CNP

also known as: C-type Natriuretic Peptide, Vosoritide precursor

The third natriuretic peptide — a vascular and skeletal growth factor whose analog vosoritide (Voxzogo) is FDA-approved for achondroplasia, and the endogenous cartilage growth signal.

A 22-amino-acid member of the natriuretic peptide family that acts through NPR-B (guanylyl cyclase B) rather than NPR-A, with primary roles in vascular homeostasis and endochondral bone growth rather than cardiac volume regulation.

Mechanism of action

Binds NPR-B (natriuretic peptide receptor B), a membrane-bound guanylyl cyclase distinct from the ANP/BNP receptor NPR-A. In vasculature: cGMP-mediated vasodilation and anti-proliferative effects. In growth plate cartilage: cGMP antagonizes FGFR3 overactivation (the achondroplasia defect) by inhibiting the MAPK/ERK pathway, restoring normal chondrocyte proliferation and differentiation.

Primary uses

Achondroplasia treatment (via vosoritide analog)
Skeletal growth plate biology
Vascular homeostasis research
Natriuretic peptide system studies

Typical dosing

Not established

Endogenous hormone. Vosoritide (CNP analog) dosed at 15 mcg/kg SC daily for achondroplasia.

Regulatory status

Native CNP not approved. Its analog vosoritide (Voxzogo, BioMarin) was FDA-approved in 2021 for achondroplasia in pediatric patients ≥5 years, the first therapy targeting the underlying growth plate defect.

References

[review] Potter LR, et al. "Natriuretic peptides, their receptors, and cyclic guanosine monophosphate-dependent signaling functions." Endocr Rev, 2006;27:47-72.
[clinical-trial] Savarirayan R, et al. "Once-daily, subcutaneous vosoritide therapy in children with achondroplasia: a randomised, double-blind, phase 3, placebo-controlled, multicentre trial." Lancet, 2020;396:684-692.

Related peptides

BNP

The heart failure biomarker — an endogenous cardiac peptide whose blood levels are the gold standard for diagnosing and monitoring heart failure severity.

ANP

The atrial pressure sensor — the first discovered natriuretic peptide, maintaining blood pressure and fluid balance through renal sodium excretion and vasodilation.

Nesiritide

Natrecor — the first recombinant natriuretic peptide drug for acute heart failure. FDA-approved August 2001 based on short-term dyspnea relief, became one of the most controversial drugs of the 2000s after 2005 meta-analyses raised safety concerns; ASCEND-HF (2010, n=7,141) eventually settled the safety debate but demonstrated only marginal clinical benefit. Janssen discontinued manufacturing February 2018; no longer commercially available in the US.

Disclaimer

This entry is for educational purposes only and does not constitute medical advice. Dosing information reflects published regulatory or research data and is not a recommendation. Many compounds described here are not approved for human use in the United States. Consult a licensed medical professional before considering any peptide therapy.