular endothelium is critically involved in the hypotensive and hypovolemic actions of atrial natriuretic peptide. J Clin Invest 115,1666-1674.

Sackner-Bernstein, J.D., Kowalski, M., Fox, M., & Aaronson, K. (2005). Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA 293,1900-1905.

Sackner-Bernstein, J.D., Skopicki, H. A., & Aaronson, K. D. (2005). Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 111,1487-1491.

Sala, C., Ambrosi, B., & Morganti, A. (2001). Blunted vascular and renal effects of exogenous atrial natriuretic peptide in patients with Cushing's disease. J Clin Endocrinol Metabol 86,1957-1961.

Sampson, U. K. A., Edwards, T. L., Jahangir, E., Munro, H., Wariboko, M., Wassef, M. G., et al. (2014). Factors associated with the prevalence of hypertension in the southeastern united states: insights from 69 211 Blacks and Whites in the Southern Community Cohort Study. Circulation 7,33-54.

Samuel, V. T., & Shulman, G. I. (2012). Mechanisms for insulin resistance: common threads and missing links. Cell 148,852-871.

Sarzani, R., Dessi-Fulgheri, P., Paci, V. M., Espinosa, E., & Rapelli, A. (1996). Expression of natriuretic peptide receptors in human adipose and other tissues. J Endocrinol Invest 19, 581-585.

Sarzani, R., Marcucci, P., Salvi, F., Bordicchia, M., Espinosa, E., Mucci, L., et al. (2007). Angiotensin II stimulates and atrial natriuretic peptide inhibits human visceral adipocyte growth. Int J Obes 32,259-267.

Sarzani, R., Paci, V., Zingaretti, C., Pierleoni, C., Cinti, S., Cola, G., et al. (1995). Fasting inhibits natriuretic peptides clearance receptor expression in rat adipose tissue. J Hypertens 13,1241-1246.

Sarzani, R., Dessi-Fulgheri, P., Salvi, F., Serenelli, M., Spagnolo, D., Cola, G., Pupita, M., et al. (1999). A novel promoter variant of the natriuretic peptide clearance receptor gene is associated with lower atrial natriuretic peptide and higher blood pressure in obese hypertensives. Journal of Hypertension 17,1301-1305.

Sarzani, R., Strazzullo, P., Salvi, F., Iacone, R., Pietrucci, F., Siani, A., et al. (2004). Natriuretic peptide clearance receptor alleles and susceptibility to abdominal adiposity. Obes Res 12, 351-356.

Scharhag, J. r., Herrmann, M., Urhausen, A., Haschke, M., Herrmann, W., & Kindermann, W. (2005). Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J 150,1128-1134.

Schroeder, C., Birkenfeld, A. L., Mayer, A. F., Tank, J., Diedrich, A., Luft, F. C., et al. (2006). Norepinephrine transporter inhibition prevents tilt-induced pre-syncope. J Am Coll Cardiol 48, 516-522.

Schulz, S. (2005). C-type natriuretic peptide and guanylyl cyclase B receptor. Peptides 26, 1024-1034.

Schulz, S., Singh, S., Bellet, R A., Singh, G., Tubb, D. J., Chin, H., et al. (1989). The primary structure of a plasma membrane guanylate cyclase demonstrates diversity within this new receptor family. Cell 58,1155-1162.

Schulz, T. J., & Tseng, Y. H. (2013). Systemic control of brown fat thermogenesis: integration of peripheral and central signals. Ann N Y Acad Sci 1302, 35-41.

Schupp, M., & Lazar, M.A. (2010). Endogenous ligands for nuclear receptors: digging deeper. J Biol Chem 285,40409-40415.

Sengenes, C., Berlan, M., De Glisezinski, I., Lafontan, M., & Galitzky, J. (2000). Natriuretic peptides: a new lipolytic pathway in human adipocytes. FASEBJ 14,1345-1351.

Sengenes, C., Bouloumie, A., Hauner, H., Berlan, M., Busse, R., Lafontan, M., et al. (2003). Involvement of a cGMP-dependent pathway in the natriuretic peptide-mediated hormone-sensitive lipase phosphorylation in human adipocytes. J Biol Chem 278, 48617-48626.

Sengenes, C., Zakaroff-Girard, A., Moulin, A., Berlan, M., Bouloumie, A., Lafontan, M., et al. (2002). Natriuretic peptide-dependent lipolysis in fat cells is a primate specificity. Am J Physiol Regul Integr Comp Physiol 283, R257-R265.

Shi, S., Nguyen, H. T., Sharma, G. D., Navar, L. G., & Pandey, K. N. (2001). Genetic disruption of atrial natriuretic peptide receptor-A alters renin and angiotensin II levels. Am J Physiol Renal Physiol 281, F665-F673.

Shibusawa, N., Yamada, M., Hashida, T., Hashimoto, K., Satoh, T., Horiguchi, J., et al. (2013). Dilated cardiomyopathy as a presenting feature of Cushing's syndrome. Intern Med 52,1067-1071.

Smith, R. E., & Roberts, J. C. (1964). Thermogenesis of brown adipose tissue in cold-acclimated rats. Am J Physiol 206,143-148.

Song, D. -L., Kohse, K. P., & Murad, F. (1988). Brain natriuretic factor Augmentation of cellular cyclic GMP, activation of particulate guanylate cyclase and receptor binding. FEBS Lett 232,125-129.

Sonnenberg, H., Honrath, U., Chong, C., & Wilson, D. (1986). Atrial natriuretic factor inhibits sodium transport in medullary collecting duct. Am J Physiol 250, 963-966.

ARTICLE IN PRESS

N. Schlueter et al. / Pharmacology & Therapeutics xxx (2014) xxx-xxx

Souza, S.C., Chau, M.D. L., Yang, Q., Gauthier, M. -S., Clairmont, K. B., Wu, Z., et al. (2011). Atrial natriuretic peptide regulates lipid mobilization and oxygen consumption in human adipocytes by activating AMPK. Biochem Biophys Res Commun 410,398-403.

Stamler, R., Stamler, J., Riedlinger, W. F., Algera, G., & Roberts, R. H. (1978). Weight and blood pressure: findings in hypertension screening of 1 million americans. JAMA 240,1607-1610.

Standeven, K. F., Hess, K., Carter, A.M., Rice, G. I., Cordell, P. A., Balmforth, A. J., et al. (2011). Neprilysin, obesity and the metabolic syndrome. Int J Obes 35,1031-1040.

Stavrakis, S., Pakala, A., Thomas, J., Chaudhry, M.A., & Thadani, U. (2013). Obesity, brain natriuretic peptide levels and mortality in patients hospitalized with heart failure and preserved left ventricular systolic function. Am J Med Sci 345, 211-217, http:// dx.doi.org/10.1097/MAJ.1090b1013e318271c318012.

Stingo, A. J., Clavell, A. L., Heublein, D.M., Wei, C. M., Pittelkow, M. R., & Burnett, J. C. (1992). Presence of C-type natriuretic peptide in cultured human endothelial cells and plasma. Heart Circ Physiol 263, H1318-H1321.

Stralfors, P., & Belfrage, P. (1983). Phosphorylation of hormone-sensitive lipase by cyclic AMP-dependent protein kinase. J Biol Chem258,15146-15152.

Stralfors, P., Björgell, P., & Belfrage, P. (1984). Hormonal regulation of hormone-sensitive lipase in intact adipocytes: identification of phosphorylated sites and effects on the phosphorylation by lipolytic hormones and insulin. Proc Natl Acad Sci U S A 81, 3317-3321.

Sudoh, T., Kangawa, K., Minamino, N., & Matsuo, H. (1988). A new natriuretic peptide in porcine brain. Nature 332, 78-81.

Sudoh, T., Minamino, N., Kangawa, K., & Matsuo, H. (1990). C-Type natriuretic peptide (CNP): a new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun 168, 863-870.

Suga, S., Nakao, K., Hosoda, K., Mukoyama, M., Ogawa, Y., Shirakami, G., et al. (1992). Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide. Endocrinology 130, 229-239.

Suga, S., Nakao, K., Itoh, H., Komatsu, Y., Ogawa, Y., Hama, N., et al. (1992). Endothelial production of C-type natriuretic peptide and its marked augmentation by transforming growth factor-beta. Possible existence of "vascular natriuretic peptide system". J Clin Invest 90,1145-1149.

Sugisawa, T., Kishimoto, I., Kokubo, Y., Makino, H., Miyamoto, Y., & Yoshimasa, Y. (2010). Association of plasma B-type natriuretic peptide levels with obesity in a general urban Japanese population: the Suita Study. Endocr J 57, 727-733.

Suwa, M., Seino, Y., Nomachi, Y., Matsuki, S., & Funahashi, K. (2005). Multicenter prospective investigation on efficacy and safety of carperitide for acute heart failure in the 'real world' of therapy. Circ J 69,283-290.

Suzuki, S., Yoshihisa, A., Yamaki, T., Sugimoto, K., Kunii, H., Nakazato, K., et al. (2013). Acute heart failure volume control multicenter randomized (AVCMA) trial: comparison of tolvaptan and carperitide. J Clin Pharmacol 53,1277-1285.

Szabo, T., Postrach, E., Mahler, A., Kung, T., Turhan, G., von Haehling, S., et al. (2013). Increased catabolic activity in adipose tissue of patients with chronic heart failure. Eur J Heart Fail 15,1131-1137.

Tabarin, A., Corcuff, J., Laval, M., Aupetit, B., Carayon, A., Florentin, C., et al. (1990). Plasma concentration of atrial natriuretic hormone during endogenous glucocorticoid hypercorticism. Horm Res 34,229-233.

Tamura, N., Ogawa, Y., Chusho, H., Nakamura, K., Nakao, K., Suda, M., et al. (2000). Cardiac fibrosis in mice lacking brain natriuretic peptide. Proc Natl Acad Sci 97,4239-4244.

Tanaka, T., Tsutamoto, T., Sakai, H., Nishiyama, K., Fujii, M., Yamamoto, T., et al. (2008). Effect of atrial natriuretic peptide on adiponectin in patients with heart failure. Eur J Heart Fail 10,360-366.

Taylor, H. A., Coady, S. A., Levy, D., Walker, E. R., Vasan, R S., Liu, J., et al. (2010). Relationships of BMI to cardiovascular risk factors differ by ethnicity. Obesity 18,1638-1645.

Thielecke, F., Rahn, G., Bohnke, J., Adams, F., Birkenfeld, A. L., Jordan, J., et al. (2010). Epigallocatechin-3-gallate and postprandial fat oxidation in overweight/obese male volunteers: a pilot study. Eur J Clin Nutr 64, 704-713.

Tian, Y., Nie, J., Huang, C., & George, K. P. (2012). The kinetics of highly sensitive cardiac troponin T release after prolonged treadmill exercise in adolescent and adult athletes. Eur J Appl Physiol 113, 418-425.

Toja, P.M., Branzi, G., Ciambellotti, F., Radaelli, P., De Martin, M., Lonati, L. M., et al. (2012). Clinical relevance of cardiac structure and function abnormalities in patients with Cushing's syndrome before and after cure. Clin Endocrinol (Oxf) 76, 332-338.

Topol, E. J. (2011). The lost decade of nesiritide. N Engl J Med 365, 81 -82.

Torp-Pedersen, C., Caterson, I., Coutinho, W., Finer, N., Van Gaal, L., Maggioni, A., et al. (2007). Cardiovascular responses to weight management and sibutramine in high-risk subjects: an analysis from the SCOUT trial. Eur Heart J 28, 2915-2923.

Tsuji, T., & Kunieda, T. (2005). A loss-of-function mutation in natriuretic peptide receptor 2 (Npr2) gene is responsible for disproportionate dwarfism in cn/cn mouse. J Biol Chem 280,14288-14292.

Uehlinger, D. E., Weidmann, P., Gnädinger, M. P., Hasler, L., Bachmann, C., Shaw, S., et al. (1986). Increase in circulating insulin induced by atrial natriuretic peptide in normal humans. J Cardiovasc Pharmacol 8,1122-1129.

Uehlinger, D. E., Zaman, T., Weidmann, P., Shaw, S., & Gnädinger, M. P. (1987). Pressure dependence of atrial natriuretic peptide during norepinephrine infusion in humans. Hypertension 10, 249-253.

Ussher, J. R., & Drucker, D.J. (2012). Cardiovascular biology of the incretin system. Endocr Rev 33,187-215.

van der Zander, K., Houben, A. J. H. M., Kroon, A. A., & de Leeuw, P. W. (1999). Effects of brain natriuretic peptide on forearm vasculature: comparison with atrial natriuretic peptide. Cardiovasc Res 44, 595-600.

Vasan, R S., Benjamin, E. J., Larson, M. G., et al. (2002). Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham Heart Study. JAMA 288,1252-1259.

Veronese, F. M., & Pasut, G. (2005). PEGylation, successful approach to drug delivery. Drug Discov Today 10,1451-1458.

Vila, G., Grimm, G., Resl, M., Heinisch, B., Einwallner, E., Esterbauer, H., etal. (2012). B-type natriuretic peptide modulates ghrelin, hunger, and satiety in healthy men. Diabetes 61, 2592-2596.

von Haehling, S., Doehner, W., & Anker, S. D. (2007). Nutrition, metabolism, and the complex pathophysiology of cachexia in chronic heart failure. Cardiovasc Res 73, 298-309.

Waldman, S. A., Rapoport, R M., & Murad, F. (1984). Atrial natriuretic factor selectively activates particulate guanylate cyclase and elevates cyclic GMP in rat tissues. J Biol Chem 259,14332-14334.

Wang, T. J. (2012). The natriuretic peptides and fat metabolism. N Engl J Med 367, 377-378.

Wang, T. J., Larson, M. G., Keyes, M.J., Levy, D., Benjamin, E. J., & Vasan, R S. (2007). Association of plasma natriuretic peptide levels with metabolic risk factors in ambulatory individuals. Circulation 115,1345-1353.

Wang, T. J., Larson, M. G., Levy, D., Benjamin, E. J., Leip, E. P., Wilson, P. W. F., et al. (2004). Impact of obesity on plasma natriuretic peptide levels. Circulation 109, 594-600.

Wang, J. H., Lee, C.J., Hsieh,J. C., Chen, Y. C., & Hsu, B. G. (2013, Sep. 17). Serum atrial natriuretic peptide level inversely associates with metabolic syndrome in older adults. Geriatr Gerontol Int.

Wang, C. -H., Leung, N., Lapointe, N., Szeto, L., Uffelman, K. D., Giacca, A., et al. (2003). Vasopeptidase inhibitor omapatrilat induces profound insulin sensitization and increases myocardial glucose uptake in zucker fatty rats: studies comparing a vasopeptidase inhibitor, angiotensin-converting enzyme inhibitor, and angiotensin II type I receptor blocker. Circulation 107,1923-1929.

Werle, M., & Bernkop-Schnürch, A. (2006). Strategies to improve plasma half life time of peptide and protein drugs. Amino Acids 30, 351-367.

Witteles, R. M., Kao, D., Christopherson, D., Matsuda, K., Vagelos, R. H., Schreiber, D., et al. (2007). Impact of nesiritide on renal function in patients with acute decompensated heart failure and pre-existing renal dysfunction: a randomized, double-blind, placebo-controlled clinical trial. J Am Coll Cardiol 50,1835-1840.

Yamada-Goto, N., Katsuura, G., Ebihara, K., Inuzuka, M., Ochi, Y., Yamashita, Y., et al. (2013). Intracerebroventricular administration of C-type natriuretic peptide suppresses food intake via activation of the melanocortin system in mice. Diabetes 62,1500-1504.

Yamaji, T., Ishibashi, M., Yamada, A., Takaku, F., Itabashi, A., Katayama, S., et al. (1988). Plasma levels of atrial natriuretic hormone in Cushing's syndrome. J Clin Endocrinol Metabol 67, 348-352.

Yan, W., Wu, F., Morser, J., & Wu, Q. (2000). Corin, a transmembrane cardiac serine protease, acts as a pro-atrial natriuretic peptide-converting enzyme. Proc Natl Acad SciUSA 97, 8525-8529.

Yancy, C. W., Krum, H., Massie, B.M., Silver, M.A., Stevenson, L W., Cheng, M., et al. (2008). Safety and efficacy of outpatient nesiritide in patients with advanced heart failure: results of the second Follow-Up Serial Infusions of Nesiritide (FUSION II) trial. Circ Heart Fail 1, 9-16.

Yasoda, A., Ogawa, Y., Suda, M., Tamura, N., Mori, K., Sakuma, Y., et al. (1998). Natriuretic peptide regulation of endochondral ossification: evidence for possible roles of the C-type natriuretic peptide/guanylyl cyclase-B pathway. J Biochem 273,11695-11700.

Yoshimura, M., Yasue, H., Morita, E., Sakaino, N., Jougasaki, M., Kurose, M., et al. (1991). Hemodynamic, renal, and hormonal responses to brain natriuretic peptide infusion in patients with congestive heart failure. Circulation 84,1581-1588.

You, H., & Laychock S. G. (2009). Atrial natriuretic peptide promotes pancreatic Islet ß-cell growth and Akt/Foxo1a/Cyclin D2 signaling. Endocrinology 150, 5455-5465.

You, H., & Laychock, S. G. (2011). Long-term treatment with atrial natriuretic peptide inhibits ATP production and insulin secretion in rat pancreatic islets. Am J Physiol Endocrinol Metab 300, E435-E444.

Zechner, R., Zimmermann, R., Eichmann, T. O., Kohlwein, S. D., Haemmerle, G., Lass, A., et al. (2012). FAT SIGNALS — lipases and lipolysis in lipid metabolism and signaling. Cell Metab 15, 279-291.