{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:39:04Z","timestamp":1790948344483,"version":"4.1.0"},"reference-count":242,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T00:00:00Z","timestamp":1716336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Education, Universities and Research","award":["PRIN-2017ATZ2YK"],"award-info":[{"award-number":["PRIN-2017ATZ2YK"]}]},{"name":"Ministry of Education, Universities and Research","award":["1557 11.10.2022"],"award-info":[{"award-number":["1557 11.10.2022"]}]},{"name":"National Recovery and Resilience Plan","award":["PRIN-2017ATZ2YK"],"award-info":[{"award-number":["PRIN-2017ATZ2YK"]}]},{"name":"National Recovery and Resilience Plan","award":["1557 11.10.2022"],"award-info":[{"award-number":["1557 11.10.2022"]}]},{"name":"Next Generation EU","award":["PRIN-2017ATZ2YK"],"award-info":[{"award-number":["PRIN-2017ATZ2YK"]}]},{"name":"Next Generation EU","award":["1557 11.10.2022"],"award-info":[{"award-number":["1557 11.10.2022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Adrenomedullin (ADM) is a peptide hormone produced primarily in the adrenal glands, playing a crucial role in various physiological processes. As well as improving vascular integrity and decreasing vascular permeability, ADM acts as a vasodilator, positive inotrope, diuretic, natriuretic and bronchodilator, antagonizing angiotensin II by inhibiting aldosterone secretion. ADM also has antihypertrophic, anti-apoptotic, antifibrotic, antioxidant, angiogenic and immunoregulatory effects and antimicrobial properties. ADM expression is upregulated by hypoxia, inflammation-inducing cytokines, viral or bacterial substances, strength of shear stress, and leakage of blood vessels. These pathological conditions are established during systemic inflammation that can result from infections, surgery, trauma\/accidents or burns. The ability to rapidly identify infections and the prognostic, predictive power makes it a valuable tool in severe viral and bacterial infections burdened by high incidence and mortality. This review sheds light on the pathophysiological processes that in severe viral or bacterial infections cause endothelitis up to the development of organ damage, the resulting increase in ADM levels dosed through its more stable peptide mid-regional proadrenomedullin (MR-proADM), the most significant studies that attest to its diagnostic and prognostic accuracy in highlighting the severity of viral or bacterial infections and appropriate therapeutic insights.<\/jats:p>","DOI":"10.3390\/cells13110892","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T11:03:47Z","timestamp":1716375827000},"page":"892","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["A Focus on the Pathophysiology of Adrenomedullin Expression: Endothelitis and Organ Damage in Severe Viral and Bacterial Infections"],"prefix":"10.3390","volume":"13","author":[{"given":"Silvia","family":"Spoto","sequence":"first","affiliation":[{"name":"Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6987-1926","authenticated-orcid":false,"given":"Stefania","family":"Basili","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University, Viale dell\u2019Universit\u00e0, 30, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-2061","authenticated-orcid":false,"given":"Roberto","family":"Cangemi","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University, Viale dell\u2019Universit\u00e0, 30, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8502-9539","authenticated-orcid":false,"given":"Jos\u00e9 Ram\u00f3n","family":"Yuste","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Faculty of Medicine, Clinica Universidad de Navarra, University of Navarra, Avda. P\u00edo XII, 36, 31008 Pamplona, Spain"},{"name":"Department of Internal Medicine, Faculty of Medicine, Clinica Universidad de Navarra, University of Navarra, Avda. P\u00edo XII, 36, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4999-6753","authenticated-orcid":false,"given":"Felipe","family":"Lucena","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Clinica Universidad de Navarra, Avda. P\u00edo XII, 36, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-8942","authenticated-orcid":false,"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University, Viale dell\u2019Universit\u00e0, 30, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2100-5682","authenticated-orcid":false,"given":"Valeria","family":"Raparelli","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University, Viale dell\u2019Universit\u00e0, 30, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1696-7753","authenticated-orcid":false,"given":"Josepmaria","family":"Argemi","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Interna, Clinica Universidad de Navarra, Avda. 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