1
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Wittczak A, Ślot M, Bielecka-Dabrowa A. The Importance of Optimal Hydration in Patients with Heart Failure-Not Always Too Much Fluid. Biomedicines 2023; 11:2684. [PMID: 37893057 PMCID: PMC10604032 DOI: 10.3390/biomedicines11102684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.
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Affiliation(s)
- Andrzej Wittczak
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Maciej Ślot
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
- Faculty of Physics and Applied Informatics, University of Lodz, 90-236 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
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2
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Wang XY, Zhang F, Zhang C, Zheng LR, Yang J. The Biomarkers for Acute Myocardial Infarction and Heart Failure. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2018035. [PMID: 32016113 PMCID: PMC6988690 DOI: 10.1155/2020/2018035] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023]
Abstract
The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.
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Affiliation(s)
- Xi-Ying Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fen Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang-Rong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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3
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Arrigo M, Vodovar N, Nougué H, Sadoune M, Pemberton CJ, Ballan P, Ludes PO, Gendron N, Carpentier A, Cholley B, Bizouarn P, Cohen-Solal A, Singh JP, Szymonifka J, Latremouille C, Samuel JL, Launay JM, Pottecher J, Richards AM, Truong QA, Smadja DM, Mebazaa A. The heart regulates the endocrine response to heart failure: cardiac contribution to circulating neprilysin. Eur Heart J 2019; 39:1794-1798. [PMID: 29244074 DOI: 10.1093/eurheartj/ehx679] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022] Open
Abstract
Aims Heart failure (HF) is accompanied by major neuroendocrine changes including the activation of the natriuretic peptide (NP) pathway. Using the unique model of patients undergoing implantation of the CARMAT total artificial heart and investigating regional differences in soluble neprilysin (sNEP) in patients with reduced or preserved systolic function, we studied the regulation of the NP pathway in HF. Methods and results Venous blood samples from two patients undergoing replacement of the failing ventricles with a total artificial heart were collected before implantation and weekly thereafter until post-operative week 6. The ventricular removal was associated with an immediate drop in circulating NPs, a nearly total disappearance of circulating glycosylated proBNP and furin activity and a marked decrease in sNEP. From post-operative week 1 onwards, NP concentrations remained overall unchanged. In contrast, partial recoveries in glycosylated proBNP, furin activity, and sNEP were observed. Furthermore, while in patients with preserved systolic function (n = 6), sNEP concentrations in the coronary sinus and systemic vessels were similar (all P > 0.05), in patients with reduced left-ventricular systolic function, sNEP concentration, and activity were ∼three-fold higher in coronary sinus compared to systemic vessels (n = 21, all P < 0.0001), while the trans-pulmonary gradient was neutral (n = 5, P = 1.0). Conclusion The heart plays a pivotal role as a regulator of the endocrine response in systolic dysfunction, not only by directly releasing NPs but also by contributing to circulating sNEP, which in turn determines the bioavailability of other numerous vasoactive peptides.
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Affiliation(s)
- Mattia Arrigo
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Hélène Nougué
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France.,Department of Anaesthesiology and Intensive Care, Lariboisière Hospital, Paris, France
| | - Malha Sadoune
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France
| | | | - Pamela Ballan
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Pierre-Olivier Ludes
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Nicolas Gendron
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Inserm UMR-S 1140, Faculté de Pharmacie, Paris, France.,Department of Haematology, Georges Pompidou European Hospital, Paris, France
| | - Alain Carpentier
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France
| | - Bernard Cholley
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Department of Anaesthesiology and Intensive Care, Georges Pompidou European Hospital, Paris, France
| | - Philippe Bizouarn
- Department of Anaesthesiology and Intensive Care, CHU Nantes, France
| | - Alain Cohen-Solal
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France.,Université Paris Diderot-Sorbonne Paris Cité, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
| | - Jagmeet P Singh
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jackie Szymonifka
- Department of Radiology and Division of Cardiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Christian Latremouille
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Department of Cardiovascular Surgery, Georges Pompidou European Hospital, Paris, France
| | | | - Jean-Marie Launay
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France.,Centre for Biological Resources BB-0033-00064, Lariboisière Hospital, Paris, France
| | - Julien Pottecher
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - A Mark Richards
- University of Otago, Christchurch, New Zealand.,National University Health System, Singapore, Singapore
| | - Quynh A Truong
- Department of Radiology and Division of Cardiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - David M Smadja
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Inserm UMR-S 1140, Faculté de Pharmacie, Paris, France.,Department of Haematology, Georges Pompidou European Hospital, Paris, France
| | - Alexandre Mebazaa
- Inserm UMR-S 942, Hôpital Lariboisière, Paris, France.,Department of Anaesthesiology and Intensive Care, Lariboisière Hospital, Paris, France.,Université Paris Diderot-Sorbonne Paris Cité, Paris, France
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4
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Volpe M, Battistoni A, Mastromarino V. Natriuretic peptides and volume handling in heart failure: the paradigm of a new treatment. Eur J Heart Fail 2018; 18:442-4. [PMID: 27203476 DOI: 10.1002/ejhf.508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/11/2016] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Massimo Volpe
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189 Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Allegra Battistoni
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189 Rome, Italy
| | - Vittoria Mastromarino
- Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035-39, 00189 Rome, Italy
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5
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Ferreira MPA, Ranjan S, Kinnunen S, Correia A, Talman V, Mäkilä E, Barrios-Lopez B, Kemell M, Balasubramanian V, Salonen J, Hirvonen J, Ruskoaho H, Airaksinen AJ, Santos HA. Drug-Loaded Multifunctional Nanoparticles Targeted to the Endocardial Layer of the Injured Heart Modulate Hypertrophic Signaling. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2017; 13:1701276. [PMID: 28714245 DOI: 10.1002/smll.201701276] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/31/2017] [Indexed: 05/23/2023]
Abstract
Ischemic heart disease is the leading cause of death globally. Severe myocardial ischemia results in a massive loss of myocytes and acute myocardial infarction, the endocardium being the most vulnerable region. At present, current therapeutic lines only ameliorate modestly the quality of life of these patients. Here, an engineered nanocarrier is reported for targeted drug delivery into the endocardial layer of the left ventricle for cardiac repair. Biodegradable porous silicon (PSi) nanoparticles are functionalized with atrial natriuretic peptide (ANP), which is known to be expressed predominantly in the endocardium of the failing heart. The ANP-PSi nanoparticles exhibit improved colloidal stability and enhanced cellular interactions with cardiomyocytes and non-myocytes with minimal toxicity. After confirmation of good retention of the radioisotope 111-Indium in relevant physiological buffers over 4 h, in vivo single-photon emission computed tomography (SPECT/CT) imaging and autoradiography demonstrate increased accumulation of ANP-PSi nanoparticles in the ischemic heart, particularly in the endocardial layer of the left ventricle. Moreover, ANP-PSi nanoparticles loaded with a novel cardioprotective small molecule attenuate hypertrophic signaling in the endocardium, demonstrating cardioprotective potential. These results provide unique insights into the development of nanotherapies targeted to the injured region of the myocardium.
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Affiliation(s)
- Mónica P A Ferreira
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Sanjeev Ranjan
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
- Department of Chemistry, University of Helsinki, Helsinki, FI-00014, Finland
| | - Sini Kinnunen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Alexandra Correia
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Virpi Talman
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Ermei Mäkilä
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
- Laboratory of Industrial Physics, Department of Physics, University of Turku, Turku, FI-20014, Finland
| | | | - Marianna Kemell
- Department of Chemistry, University of Helsinki, Helsinki, FI-00014, Finland
| | - Vimalkumar Balasubramanian
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Jarno Salonen
- Laboratory of Industrial Physics, Department of Physics, University of Turku, Turku, FI-20014, Finland
| | - Jouni Hirvonen
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Heikki Ruskoaho
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
| | - Anu J Airaksinen
- Department of Chemistry, University of Helsinki, Helsinki, FI-00014, Finland
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, FI-00014, Finland
- Helsinki Institute of Life Science, HiLIFE, University of Helsinki, Helsinki, FI-00014, Finland
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6
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Abstract
Neprilysin has a major role in both the generation and degradation of bioactive peptides. LCZ696 (valsartan/sacubitril, Entresto), the first of the new ARNI (dual-acting angiotensin-receptor-neprilysin inhibitor) drug class, contains equimolar amounts of valsartan, an angiotensin-receptor blocker, and sacubitril, a prodrug for the neprilysin inhibitor LBQ657. LCZ696 reduced blood pressure more than valsartan alone in patients with hypertension. In the PARADIGM-HF study, LCZ696 was superior to the angiotensin-converting enzyme inhibitor enalapril for the treatment of heart failure with reduced ejection fraction, and LCZ696 was approved by the FDA for this purpose in 2015. This approval was the first for chronic neprilysin inhibition. The many peptides metabolized by neprilysin suggest many potential consequences of chronic neprilysin inhibitor therapy, both beneficial and adverse. Moreover, LBQ657 might inhibit enzymes other than neprilysin. Chronic neprilysin inhibition might have an effect on angio-oedema, bronchial reactivity, inflammation, and cancer, and might predispose to polyneuropathy. Additionally, inhibition of neprilysin metabolism of amyloid-β peptides might have an effect on Alzheimer disease, age-related macular degeneration, and cerebral amyloid angiopathy. Much of the evidence for possible adverse consequences of chronic neprilysin inhibition comes from studies in animal models, and the relevance of this evidence to humans is unknown. This Review summarizes current knowledge of neprilysin function and possible consequences of chronic neprilysin inhibition that indicate a need for vigilance in the use of neprilysin inhibitor therapy.
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Affiliation(s)
- Duncan J Campbell
- St Vincent's Institute of Medical Research, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.,University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia
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7
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Halfinger B, Hammerer-Lercher A, Amplatz B, Sarg B, Kremser L, Lindner HH. Unraveling the Molecular Complexity of O-Glycosylated Endogenous (N-Terminal) pro-B-Type Natriuretic Peptide Forms in Blood Plasma of Patients with Severe Heart Failure. Clin Chem 2016; 63:359-368. [PMID: 28062629 DOI: 10.1373/clinchem.2016.265397] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 10/14/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Currently, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and its physiologically active counterpart, BNP, are most frequently used as biomarkers for diagnosis, prognosis, and disease monitoring of heart failure (HF). Commercial NT-proBNP and BNP immunoassays cross-react to varying degrees with unprocessed proBNP, which is also found in the circulation. ProBNP processing and immunoassay response are related to O-linked glycosylation of NT-proBNP and proBNP. There is a clear and urgent need to identify the glycosylation sites in the endogenously circulating peptides requested by the community to gain further insights into the different naturally occurring forms. METHODS The glycosylation sites of (NT-) proBNP (NT-proBNP and/or proBNP) were characterized in leftovers of heparinized plasma samples of severe HF patients (NT-proBNP: >10000 ng/L) by using tandem immunoaffinity purification, sequential exoglycosidase treatment for glycan trimming, β-elimination and Michael addition chemistry, as well as high-resolution nano-flow liquid chromatography electrospray multistage mass spectrometry. RESULTS We describe 9 distinct glycosylation sites on circulating (NT-) proBNP in HF patients. Differentially glycosylated variants were detected based on highly accurate mass determination and multistage mass spectrometry. Remarkably, for each of the identified proteolytic glycopeptides, a nonglycosylated form also was detectable. CONCLUSIONS Our results directly demonstrate for the first time a rather complex distribution of the endogenously circulating glycoforms by mass spectrometric analysis in HF patients, and show 9 glycosites in human (NT-) proBNP. This information may also have an impact on commercial immunoassays applying antibodies specific for the central region of (NT-) proBNP, which detect mostly nonglycosylated forms.
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Affiliation(s)
- Bernhard Halfinger
- Division of Clinical Biochemistry and Protein Micro-Analysis Facility, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | | | - Benno Amplatz
- Division of Clinical Biochemistry and Protein Micro-Analysis Facility, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Bettina Sarg
- Division of Clinical Biochemistry and Protein Micro-Analysis Facility, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Leopold Kremser
- Division of Clinical Biochemistry and Protein Micro-Analysis Facility, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Herbert H Lindner
- Division of Clinical Biochemistry and Protein Micro-Analysis Facility, Biocenter, Innsbruck Medical University, Innsbruck, Austria;
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8
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Tripathi R, Wang D, Sullivan R, Fan THM, Gladysheva IP, Reed GL. Depressed Corin Levels Indicate Early Systolic Dysfunction Before Increases of Atrial Natriuretic Peptide/B-Type Natriuretic Peptide and Heart Failure Development. Hypertension 2015; 67:362-7. [PMID: 26667411 DOI: 10.1161/hypertensionaha.115.06300] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/18/2015] [Indexed: 01/05/2023]
Abstract
Dilated cardiomyopathy is a major cause of heart failure (HF) that affects millions. Corin cleaves and biologically activates pro-atrial natriuretic peptide (pro-ANP) and pro-B-type natriuretic peptide (pro-BNP). High corin levels reduce the development of systolic dysfunction and HF in experimental dilated cardiomyopathy. Yet, patients with significant HF unexpectedly show low corin levels with high plasma ANP/BNP levels. Therefore, we examined the relationship between cardiac corin expression, ANP/BNP levels, and the stages of HF. We used a well-established, dilated cardiomyopathy model to evaluate gene and protein expression as mice longitudinally developed Stages A-D HF. Cardiac systolic function (ejection fraction) continuously declined over time (P<0.001). Cardiac corin transcripts were decreased at early Stage B HF and remained low through Stages C and D (P<0.001). Cardiac corin levels were positively correlated with systolic function (r=0.96, P=0.003) and inversely with lung water (r=-0.92, P=0.001). In contrast, cardiac pro-ANP/BNP transcripts increased later (Stages C and D) and plasma levels rose only with terminal HF (Stage D, P<0.001). Immunoreactive plasma ANP and BNP levels were positively associated with plasma cyclic guanosine monophosphate levels (r=0.82, P=0.01 and r=0.8, P=0.02, respectively). In experimental dilated cardiomyopathy, corin levels declined early with progressive systolic dysfunction before the development of HF, whereas significant increases in plasma ANP, BNP, and cyclic guanosine monophosphate levels were found only in later stage (C and D) HF. This dyssynchrony in expression of corin versus ANP/BNP may impair cleavage activation of pro-natriuretic peptides, and thereby promote the transition from earlier to later stage HF.
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Affiliation(s)
- Ranjana Tripathi
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis
| | - Dong Wang
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis
| | - Ryan Sullivan
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis
| | - Tai-Hwang M Fan
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis
| | - Inna P Gladysheva
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis.
| | - Guy L Reed
- From the Departments of Medicine (R.T., D.W., T.-H.M.F., I.P.G., G.L.R.) and Comparative Medicine (R.S.), University of Tennessee Health Science Center, Memphis.
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9
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Abstract
The intracellular nucleotide cyclic guanosine monophosphate (cGMP) is found in many human organ tissues. Its concentration increases in response to the activation of receptor enzymes called guanylyl cyclases (GCs). Different ligands bind GCs, generating the second messenger cGMP, which in turn leads to a variety of biological actions. A deficit or dysfunction of this pathway at the cardiac, vascular, and renal levels manifests in cardiovascular diseases such as heart failure, arterial hypertension, and pulmonary arterial hypertension. An impairment of the cGMP pathway also may be involved in the pathogenesis of obesity as well as dementia. Therefore, agents enhancing the generation of cGMP for the treatment of these conditions have been intensively studied. Some have already been approved, and others are currently under investigation. This review discusses the potential of novel drugs directly or indirectly targeting cGMP as well as the progress of research to date.
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Affiliation(s)
- Alessia Buglioni
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905; ,
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905; ,
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10
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Solter PF, Oyama MA, Machen MC, Trafny DJ, Sisson DD. Detection by ELISA of C-terminal proBNP in plasma from cats with cardiomyopathy. Vet J 2015; 206:213-7. [PMID: 26324638 DOI: 10.1016/j.tvjl.2015.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/01/2015] [Accepted: 07/12/2015] [Indexed: 12/29/2022]
Abstract
The B-type natriuretic peptide prohormone (proBNP) is enzymatically cleaved into an inactive N-terminal peptide and a biologically active C-terminal peptide with many beneficial cardiorenal effects. The purpose of this study was to develop and test in cats with cardiomyopathy an immunoassay to quantify the concentrations of C-terminal proBNP in feline plasma. An anti-canine proBNP monoclonal antibody (UI-1021) was shown to have adequate binding affinity to proBNP 80-106 for use in a solid-phase immunoassay, and by epitope mapping to bind within positions 84-87 of feline proBNP. UI-1021 was paired with an affinity-purified rabbit polyclonal detection antibody to feline proBNP 100-106, in a sandwich ELISA with feline proBNP 80-106 standard. The linearity and analytical range and sensitivity of the assay were confirmed from 1.4 to 85 pmol/L. Spike recovery averaged 106.5% (95% confidence interval 78-135%). Within run and intra-assay coefficients of variation were <12%. A protease inhibitor mixture preserved proBNP 80-106 immunoreactivity for at least 5 days in plasma. Clinical verification of the ELISA was done using plasma from 13 cats with cardiomyopathy, whose C-terminal proBNP concentrations ranged from 1.7 to 78.8 pmol/L vs. <1.4-1.8 pmol/L in plasma from 18 healthy cats. Concentrations were found to be substantially lower than reported N-terminal proBNP concentrations, and similar to those of human heart failure patients where relative C-terminal BNP deficiencies have been proposed as contributory to the progression of the disease.
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Affiliation(s)
- Philip F Solter
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois Urbana-Champaign, USA.
| | - Mark A Oyama
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - Maggie C Machen
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - Dennis J Trafny
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, USA
| | - D David Sisson
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, USA
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11
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Singh JSS, Lang CC. Angiotensin receptor-neprilysin inhibitors: clinical potential in heart failure and beyond. Vasc Health Risk Manag 2015; 11:283-95. [PMID: 26082640 PMCID: PMC4459540 DOI: 10.2147/vhrm.s55630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure remains a major concern across the globe as life expectancies and delivery of health care continue to improve. There has been a dearth of new developments in heart failure therapies in the last decade until last year, with the release of the results from the PARADIGM-HF Trial heralding the arrival of a promising new class of drug, ie, the angiotensin receptor-neprilysin inhibitor. In this review, we discuss the evolution of our incremental understanding of the neurohormonal mechanisms involved in the pathophysiology of heart failure, which has led to our success in modulating its various pathways. We start by examining the renin-angiotensin-aldosterone system, followed by the challenges of modulating the natriuretic peptide system. We then delve deeper into the pharmacology and mechanisms by which angiotensin receptor-neprilysin inhibitors achieve their significant cardiovascular benefits. Finally, we also consider the potential application of this new class of drug in other areas, such as heart failure with preserved ejection fraction, hypertension, patients with renal impairment, and following myocardial infarction.
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Affiliation(s)
- Jagdeep S S Singh
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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12
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Affiliation(s)
- Roland Seifert
- From the Institute of Pharmacology, Hannover Medical School, Hannover, Germany.
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