Copeptin (human)
(Synonyms: 和肽素) 目录号 : GA21279和肽素是一种由 39 个氨基酸组成的肽,主要产生于下丘脑的室旁神经元和视上核。
Cas No.:78362-34-2
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Copeptin is a peptide composed of 39-amino acids that is produced primarily in paraventricular neurons and the supraoptic nucleus of the hypothalamus[1].
Copeptin may aid in the folding of vasopressin during transport. Vasopressin has a direct antidiuretic effect on the kidneys and also causes constriction of peripheral blood vessels. Copeptin can be used as a vasopressin surrogate in clinical test[2-4].
In vivo£¬In In the analysis of systemic anaphylaxis, the body temperature of the model group (Compound 48/80) was significantly lower than that of the control group. Compound 48/80 induced increased serum concentrations of HIS, TNF-¦Á and IL-8[8]. Compound 48/80-induced MC degranulation produced anticonvulsive effects against PTZ-induced epileptic seizures by extending the onset time of both myoclonic-jerk and generalized tonic¨Cclonic seizure, and by shortening the duration of generalized tonic¨Cclonic seizure[9].
References:
[1]. Baranowska B, Kochanowski J. Copeptin - a new diagnostic and prognostic biomarker in neurological and cardiovascular diseases. Neuro Endocrinol Lett. 2019 Dec;40(5):207-214. PMID: 32112544.
[2]. Balanescu S, Kopp P, Gaskill MB, Morgenthaler NG, Schindler C, Rutishauser J. Correlation of plasma copeptin and vasopressin concentrations in hypo-, iso-, and hyperosmolar States. J Clin Endocrinol Metab. 2011 Apr;96(4):1046-52. doi: 10.1210/jc.2010-2499. Epub 2011 Feb 2. PMID: 21289257.
[3]. Morgenthaler NG, Struck J, Alonso C, Bergmann A. Assay for the measurement of copeptin, a stable peptide derived from the precursor of vasopressin. Clin Chem. 2006 Jan;52(1):112-9. doi: 10.1373/clinchem.2005.060038. Epub 2005 Nov 3. PMID: 16269513.
[4]. Christ-Crain M. Vasopressin and Copeptin in health and disease. Rev Endocr Metab Disord. 2019 Sep;20(3):283-294. doi: 10.1007/s11154-019-09509-9. PMID: 31656992.
和肽素是一种由 39 个氨基酸组成的肽,主要产生于下丘脑的室旁神经元和视上核[1]。
和肽素可能有助于加压素在运输过程中的折叠。加压素对肾脏有直接的抗利尿作用,也会引起外周血管收缩。和肽素可作为血管加压素的替代物进行临床试验[2-4]。
In vivo:在全身过敏反应分析中,模型组(Compound 48/80)的体温明显低于对照组。化合物 48/80 诱导 HIS、TNF-α 和 IL-8[8] 血清浓度升高。化合物 48/80 诱导的 MC 脱颗粒通过延长肌阵挛发作和全身性强直性发作的发作时间,以及缩短全身性强直性发作的持续时间,对 PTZ 诱导的癫痫发作产生抗惊厥作用[9 ].
Cas No. | 78362-34-2 | SDF | |
别名 | 和肽素 | ||
分子式 | C177H279N49O58 | 分子量 | 4021.46 |
溶解度 | Soluble in DMSO | 储存条件 | Store at -20°C |
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Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines
Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status. Recently identified parameters, including fractional uric acid excretion and plasma copeptin concentration, may further improve the diagnostic approach. The treatment for hyponatremia is chosen on the basis of duration and symptoms. For acute or severely symptomatic hyponatremia, both guidelines adopted the approach of giving a bolus of hypertonic saline. Although fluid restriction remains the first-line treatment for most forms of chronic hyponatremia, therapy to increase renal free water excretion is often necessary. Vasopressin receptor antagonists, urea, and loop diuretics serve this purpose, but received different recommendations in the two guidelines. Such discrepancies may relate to different interpretations of the limited evidence or differences in guideline methodology. Nevertheless, the development of guidelines has been important in advancing this evolving field.
Copeptin and its role in the diagnosis of diabetes insipidus and the syndrome of inappropriate antidiuresis
Copeptin is secreted in an equimolar amount to arginine vasopressin (AVP) but can easily be measured in plasma or serum with a sandwich immunoassay. The main stimuli for copeptin are similar to AVP, that is an increase in osmolality and a decrease in arterial blood volume and pressure. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation. Copeptin has, therefore, been evaluated as diagnostic biomarker in vasopressin-dependent disorders of body fluid homeostasis. Disorders of body fluid homeostasis are common and can be divided into hyper- and hypoosmolar circumstances: the classical hyperosmolar disorder is diabetes insipidus, while the most common hypoosmolar disorder is the syndrome of inappropriate antidiuresis (SIAD). Copeptin measurement has led to a "revival" of the direct test in the differential diagnosis of diabetes insipidus. Baseline copeptin levels, without prior thirsting, unequivocally identify patients with nephrogenic diabetes insipidus. In contrast, for the difficult differentiation between central diabetes insipidus and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is clearly superior to the classical water deprivation test. On the contrary, in the SIAD, copeptin measurement is of only little diagnostic value. Copeptin levels widely overlap in patients with hyponatraemia and emphasize the heterogeneity of the disease. Additionally, a variety of factors lead to unspecific copeptin elevations in the acute setting further complicating its interpretation. The broad use of copeptin as diagnostic marker in hyponatraemia and specifically to detect cancer-related disease in SIADH patients can, therefore, not be recommended.
Diabetes insipidus
Diabetes insipidus (DI) is a disorder characterized by a high hypotonic urinary output of more than 50ml per kg body weight per 24 hours, with associated polydipsia of more than 3 liters a day [1,2]. Central DI results from inadequate secretion and usually deficient synthesis of Arginine vasopressin (AVP) in the hypothalamus or pituitary gland. Besides central DI further underlying etiologies of DI can be due to other primary forms (renal origin) or secondary forms of polyuria (resulting from primary polydipsia). All these forms belong to the Polyuria Polydipsia Syndrom (PPS). In most cases central and nephrogenic DI are acquired, but there are also congenital forms caused by genetic mutations of the AVP gene (central DI) [3] or by mutations in the gene for the AVP V2R or the AQP2 water channel (nephrogenic DI) [4]. Primary polydipsia (PP) as secondary form of polyuria includes an excessive intake of large amounts of fluid leading to polyuria in the presence of intact AVP secretion and appropriate antidiuretic renal response. Differentiation between the three mentioned entities is difficult [5], especially in patients with Primary polydipsia or partial, mild forms of DI [1,6], but different tests for differential diagnosis, most recently based on measurement of copeptin, and a thorough medical history mostly lead to the correct diagnosis. This is important since treatment strategies vary and application of the wrong treatment can be dangerous [7]. Treatment of central DI consists of fluid management and drug therapy with the synthetic AVP analogue Desmopressin (DDAVP), that is used as nasal or oral preparation in most cases. Main side effect can be dilutional hyponatremia [8]. In this review we will focus on central diabetes insipidus and describe the prevalence, the clinical manifestations, the etiology as well as the differential diagnosis and management of central diabetes insipidus in the out- and inpatient setting.
Diabetes Insipidus: New Concepts for Diagnosis
Diabetes insipidus (DI), be it from central or from nephrogenic origin, has to be differentiated from primary polydipsia. This differentiation is crucial since wrong treatment can have dangerous consequences. For decades, the "gold standard" for differential diagnosis has been the standard water deprivation test. However, this test has several limitations leading to an overall limited diagnostic accuracy. In addition, the test has a long duration of 17 h and is cumbersome for patients. Also clinical signs and symptoms and MRI characteristics overlap between patients with DI and primary polydipsia. Direct measurement of arginine vasopressin (AVP) upon osmotic stimulation was first shown to overcome these limitations, but failed to enter clinical practice mainly due to technical limitations of the AVP assay. Copeptin is secreted in equimolar ratio to AVP, mirroring AVP concentrations in the circulation. We have shown that copeptin, without prior fluid deprivation, identifies patients with nephrogenic DI. For the more difficult differentiation between central DI and primary polydipsia, a copeptin level of 4.9 pmol/L stimulated with hypertonic saline infusion differentiates between these 2 entities with a high diagnostic accuracy and is superior to the water deprivation test. However, it is important to note that close and regular sodium monitoring every 30 min during the hypertonic saline test is a prerequisite, which is not possible in all hospitals. Furthermore, side effects are common. Therefore, a nonosmotic stimulation test would be advantageous. Arginine significantly stimulates copeptin and therefore is a novel, so far unknown stimulus of this peptide. Consequently, infusion of arginine with subsequent copeptin measurement was shown to be an even simpler and better tolerated test, but head to head comparison is still lacking.