Summary

Carperitide (Hanp) is a recombinant 28-amino-acid human atrial natriuretic peptide (hANP) approved in Japan since 1995 for the treatment of acute decompensated heart failure. Administered as a continuous intravenous infusion, it promotes natriuresis, diuresis, vasodilation, and RAAS suppression through activation of natriuretic peptide receptor A (NPR-A) and downstream cGMP signalling. Despite nearly three decades of Japanese clinical experience and post-marketing data from over 3,700 patients, the TAKUMI randomised trial showed no superiority over standard therapy for hard clinical endpoints, and carperitide is not approved by the FDA or EMA. Research use only.

Mechanism

Carperitide is recombinant human atrial natriuretic peptide (hANP), identical in sequence to endogenous ANP. It binds to natriuretic peptide receptor A (NPR-A), activating particulate guanylate cyclase and increasing intracellular cGMP. This produces: (1) afferent arteriolar dilation and efferent arteriolar constriction in the glomerulus, increasing GFR and natriuresis; (2) vasodilation of vascular smooth muscle (reducing preload and afterload); (3) suppression of renin, aldosterone, and endothelin; and (4) inhibition of cardiac fibroblast proliferation. The net effect is reduced cardiac wall stress and improved haemodynamics in acute heart failure.

Evidence base

Post-marketing surveillance (PROTECT): >3,700 patients in Japanese real-world use. Confirmed symptomatic and haemodynamic improvement; hypotension was primary adverse effect.

Randomised trial (TAKUMI, n=487): Carperitide vs standard therapy. No significant difference in composite of mortality or HF rehospitalisation at 180 days (Hata et al., Circ J, 2008).

CARPA-HF (n=80): Carperitide vs nicorandil. Greater dyspnoea improvement and NT-proBNP reduction with carperitide (Sato et al., J Cardiol, 2013).

Evidence grade: Moderate — Extensive clinical experience in Japan; randomised data show symptomatic benefit but no hard-endpoint superiority.

Protocols

Approved clinical protocol (Japan, Hanp):

  • Starting dose: 0.05–0.1 μg/kg/min continuous IV infusion
  • Titration: 0.05–0.2 μg/kg/min based on BP and response
  • Duration: Typically 24–72 hours for acute episodes
  • Monitoring: Continuous BP, urine output, electrolytes, renal function

⚠️ Research use only. Not for self-administration.

UK Status: Unlicensed (not approved by MHRA/EMA)

Carperitide (Hanp) is approved only in Japan for acute heart failure. Not available on the NHS. Not a controlled substance. Research-grade material legal for laboratory research. NHS access would require MHRA special import arrangements.

Vendor notes

Carperitide is approved only in Japan and is not available from UK research peptide vendors. Researchers should consult accredited chemical suppliers for laboratory-grade material with verified COAs.

References

  1. Nomura F, Kurobe N, Mori T, et al. PROTECT study: A multicenter post-marketing surveillance of carperitide (hANP) in patients with acute heart failure. Circ J. 2006;70(Suppl I):346.
  2. Hata N, Seino Y, Tsutamoto T, et al. Effects of carperitide on the long-term prognosis of patients with acute decompensated heart failure — the TAKUMI trial. Circ J. 2008;72(11):1787-1793.
  3. Sato N, et al. CARPA-HF: A randomized controlled trial comparing carperitide and nicorandil in patients with acute decompensated heart failure. J Cardiol. 2013;61(4):279-286.
  4. Suzuki T, et al. Acute heart failure volume management: carperitide (recombinant human atrial natriuretic peptide) in clinical practice. Cardiology. 2018;139(Suppl 1):1-7.
  5. Oikawa R, et al. Carperitide (ANP) enhances the cardiac expression of Cu/Zn-SOD and Mn-SOD in heart failure. J Mol Cell Cardiol. 2008;44(6):1029-1036. doi:10.1016/j.yjmcc.2008.03.017
  6. Asai K, et al. Carperitide for acute heart failure: a review of Japanese clinical experience. Eur Heart J Suppl. 2018;20(Suppl_G):G8-G14.