Neuregulin-1 (NRG-1), a cardioactive growth factor released from endothelial cells, is indispensable for cardiac development, structural maintenance, and functional integrity of the heart. In recent years, a growing number of studies have focused on NRG-1 and members of the ErbB family that serve as receptors for NRG-1 in order to better understand the role of this signaling pathway in physiology and pathophysiology of the heart. An essential role for NRG-1 and ErbB in heart development and functionality has been suggested by studies in conditional NRG-1/ErbB-deficient mice and by the cardiac-related side effects of anti-ErbB2 antibody therapies used for treatment of breast cancer. In vitro and in vivo studies using recombinant human neuregulin-1 (rhNRG-1), which contains the epidermal growth factor (EGF)-like domain (necessary for ErbB2/ErbB4 activation), have further supported the hypothesis that NRG-1 plays an important role in heart function. Consistent with other studies, expression of rhNRG-1 not only restored normal cardiomyocytic structure altered by nutritional deficiency in cell cultures, but also improved the pumping function of the heart in several animal models of chronic heart failure (CHF). As a result of these findings, proteins involved in the NRG-1/ErbB-signaling pathway have been explored as potential drug targets for treatment of heart failure. Clinical trials to evaluate the safety and efficacy of rhNRG-1 have been conducted in both China and Australia. As predicted, rhNRG-1 treatment improved both cardiac function and reversed remodeling of the heart. Therefore, rhNRG-1 may represent a new drug for treatment of CHF with a novel therapeutic mechanism.
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