Medical leaders support novel theragnostic approach to help patients with leaky blood vessels
HENNIGSDORF, Germany 05. January 2018 — Disorders caused by a leaky vasculature are more common than most people think. Despite ICU treatment, one third of the 27 million patients globally that suffer from sepsis, and up to 20% of the more than 5 million US patients with congestive heart failure die every year from their condition. Other disorders that involve a disturbed barrier function of the endothel , the innermost cell layer of blood vessels, include diabetes, migraine or inflammatory diseases. Medical opinion leaders have now confirmed evidence that adrenomedullin, a central regulator of endothelial function, could serve both as a diagnostic biomarker and a therapeutic target in disorders caused by endothelial dysfunction.
Until now, physicians had no means to identify patients with bad sepsis prognosis and those heart failure patients with congestion who relapse due to residual disease at discharge. International medical leaders have now compiled clinical data from more than 10,000 patients suffering from sepsis and congestive heart failure, whose survival was linked to blood levels of the peptide hormone adrenomedullin. Results presented in Berlin identify the active form of adrenomedullin, dubbed bio-ADM, as a biomarker that predicts development of septic shock and for the first time allows doctors to identify heart failure patients, who will relapse despite decongestive treatment with loop diurectics. While sepsis supportive treatment causes annual healthcare cost of nearly $24bn, congestive heart failure treatment and rehospitalisation costs due to unidentified residual disease totaled at $31bn in the US alone. The latter annual cost is expected to double by 2030.
A diagnostic test for bio-ADM , developed and marketed by diagnostics company Sphingotec in Europe and China, is already in place. An adrenomedullin-specific therapeutic antibody, developed by Berlin-based Adrenomed AG, has just entered proof-of-concept studies in septic shock patients; a Phase II study in patients with decompensated heart failure is expected to start in 2018. According to serial entrepreneur Andreas Bergmann, founder of both companies and co-founder of BRAHMS (taken over in 2009), “bio-ADM is a general indicator for endothelial dysfunction and the need of vascular repair.”
Clinical data from more than 4,000 Caucasian and Asian sepsis patients presented at the scientific symposium “Endothelial dysfunction – Adrenomedullin as a diagnostic and therapeutic target” demonstrate that low bio-ADM plasma levels (<70pg/mg) at baseline were linked to a good outcome. In contrast, bio-ADM levels above that cut-off value were linked to significantly higher mortality (up to 13-fold), organ dysfunction and high vasopressor demand. As bio-ADM levels rose 24+ hours before septic shock occurred it allowed both early intervention and therapy monitoring. bio-ADM indicated endothelial integrity in sepsis patients at emergency departments, ICUs and patients with surgical sepsis.
Further clinical data from more than 6,000 patients with acute and chronic heart failure suffering from congestion and edema caused by high venous pressure and vascular fluid leakage, demonstrate that high bio-ADM levels predicted residual congestion, rehospitalisation and 180-day mortality. Measuring bio-ADM levels is the very first method that allows identification of patients with acute heart failure that have residual congestion and mustn’t be discharged in order to prevent rehospitalisation and death.
Using adrenomedullin as a therapeutic target seems to be a next logical step.
Preclinically, Adrecizumab, a humanized antibody that binds adrenomedullin without affecting its receptor binding in the endothel, led to a 40% survival benefit in mice. In two Phase I trials the first-in-class antibody showed excellent safety and tolerability in sepsis patients. Pharmakokinetic and pharmacodynamic data suggest that antibody stabilizes adrenomedullin’s half-life from 22 minutes to several days and that antibody binding leads to a redistribution from the vessel interstitium to its lumen, where is closes in gaps in the endothelium and thus restores the blood vessels barrier function. A Phase II trail on 300 patients with early septic shock is underway, while a Phase II study in congestive heart failure patients is in preparation and is expected to start in 2018.
About the speakers at the scientific symposium
- Prof. Dr. Inder Anand, Department of Cardiovascular Medicine, University of Minnesota Medical School,
- VA Medical Center Minneapolis MN and ‪San Diego, USA
- Prof. Dr. Aw Tar Choon, Changi General Hospital, Singapore
- Prof. Dr. Javed Butler, Chief of the Cardiology Divisionat Stony Brook School of Medicine, USA
- Prof. Dr Salvatore Di Somma, Director Emergency Medicine, University La Sapienza, Rome, Italy
- Asj-Prof. Dr. Hans-Dirk Düngen, Head Multicentric Studies Cardiology, Charité Berlin, Germany
- Prof. Dr. Mina Hur, Director Department of Laboratory Medicine, Konkuk University Seoul, Korea
- Prof. Dr Pierre-Francois Laterre, Head of the medical-surgical intensive care unit at St. Luc Hospital, Brussels, Belgium
- Dr. Roberto Latini, Istituto di Ricerche Farmacologiche Mario Negri Milano, Italy
- Prof. Dr. Gernot Marx, Director Operative Intensive Care and Intermediate Care, University Clinic Aachen, Germany
- Prof. Alexandre Mebazaa, Head AP-HP, Hôpital Lariboisière Paris, France
- Prof. Dr. Olle Melander, Principal investigator at Hypertension and Cardiovascular Disease, Lund University Malmö, Sweden
- Prof. Dr. Marco Metra, Department of Medical and Surgical Specialties. Universita degli Studi di Brescia, Italy
- Prof. Leong L. Ng, Principal Investigator, Department of Cardiovascular Sciences, University Leicester, UK
- Prof. Dr. Peter Pickkers, Department of Intensive Care. Radboud University, Nijmegen, The Netherlands
- Prof. Adriaan A. Voors, Director of the Heart Failure Clinic and the Outpatient Clinic of the.Department of Cardiology, UMC Groningen, The Netherlands
About congestive heart failure:
About 5 million US-Americans suffer from congestive heart failure. The characteristic loss of pump function of the heart triggers cardiac remodeling – the heart gets stiffer, fibrotic, and cannot pump enough blood into the circulatory system. The lower pump efficacy causes lower oxygen saturation and results in congestion, which means that blood returning to the heart through the veins backs up, resulting in higher venous pressure and causing fluids to build up in the tissues (edema). About 80% of patients with congestive heart failure are also at risk to develop edema, because their microvasculature becomes leaky due to venous hypertension. Physicians try to prevent the worst case – deadly lung edemas – by administration of loop diuretics, which can reduce hypertension by increasing water excretion. However, not all patients fully respond to diuretics. Incomplete response to diuretics therapy is the most common cause of re-hospitalization and post discharge mortality in patients with congestive heart failure. It’s not yet fully understood why patients with congestive heart failure often experience acute kidney injury (AKI). However, there is growing evidence that AKI can be attributed to congestion („cardio-renal syndrome“) and that, vice versa, AKI can trigger heart problems. Management of fluid balance with loop diuretics is challenging – if too much fluid is excreted from tissues, this will support development of AKI. On the other hand, if too little fluid is excreted, lung edemas could return. Besides that, a large proportion of patients with congestive heart failure does not fully respond to diuretics treatment, leading to undetected residual congestion. To date, physicians have no means to identify these patient group at discharge, resulting in high re-hospitalization and post-discharge mortality rates.
About septic shock
Septic shock is defined as a life-threatening organ dysfunction due to dysregulated host response to a proven or suspected infection which leads to a decline of Mean Arterial Pressure (MAP) < 65 mmHg, which is refractory to fluid resuscitation and requires vasopressors. Refractoriness to fluid resuscitation is defined as a lack of response to the administration of 30 mL of fluid per kilogram of body weight or is determined according to a clinician’s assessment of inadequate hemodynamic results
About Adrenomedullin
Adrenomedullin is a strong vaso-regulatory hormone released by smooth muscle cells and the endothelium. It is a key regulator of blood pressure and vascular tone and plays a pivotal role in the regulation of the endothelial barrier function.
About Adrecizumab
Adrecizumab is a proprietary humanized monoclonal Adrenomedullin-specific antibody, as first-in-class therapy for the treatment and prevention of impaired vascular integrity, which is a hallmark of septic shock. Adrecizumab showed excellent safety & tolerability as well as high efficacy in a variety of preclinical animal models, mimicking human standard of care treatment on ICU. In several resuscitated vascular integrity models (mouse, rat, pig), Adrecizumab reduced vascular leakage, stabilized the circulation, by restoring blood pressure, normalized fluid balance and reduced vasopressor demand, improved renal function and reduced mortality from septic shock by 50%. The excellent tolerability and safety of Adrecizumab was confirmed in two clinical Phase-I studies in healthy subjects with and without LPS challenge.
About SphingoTec GmbH:
SphingoTec GmbH (Hennigsdorf, Germany) develops innovative biomarkers for prediction, diagnosis and therapy monitoring of AKI, congestive heart failure and septic shock. The company, founded by Dr. Andreas Bergmann in 2002, has also in its portfolio biomarkers which can predicts risks of obesity, breast cancer and cardiovascular diseases.
About Adrenomed
Adrenomed AG is a privately financed biopharmaceutical company, based in Hennigsdorf near Berlin, Germany, with the mission to improve survival by improving vascular integrity in critically ill patients. Its lead candidate, Adrecizumab, a monoclonal antibody therapy targeting the vasoactive adrenomedullin system, is in clinical testing for early septic shock. Impaired vascular integrity is a pathology observed in a variety of medical conditions. A further indication besides sepsis and early septic shock is acute decompensated heart failure.
A new peer-reviewed study in Physiological Reports is the first to evaluate Proenkephalin A 119-159 (penKid) for kidney functional reserve (KFR) assessment, a stress test designed to reveal loss of kidney capacity that may not be apparent from routine blood tests. Within that method, penKid stood out: its dynamic had a far wider range after a protein stimulus than cystatin C (44.2% vs. 10.5% median fractional change) while reaching its maximal response within approx. two hours after protein stimulation. The results extend the published evidence for penKid beyond acute kidney injury into a potential complementary application: assessing kidney functional reserve. Hennigsdorf, Germany – October 6, 2026 – penKid has been evaluated for the first time as a marker of kidney functional reserve (KFR): a new study in Physiological Reports (1) found that its response spanned a much wider range than cystatin C and creatinine clearance after a protein stimulus. The study in 62 participants marks the first published evaluation of penKid for this use. Clinical context and unmet need Kidney function may appear normal on a standard blood test until a large portion of capacity has already gone. Kidney functional reserve testing addresses this gap by measuring how much a kidney's filtration rate can still rise in response to a stimulus, most commonly a protein meal. Once that reserve narrows, the kidney has less room to compensate for future stress such as major surgeries. The study authors note that reserve testing is rarely used in clinical practice, largely because the reference method used, creatinine clearance, is cumbersome, requiring blood and urine collection, can be difficult to perform outside specialized settings, and is affected by processes in the kidney unrelated to filtration itself. Study design and key findings Researchers at the University of New South Wales and Prince of Wales Hospital in Sydney conducted the study in 62 participants: 40 patients having heart surgery, and 22 healthy people, including volunteers, kidney donors, and patients who had a kidney auto-transplant. Participants drank a protein shake, followed by hourly collection of blood samples over a five hour-period. Urine samples were also collected for creatinine clearance testing. After a high protein intake, kidney filtration increases for a few hours: this "extra work" is what the methods were designed to measure. PenKid showed the largest dynamic response, with a median fractional increase of 44% from baseline compared with 30% for creatinine clearance and only about 10% for cystatin C. Unlike creatinine clearance, penKid differentiated healthy participants from cardiac surgery patients, who had a lower KFR. The study also found penKid measurements to be more homogeneous than creatinine clearance measurements, indicating greater consistency across assessments. PenKid was also fast, reaching its peak functional response in about two hours, similar in timing to a two-hour diabetes test (oral glucose tolerance test). Implications for clinical practice Beyond its wider dynamic range, the authors highlight practical advantages specific to penKid-based functional reserve testing: no urine collection is needed, minimal fasting is required, and penKid enables near real-time assessment of kidney functional reserve from blood samples alone. These features suggest penKid may offer a fast and simple alternative to assess how much reserve an individual patient has. "PenKid gave us a fast, consistent read on how much filtration capacity a kidney still has in reserve," said Prof. Zoltan H. Endre, corresponding author of the study, Department of Nephrology, Prince of Wales Hospital, and School of Clinical Medicine, University of New South Wales, Sydney. "A signal that's clear, captured that quickly, turns a kidney stress test from a research tool into something a clinic could actually use." About penKid, scientific insights PenKid is a biomarker for real-time assessment of kidney function. Unlike creatinine, penKid levels are not influenced by inflammation or factors such as age or sex, and prior studies show penKid can detect acute kidney injury (AKI) up to 48 hours before conventional criteria are met (2,3). The new Physiological Reports study provides data for another, complementary application: measuring kidney functional reserve to identify subclinical kidney disease. About SphingoTec SphingoTec GmbH ("SphingoTec"; Hennigsdorf near Berlin, Germany) is a biomarker company focusing on the out-licensing of innovative critical care solutions for diagnosing, predicting, and monitoring acute medical conditions. SphingoTec develops its biomarkers to the commercial stage and partners with IVD companies to make them available on different IVD platforms. SphingoTec's proprietary biomarker portfolio includes Proenkephalin A 119-159 (penKid), a biomarker for the assessment of kidney function in critical diseases, and bioactive Adrenomedullin 1-52 (bio-ADM), a biomarker for the assessment of endothelial function in conditions like acute heart failure. Discover more on www.sphingotec.com References (1) Rodrigues, C. E. et. al. (2026). Plasma proenkephalin-a facilitates measurement of human kidney functional reserve: From healthy kidney donors to polymorbid patients. Physiological Reports, 14, e71083. https://doi.org/10.14814/phy2.71083 . (2) Caironi P, et al. (2018) Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock.; https://doi.org/10.1373/clinchem.2018.288068 (3) Rosenqvist M, et. al. (2019) Proenkephalin a 119-159 (penKid) - a novel biomarker for acute kidney injury in sepsis: an observational study. BMC Emerg Med, doi: 10.1186/s12873-019-0283-9. Media Contact: Email: press@sphingotec.com Phone +49-3302-20565-0 SphingoTec GmbH Neuendorfstr. 15A 16761 Hennigsdorf, Germany
In a prospective, real-world study of 1,436 critically ill ICU patients, proenkephalin A 119–159 (penKid) provided clinically relevant information across AKI severity and during kidney replacement therapy (KRT). PenKid addressed a key unmet need in KRT management by identifying, with greater precision than standard biomarkers, patients at high risk of KRT liberation failure – helping to avoid stopping therapy too early. The findings support a future role for penKid in helping to standardize one of the few intensive care processes where the need for better decision support is widely acknowledged and current tools remain insufficient. Hennigsdorf, Germany – August 27, 2026 – SphingoTec GmbH announces the publication of new real-world data on proenkephalin A 119–159 (penKid) in critically ill patients. The data, published in Annals of Intensive Care, add to the growing body of evidence supporting penKid as a functional biomarker for kidney function and help inform clinical decision-making in AKI and KRT (1). In a prospective observational study at Heidelberg University Hospital, penKid was measured in 1,436 critically ill patients, including 138 patients receiving KRT for liberation analyses. The findings showed that penKid rose with AKI severity and, unlike serum creatinine and urine output, distinguished stage 3 AKI patients with and without an acute KRT requirement. In contrast to serum creatinine, penKid also differentiated acute KRT patients from those with pre-existing kidney failure and on chronic hemodialysis prior ICU admission, even while KRT treatment was ongoing (1). The study further showed that penKid levels increased progressively from the start of KRT, while serum creatinine decreased under treatment. Following successful liberation from KRT, penKid declined, whereas higher levels were seen in cases of liberation failure. In multivariable analysis, penKid was the strongest independent predictor of liberation failure and outperformed serum creatinine. A penKid cut-off of ≥250 pmol/L provided more than 90% specificity for liberation failure (1). By identifying patients at high risk of unsuccessful liberation, penKid may help clinicians make KRT discontinuation decisions more objectively, reduce the risk of stopping therapy too early, and support more standardized decision-making across critical care settings. “These data are important because they address a real-world clinical problem: how to better assess kidney function and support KRT decisions when standard markers fall short,” said Deborah Bergmann, CEO of SphingoTec. “penKid provides clinicians with an objective, real-time measurable parameter that may help support more informed and consistent kidney-related decisions in critical care.” Christian Nusshag, MD, Department of Nephrology, Heidelberg University Hospital, said: “Current markers often leave clinicians with an incomplete picture. Our findings suggest that penKid may help standardize decision-making by providing additional, actionable information on kidney integrity and recovery.” About penKid, scientific insights PenKid is a biomarker that enables real-time assessment of kidney function. Unlike conventional markers such as serum creatinine, penKid levels are not influenced by inflammation or other confounding factors like age or sex. Studies have shown that penKid allows earlier detection of AKI, predicting changes in serum creatinine up to 48 hours before conventional diagnostic criteria are met. This early detection capability is particularly valuable in critically ill patients, including those with sepsis or septic shock. Additionally, penKid has shown potential for monitoring renal recovery under KRT and could help predict successful liberation from KRT. About SphingoTec SphingoTec GmbH ("SphingoTec"; Hennigsdorf near Berlin, Germany) is a biomarker company focusing on the out-licensing of innovative critical care solutions for diagnosing, predicting, and monitoring acute medical conditions. SphingoTec develops its biomarkers to the commercial stage and partners with IVD companies to make them available on different IVD platforms. SphingoTec's proprietary biomarker portfolio includes Proenkephalin A 119-159 (penKid), a biomarker for the assessment of kidney function in critical diseases, and bioactive Adrenomedullin 1-52 (bio-ADM), a biomarker for the assessment of endothelial function in conditions like acute heart failure. Discover more on www.sphingotec.com References (1) Gabriel DC, Sauer P, Happel R, et al. Proenkephalin A for Assessing Kidney Integrity and Guiding KRT Liberation Decisions in Critically Ill Patients. Annals of Intensive Care. 2026. DOI: 10.1016/j.aicoj.2026.100113. Media Contact: Email: press@sphingotec.com Phone +49-3302-20565-0 SphingoTec GmbH Neuendorfstr. 15A 16761 Hennigsdorf, Germany