Copeptin and cardiovascular disease: A review of a novel neurohormone

Abstract

Neurohormones (NHs) in the cascade of the arginine vasopressin (AVP) system have drawn particular attention in the recent years. Copeptin, the C-terminal portion of provasopressin, is a novel NH of the AVP system, and is known to be co-released with AVP from hypothalamus (neurohypophysis). As a surrogate marker of the AVP system, copeptin has gradually replaced AVP in several clinical studies largely due to its structural and methodological advantages. Copeptin has been regarded as a marker of non-specific stress response, and has also been suggested to have clinical implications in a variety of non-cardiovascular (pneumonia, sepsis, etc.) and cardiovascular conditions (heart failure and acute coronary syndromes (ACSs, etc.)). However, current data on relation of copeptin with other cardiovascular conditions ( arrhythmias, etc.) are still insufficient. The present review primarily focuses on general features of copeptin, its general clinical implications, and specifically aims to cover its potential clinical value in a variety of cardiovascular conditions.

Introduction

Neurohormones (NHs) have gained widespread popularity in the recent years largely due to their diagnostic and prognostic values in the setting of a variety of cardiovascular conditions including acute coronary syndromes (ACSs) and congestive heart failure (CHF), etc. [1]. Among NHs, natriuretic peptides including N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) have been known to be associated with a variety of cardiac diseases primarily affecting myocardium including CHF [2], and thus have been the most extensively investigated NHs in the cardiovascular research arena. Several mechanisms including enhanced myocardial stretch, systemic hypoperfusion, etc. have been propounded regarding acutely and chronically elevated NH levels in the setting of cardiovascular conditions. Notwithstanding the extensive research on conventional NHs, novel biomarkers with strong diagnostic and prognostic values that may additionally offer novel aspects and better understanding of cardiovascular pathologies are still warranted for the absolute diagnosis, risk stratification, and accordingly proper management of patients with cardiovascular diseases.

In the recent years, there has been growing interest towards the NHs in the cascade of the arginine vasopressin (AVP) system including AVP and copeptin. AVP is a conventional NH that is well known to be released from hypothalamus in response to hypovolemia and increased plasma osmolality [2]. Copeptin, the C-terminal portion of provasopressin, is a novel NH of the AVP system [3] and is known to be co-secreted with AVP from hypothalamus. Based on its favorable structural features, copeptin has gradually replaced AVP in the clinical setting [1], and accordingly several recent studies investigating the association between AVP system and various clinical conditions have particularly focused on copeptin rather than AVP. Therefore, the potential value of copeptin has been investigated in various cardiovascular and non-cardiovascular conditions. The present review primarily discusses general features of the novel NH copeptin, and aims to cover its clinical implications, particularly in a variety of cardiovascular conditions.