Adrenomedullin as a Multifunctional Regulator: Mechanisms and Clinical Implications Across Disease States

Adrenomedullin (ADM) is a multifunctional peptide hormone first recognized for its potent vasodilatory activity but now understood as a key regulator in diverse physiological and pathological processes. Its functions extend to angiogenesis, immune modulation, and tissue repair, placing it at the intersection of oncology, gastroenterology, and infectious diseases. Within the tumor microenvironment, ADM promotes cancer progression by facilitating immune evasion, stimulating angiogenesis, and contributing to chemotherapy resistance. In the gastrointestinal system, ADM and its related peptide PAMP act as essential regulatory hormones, supporting gastric motility, maintaining epithelial integrity, modulating mucosal immunity, and promoting repair—functions that underline their protective roles in inflammatory bowel diseases. Beyond these contexts, ADM has gained importance as a prognostic biomarker in critical care, with elevated circulating levels correlating strongly with disease severity in bacterial sepsis and emerging viral infections, where it may influence immune dysregulation and neurological complications. This review summarizes the multifaceted roles of ADM, highlights its dual protective and pathogenic actions, and discusses the therapeutic potential of selectively targeting the ADM pathway through precision strategies such as tumor-specific inhibitors and bi-specific antibodies.

کلیدواژه ها:

Adrenomedullin ، PAMP ، Angiogenesis ، Tumor microenvironment ، Immune modulation ، Gut barrier ، Sepsis biomarker ، Therapeutic targeting