Peptides are cardioprotective drugs of the future. Adrenomedullin

The widespread use of percutaneous coronary intervention (PCI) as a method of treatment for acute myocardial infarction (AMI) has radically reduced mortality in this disease. However, the mortality rate still remains high and, according to some reports, for myocardial infarction with ST segment elevation can reach 7–9%. Today, when using PCI, cardiac reperfusion injury comes to the fore. Unfortunately, drugs used in clinical practice for treatment of AMI are low effective against reperfusion injury of the heart. There is an urgent need to develop drugs with a molecular mechanism of action that is different from those of drugs already used to treat AMI. The prototype for creating such drugs could be polypeptide adrenomedullin. The purpose of this review is to analyze articles devoted to the cardioprotective effect of adrenomedullin in cardiac ischemia and reperfusion. Adrenomedullin has been shown to reduce myocardial infarct size, inhibit cardiomyocyte apoptosis, and prevent the occurrence of post-infarction cardiac remodeling. Adrenomedullin is able to selectively enhance cardiac tolerance to reperfusion injury. It has been shown that the cardioprotective effect of adrenomedullin is associated with activation of Akt kinase, NO-synthase, protein kinase A, an increase in the cGMP level in myocardial tissue and increased NO synthesis in the heart.