Adrenomedullin

Where it comes from

Made in

Endothelial and vascular smooth muscle cells, adrenal medulla (where it was found), heart, kidney, placenta

Sent out by

Shear stress, hypoxia, inflammatory cytokines; rises greatly in sepsis and pregnancy

Acts on

• Vascular smooth muscle
• Endothelial junctions
• Lymphatic vessels
• Kidney
• Heart

What it does

• Relaxes vessels and lowers blood pressure
• Tightens the endothelial barrier against leak
• Needed for lymphatic vessel development; mice without it die of oedema before birth
• Protects the heart after injury in animals

In medicine

• MR-proADM, a stable fragment of its precursor, sorts patients with sepsis and pneumonia by risk of death, and is used in some emergency departments ¹
• It beat BNP at predicting ninety-day survival in 1,641 patients presenting with breathlessness, which is the finding behind that use ⁴
• There is no approved medicine that gives it, blocks it or copies it

Beyond the body’s own use

• Enibarcimab, the antibody formerly called adrecizumab, binds adrenomedullin and holds it in the blood. In 301 patients with septic shock it was well tolerated and did not change ninety-day mortality; no phase 3 result has been published ²
• Infused adrenomedullin was tested in 28 patients with steroid-resistant ulcerative colitis in Japan: the two-week primary endpoint was not met, and the eight-week difference rested on a handful of patients on the highest dose ³
• MR-proADM is the one part of this story in routine use, and it is a prognostic marker rather than a treatment: it sorts patients by risk without telling anyone what to do about it ¹
• Nothing is in human use outside trials. The peptide lasts about twenty minutes in blood and is digested if swallowed, so claims for a capsule or a drop do not survive the pharmacology