A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

Abstract

Adrenomedullin has several properties. It acts as a potent vasodilator, has natriuretic effects, and reduces endothelial permeability. It also plays a role in initiating the early hyperdynamic phase of sepsis. Since its discovery, many articles have been published studying the uses and benefits of this biomarker. The aim of this review is to determine the usefulness of adrenomedullin in pediatric patients. Relevant studies covering adrenomedullin in pediatrics (<18 years) and published up until August 2021 were identified through a search of MEDLINE, PubMed, Embase, Web of Science, Scopus, and Cochrane. Seventy studies were included in the present review, most of them with a low level of evidence (IV to VI). Research on adrenomedullin has primarily been related to infection and the cardiovascular field. The performance of adrenomedullin to quantify infection in children seems satisfactory, especially in sepsis. In congenital heart disease, this biomarker seems to be a useful indicator before, during, and after cardiopulmonary bypass. Adrenomedullin seems to be useful in the pediatric population for a large variety of pathologies, especially regarding infection and cardiovascular conditions. However, it should be used in combination with other biomarkers and clinical or analytical variables, rather than as a single tool.

Adrenomedullin Mitigates Doxorubicin-Induced Nephrotoxicity in Rats: Role of Oxidative Stress, Inflammation, Apoptosis, and Pyroptosis

“…Adrenomedullin (ADM), a biologically active endogenous peptide composed of 52 amino acids, has been separated from the pheochromocytoma of human tissues. However, it has been isolated from several tissues later on including lung, adrenal gland, heart, blood vessels, reproductive organs, and kidneys [ 18 ]. ADM has powerful antioxidant, anti-apoptotic, and anti-inflammatory properties, where it has been used to mitigate renal damage in numerous models of renal diseases such as ischemia reperfusion injury [ 19 ], mesangioproliferative glomerulonephritis, and unilateral ureteral obstruction [ 20 ].…”

Leveraging Integrated RNA Sequencing to Decipher Adrenomedullin’s Protective Mechanisms in Experimental Bronchopulmonary Dysplasia

“…Its expression is up-regulated in response to various stimuli such as hypoxia, inflammation, and mechanical stress [ 19 , 21 ]. Adm has been implicated in several pathological conditions, including cardiovascular diseases [ 20 , 22 , 23 , 24 , 25 ], pulmonary disorders [ 26 , 27 , 28 , 29 , 30 ], gastrointestinal disorders [ 31 , 32 ], sepsis [ 33 , 34 , 35 , 36 ], cancer [ 20 , 32 , 37 , 38 ], and disorders associated with pregnancy [ 39 , 40 , 41 , 42 ]. Since Adm is highly enriched in the lungs, its expression is influenced by inflammation, and the peptide plays a vital role in maintaining endothelial cell homeostasis [ 43 , 44 , 45 ]; Adm may play a pathogenic role in inflammatory lung disorders such as BPD.…”