Neutral endopeptidase inhibitors natriuretic peptides

Because renal vasodilatation and hyperfiltration are often associated with a natriuretic response, a number of activators or inhibitors of endogenous vasoactive systems can cause increased NaCl excretion, and some of these may be developed into compounds of clinical interest in special situations. Such agents include natriuretic pqDtides most notably B-type natriuretic peptide (nesiritide), neutral endopeptidase (NEP) inhibitors (thiorphan, phosphoramidon), mixed NEP and ACE inhibitors (omapatrilat), guanylin and uroguanylin, kinins, prostaglandins of the E series, adrenomedullin, relaxin, prolactin, and others. 

In addition, a new class of drugs, termed vasopepti-dase inhibitors, inhibit the enzymatic activity of ACE and neutral endopeptidase, the enzyme responsible for the breakdown of natriuretic peptides. The end result is a reduction in the synthesis of angiotensin II and an increase in the circulating level of natriuretic peptides such as ANP. Omapatrilat, a vasopeptidase inhibitor, is under study for the treatment of hypertension and congestive heart failure. 

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