1
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Prickett TCR, Espiner EA, Pearson JF. Association of natriuretic peptides and receptor activity with cardio-metabolic health at middle age. Sci Rep 2024; 14:9919. [PMID: 38689031 PMCID: PMC11061163 DOI: 10.1038/s41598-024-60677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
Natriuretic peptides (NP) have multiple actions benefitting cardiovascular and metabolic health. Although many of these are mediated by Guanylyl Cyclase (GC) receptors NPR1 and NPR2, their role and relative importance in vivo is unclear. The intracellular mediator of NPR1 and NPR2, cGMP, circulates in plasma and can be used to examine relationships between receptor activity and tissue responses targeted by NPs. Plasma cGMP was measured in 348 participants previously recruited in a multidisciplinary community study (CHALICE) at age 50 years at a single centre. Associations between bio-active NPs and bio-inactive aminoterminal products with cGMP, and of cGMP with tissue response, were analysed using linear regression. Mediation of associations by NPs was assessed by Causal Mediation Analysis (CMA). ANP's contribution to cGMP far exceed those of other NPs. Modelling across three components (demographics, NPs and cardiovascular function) shows that ANP and CNP are independent and positive predictors of cGMP. Counter intuitively, findings from CMA imply that in specific tissues, NPR1 responds more to BNP stimulation than ANP. Collectively these findings align with longer tissue half-life of BNP, and direct further therapeutic interventions towards extending tissue activity of ANP and CNP.
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Affiliation(s)
- Timothy C R Prickett
- Departments of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Eric A Espiner
- Departments of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand
| | - John F Pearson
- Departments of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140, New Zealand
- Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand
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2
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Gruson D, Hammerer-Lercher A, Collinson P, Duff C, Baum H, Pulkki K, Suvisaari J, Stankovic S, Laitinen P, Bayes-Genis A. The multidimensional value of natriuretic peptides in heart failure, integrating laboratory and clinical aspects. Crit Rev Clin Lab Sci 2024:1-15. [PMID: 38523480 DOI: 10.1080/10408363.2024.2319578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024]
Abstract
Natriuretic peptides (NP) play an essential role in heart failure (HF) regulation, and their measurement has improved diagnostic and prognostic accuracy. Clinical symptoms and objective measurements, such as NP levels, should be included in the HF definition to render it more reliable and consistent among observers, hospitals, and healthcare systems. BNP and NT-proBNP are reasonable surrogates for cardiac disease, and their measurement is critical to early diagnosis and risk stratification of HF patients. NPs should be measured in all patients presenting with dyspnea or other symptoms suggestive of HF to facilitate early diagnosis and risk stratification. Both BNP and NT-proBNP are currently used for guided HF management and display comparable diagnostic and prognostic accuracy. Standardized cutoffs for each NP assay are essential for data comparison. The value of NP testing is recognized at various levels, including patient empowerment and education, analytical and operational issues, clinical HF management, and cost-effectiveness.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | | | - Paul Collinson
- Department of Clinical Blood Science Chemical Pathology and Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christopher Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Hannsjörg Baum
- Department Laboratory Medicine, Regionale Kliniken Holding RKH, Ludwigsburg, Germany
| | - Kari Pulkki
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Janne Suvisaari
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Paivi Laitinen
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Antoni Bayes-Genis
- Germans Trias Heart Institute (iCor), Pujol, Universitat Autònoma de Barcelona; CIBERCV, Barcelona, Spain
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3
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Lewis LK, Raudsepp SD, Whitlow JC, Appleby S, Pemberton CJ, Yandle TG, Mark Richards A. Assays Specific for BNP1-32 and NT-proBNP Exhibit a Similar Performance to Two Widely Used Assays in the Diagnosis of Heart Failure. Clin Chem 2022; 68:1292-1301. [PMID: 35932191 DOI: 10.1093/clinchem/hvac126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Secretion of cardioprotective B-type natriuretic peptide 1-32 (BNP1-32) is increased proportionately with cardiac dysfunction, but its measurement in plasma is difficult. Therefore, less specific BNP and amino-terminal proBNP (NT-proBNP) assays that detect the precursor molecule proBNP alongside BNP or NT-proBNP metabolites were developed to reflect BNP1-32 secretion and are now mandated in the diagnosis of heart failure (HF). We compared the diagnostic performance of 2 widely used clinical assays: the Roche proBNPII assay, and Abbott BNP assay, against our recently developed in-house assays that measure either intact BNP1-32 or NT-proBNP. METHODS EDTA plasma samples obtained from patients presenting with breathlessness (n = 195, 60 [31%] with clinically adjudicated HF) were assayed using the Roche NT-proBNP and our specific in-house BNP1-32 and NTBNP assays. A subset (n = 75) were also assessed with the Abbott BNP assay. RESULTS Roche NT-proBNP was highly correlated with BNP1-32 and NTBNP (Spearman rho = 0.92 and 0.90, respectively, both Ps < 0.001), and all 3 assays similarly discriminated acute HF from other causes of breathlessness (ROC analysis areas under the curve 0.85-0.89). The Abbott BNP assay performed similarly to the other assays. Roche NT-proBNP and BNP1-32 assays had similar sensitivity (83% and 80%), specificity (83% and 84%), positive (70% and 71%) and negative (91% and 90%) predictive values, and accuracy (both 83%) at their optimal cutoffs of 1536 and 12 ng/L, respectively. CONCLUSIONS Since all assays exhibited similar performance in the diagnosis of HF, currently mandated assays provide a reliable proxy for circulating concentrations of active BNP1-32 in HF diagnosis.
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Affiliation(s)
- Lynley K Lewis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sara D Raudsepp
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna C Whitlow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah Appleby
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher J Pemberton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Timothy G Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand.,Cardiovascular Research Institute, National University Heart Centre, National University of Singapore, Singapore, Singapore
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4
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Goryacheva OA, Ponomaryova TD, Drozd DD, Kokorina AA, Rusanova TY, Mishra PK, Goryacheva IY. Heart failure biomarkers BNP and NT-proBNP detection using optical labels. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2021.116477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Active B-Type Natriuretic Peptide Measured by Mass Spectrometry and Response to Sacubitril/Valsartan. J Card Fail 2021; 27:1231-1239. [PMID: 34133968 DOI: 10.1016/j.cardfail.2021.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) immunoassays (BNPia) do not differentiate active and inactive forms. Inactive NT-proBNP is used to track heart failure (HF) during treatment with sacubitril/valsartan, which inhibits BNP degradation. Mass spectrometry (MS) may better assess effects of HF treatment on biologically active BNP1-32. METHODS AND RESULTS We developed a MS assay with immediate protease inhibition to quantify BNP1-32 over a linear range, using labeled recombinant BNP standard. In 4 healthy volunteers, BNP1-32 by MS (BNPMS) increased from below the 5 pg/mL detection limit to 228 pg/mL after nesiritide. In patients with HF, BNPMS was measured in parallel with BNP and NT-proBNP immunoassays before and during sacubitril/valsartan treatment. BNPMS was 4.4-fold lower than BNPia in patients with HF. Among patients not taking sacubitril/valsartan and without end-stage renal disease, BNPMS correlated with BNPia (rs = 0.77, P < .001) and NT-proBNP (rs = 0.74, P < .001). After a median of 8 weeks on sacubitril/valsartan, active BNPMS levels decreased by 50% (interquartile range -98.3% to 41.7%, n = 22, P = .048) and correlated with NT-proBNP (rs = 0.64, P < .001), but not with BNPia (rs = 0.46, P = .057). CONCLUSIONS Active BNP measured by MS accounts for only a small amount of BNP measured by immunoassays. Although decreased BNP production was anticipated to be masked by inhibition of degradation, levels of active BNP decreased during chronic sacubitril/valsartan treatment.
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Amplatz B, Sarg B, Faserl K, Hammerer-Lercher A, Mair J, Lindner HH. Exposing the High Heterogeneity of Circulating Pro B-Type Natriuretic Peptide Fragments in Healthy Individuals and Heart Failure Patients. Clin Chem 2021; 66:1200-1209. [PMID: 32797158 DOI: 10.1093/clinchem/hvaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The high molecular complexity of variably O-glycosylated and degraded pro B-type natriuretic peptide (proBNP) derived molecular forms challenges current immunoassays. Antibodies used show pronounced differences in cross-reactivities with these circulating fragments, which still need to be better characterized on a molecular level. To pave the way for advanced quantitative assays in the future, it is critical to fully understand these circulating forms. METHODS Plasma samples were collected from 8 heart failure (HF) patients and 2 healthy controls. NT-proBNP and proBNP were purified by immunoprecipitation and analyzed by nano-flow liquid chromatography coupled to high-resolution mass spectrometry. Fragments formed during proteolysis in solution digestion were distinguished from naturally occurring peptides by using an 18O stable isotope labeling strategy. RESULTS We detected 16 previously unknown circulating fragments of proBNP peptides (9 of which are located in the N-terminal and 7 in the C-terminal region), revealing a more advanced state of degradation than previously known. Two of these fragments are indicative of either unidentified processing modes or a far-reaching C-terminal degradation (or a combination thereof) of the precursor proBNP. CONCLUSIONS Our results further restrict ideal target epitopes for immunoassay antibodies and expand the current thinking of diversity, degradation, and processing of proBNP, as well as the distribution of circulating forms.
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Affiliation(s)
- Benno Amplatz
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | - Bettina Sarg
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | - Klaus Faserl
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | | | - Johannes Mair
- Department of Internal Medicine III-Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - Herbert H Lindner
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
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Rochat B, Waridel P, Barblan J, Sottas PE, Quadroni M. Robust and sensitive peptidomics workflow for plasma based on specific extraction, lipid removal, capillary LC setup and multinozzle ESI emitter. Talanta 2021; 223:121617. [PMID: 33303132 DOI: 10.1016/j.talanta.2020.121617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
We present a new workflow for the LC-MS determination of native peptides in plasma at picomolar levels. Collected whole blood was quickly diluted with an ice-cold solution in order to stop protease activity. Diluted plasma samples were extracted by protein denaturation followed by solid-phase-extraction with a polymeric stationary phase that removed most proteins and lipids. Using a specific LC-MS setup with 3 pumps, 240 μL of extracts were injected without drying-reconstitution, a step known to cause peptide losses. After an 18-fold dilution on-line, peptides were trapped on a 1 × 10 mm C8 column, back-flushed and resolved on a 0.3 × 100 mm C18 column. Extract reproducibility, robustness (column clogging), extraction yields, matrix effects, calibration curves and limits of detection were evaluated with plasma extracts and spiked-in standards. The sensitivity and applicability of 3 electrospray sources were evaluated at capillary flow rates (10 μL/min). We show that ionization sources must have a spray angle with the MS orifice when "real" extracts are injected and that a multinozzle emitter can improve very significantly peptide detection. Finally, using our workflow, we have performed a peptidomics study on dried-blood-spots collected over 65 h in a healthy volunteer and discovered 5 fragments (2.9-3.8 KDa) of the protein statherin showing circadian oscillations. This is the first time that statherin is observed in blood where its role clearly deserves further investigations. Our peptidomic protocol shows low picomolar limits of detection and can be readily applied with or without minor modifications for most peptide determinations in various biomatrices.
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Affiliation(s)
- Bertrand Rochat
- Protein Analysis Facility, University of Lausanne, Switzerland; University Hospital of Lausanne, 1015, Lausanne, Switzerland.
| | - Patrice Waridel
- Protein Analysis Facility, University of Lausanne, Switzerland.
| | - Jachen Barblan
- Protein Analysis Facility, University of Lausanne, Switzerland.
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Tu A, Shang J, Wang Y, Li D, Liu L, Gan Z, Yin Y, Zhang P. Detection of B-type natriuretic peptide by establishing a low-cost and replicable fluorescence resonance energy transfer platform. Mikrochim Acta 2020; 187:331. [PMID: 32415311 DOI: 10.1007/s00604-020-04247-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
Aiming at the establishment of a sensitive and specific diagnostic method for early heart failure (HF), we developed a cost-effective fluorescence resonance energy transfer (FRET) platform for the detection of B-type natriuretic peptide (BNP), a characteristic biomarker of HF. Graphene oxide (GO) was selected as the FRET receptor in view of its advantages including commercial availability, low-cost and chemical stability, and dye-modified aptamer was used as the energy donor of FRET as well as in charge of the specific recognition of BNP. Based on the ON (strong emission) and OFF (quenching) states of FRET in the presence and absence of BNP, respectively, specific detection of BNP was achieved in the range 0.074-0.56 pg/mL with a limit of detection as low as 45 fg/mL (3σ). This FRET platform was applied to detect BNP in 45 blood samples to demonstrate its practicability in clinical diagnosis. Compared to the commonly used Siemens method (chemiluminescence immunoassay, CLIA) in hospital, our approach is more accurate and specific for HF diagnosis with areas under the receiver operating characteristic curves of 0.869 (95% CI 0.733-1.00, P < 0.05) vs 0.850 (95% CI 0.703-0.997, P < 0.05) and specificity of 68.8% vs 65.6%. This platform is promising in early diagnosis of HF through ultrasensitive and specific detection of BNP. Graphical abstract To solve the clinical diagnostic problem for early heart failure (HF) which lacks sensitivity and specificity, we established a cost-effective and rapid fluorescence analysis method based on fluorescence resonance energy transfer (FRET) platform for the detection of B-type natriuretic peptide (BNP), a characteristic biomarker of HF.
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Affiliation(s)
- Aiping Tu
- Engineering Technology Research Center for Pharmacodynamic Evaluation of Chongqing, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Jingchuan Shang
- Engineering Technology Research Center for Pharmacodynamic Evaluation of Chongqing, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Yi Wang
- College of Chemistry, Chongqing Normal University, Chongqing, 401331, China
| | - Di Li
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Laicheng Liu
- Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Zongjie Gan
- Engineering Technology Research Center for Pharmacodynamic Evaluation of Chongqing, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Department of Medical Laboratory, Chongqing Medical University, Chongqing, 400016, China
| | - Pu Zhang
- Engineering Technology Research Center for Pharmacodynamic Evaluation of Chongqing, College of Pharmacy, Chongqing Medical University, Chongqing, 400016, China.
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9
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Harris SL, Troughton R, Lewis L, Austin N, Pemberton C. Circulating Forms of B-Type Natriuretic Peptide in Very Preterm Infants. J Appl Lab Med 2020; 5:506-515. [PMID: 32445356 DOI: 10.1093/jalm/jfaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 01/09/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a cardiac hormone released with an N-terminal fragment (NTproBNP) under conditions of ventricular pressure or volume overload. BNP has been proposed for use as a biomarker of cardiac dysfunction in premature infants in the setting of hemodynamically significant patent ductus arteriosus (HsPDA) and bronchopulmonary dysplasia (BPD). In adult settings the presence of proBNP and glycosylated isoforms may affect assay interpretation. However, there are limited data on how immature preterm physiology may affect BNP or NTproBNP levels and no published data on post-translational BNP processing in premature infants. METHODS Pooled serial plasma samples from preterm infants born at less than 30 weeks gestation were analyzed for BNP congeners using Luminex® assay and high performance liquid chromatography. Samples were grouped according to clinical status: Group 1, no HsPDA and no BPD, Group 2 HsPDA and no/mild BPD, Group 3 HsPDA and moderate/severe BPD. RESULTS Plasma from 15 infants was analyzed, and across all three groups NTproBNP predominated with minimal amounts of other isoforms; no glycosylation was detected. CONCLUSIONS NTproBNP appears to be the predominant isoform across each of our clinical groups in our pooled sample analysis with no evidence of significant glycosylation. This suggests NTproBNP is likely to be a robust marker in this clinical setting.
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Affiliation(s)
- Sarah L Harris
- Department of Pediatrics, University of Otago, Christchurch, New Zealand.,Christchurch Women's Hospital, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Lynley Lewis
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Nicola Austin
- Department of Pediatrics, University of Otago, Christchurch, New Zealand.,Christchurch Women's Hospital, Christchurch, New Zealand
| | - Chris Pemberton
- Department of Medicine, University of Otago, Christchurch, New Zealand
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10
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Lewis LK, Raudsepp SD, Prickett TCR, Yandle TG, Pemberton CJ, Richards AM. ProBNP processing is decreased by obesity in patients with heart failure. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:135. [PMID: 32175428 DOI: 10.21037/atm.2019.12.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lynley K Lewis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sara D Raudsepp
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim C R Prickett
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim G Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chris J Pemberton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand.,Cardiac Department, Cardiovascular Research Institute, National University Heart Centre, National University of Singapore, Singapore, Singapore
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Abukar Y, Lever N, Pachen M, LeGrice IJ, Ramchandra R. Impaired Baroreflex Function in an Ovine Model of Chronic Heart Failure Induced by Multiple Coronary Microembolizations. Front Physiol 2019; 10:1420. [PMID: 31824334 PMCID: PMC6882935 DOI: 10.3389/fphys.2019.01420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Testing new therapies in heart failure (HF) requires a chronic stable model of HF in large animals. Microembolization of the coronary arteries has been used to model HF previously; however, neural control has not been previously explored in this model. Thus the aim of this study was to further characterize neural control in this model of HF. HF was induced by infusion of microspheres (45 micron; 1.3 ml) into the proximal left coronary artery or left descending coronary arteries, with three sequential embolizations over 3 weeks. Twelve to 14 weeks after the final embolization, and when ejection fraction had decreased below 45%, animals were instrumented to record blood pressure and heart rate. Baroreflex control of heart rate was investigated in conscious animals. Additionally, pressure-volume loops were constructed under anesthesia. Embolization-induced HF was associated with a decrease in mean arterial pressure (67 ± 2 vs. 85 ± 4 mmHg, p < 0.05), an increase in heart rate (108 ± 4 vs. 94 ± 4 bpm, p < 0.05), and a significant increase in left ventricular end-diastolic pressure (11.4 ± 2 vs. 6.2 ± 1 mmHg, p < 0.01). Under conscious conditions, there was a significant decrease in the gain (-8.2 ± 2 vs. -4.1 ± 1 beats/min/mmHg, p < 0.05) as well as the lower plateau of the baroreflex in HF compared to control animals. HF was also associated with significantly increased respiratory rate (107 ± 4 vs. 87 ± 4 breaths/min, p < 0.01) and incidence of apneas (520 ± 24 vs. 191 ± 8 apnea periods >4 s, p < 0.05), compared to control sheep. The microembolization model of heart failure is associated with an increase in left ventricular end-diastolic pressure, impaired cardiac function, and altered baroreflex control of the heart. These findings suggest this chronic model of HF is appropriate to use for investigating interventions aimed at improving neural control in HF.
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Affiliation(s)
- Yonis Abukar
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Nigel Lever
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Mridula Pachen
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ian J LeGrice
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Rohit Ramchandra
- Department of Physiology, University of Auckland, Auckland, New Zealand
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12
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Lugnier C, Meyer A, Charloux A, Andrès E, Gény B, Talha S. The Endocrine Function of the Heart: Physiology and Involvements of Natriuretic Peptides and Cyclic Nucleotide Phosphodiesterases in Heart Failure. J Clin Med 2019; 8:jcm8101746. [PMID: 31640161 PMCID: PMC6832599 DOI: 10.3390/jcm8101746] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
Besides pumping, the heart participates in hydro-sodium homeostasis and systemic blood pressure regulation through its endocrine function mainly represented by the large family of natriuretic peptides (NPs), including essentially atrial natriuretic (ANP) and brain natriuretic peptides (BNP). Under normal conditions, these peptides are synthesized in response to atrial cardiomyocyte stretch, increase natriuresis, diuresis, and vascular permeability through binding of the second intracellular messenger’s guanosine 3′,5′-cyclic monophosphate (cGMP) to specific receptors. During heart failure (HF), the beneficial effects of the enhanced cardiac hormones secretion are reduced, in connection with renal resistance to NP. In addition, there is a BNP paradox characterized by a physiological inefficiency of the BNP forms assayed by current methods. In this context, it appears interesting to improve the efficiency of the cardiac natriuretic system by inhibiting cyclic nucleotide phosphodiesterases, responsible for the degradation of cGMP. Recent data support such a therapeutic approach which can improve the quality of life and the prognosis of patients with HF.
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Affiliation(s)
- Claire Lugnier
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
| | - Alain Meyer
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Anne Charloux
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Emmanuel Andrès
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Internal Medicine and Metabolic Diseases, Medical Clinic B, Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Bernard Gény
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Samy Talha
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
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Lewis LK, Raudsepp SD, Prickett TCR, Yandle TG, Doughty RN, Frampton CM, Pemberton CJ, Richards AM. ProBNP That Is Not Glycosylated at Threonine 71 Is Decreased with Obesity in Patients with Heart Failure. Clin Chem 2019; 65:1115-1124. [PMID: 31092393 DOI: 10.1373/clinchem.2019.302547] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Plasma concentrations of B-type natriuretic peptide (BNP) or its amino terminal congener (NT-proBNP) are used for HF diagnosis and risk stratification. Because BNP concentrations are inexplicably lowered in obese patients, we investigated the relationship between proBNP glycosylation, plasma NT-proBNP, and body mass index (BMI) in HF patients. METHODS Three assays were developed to distinguish between total proBNP (glycosylated plus nonglycosylated proBNP), proBNP not glycosylated at threonine 71 (NG-T71), and proBNP not glycosylated in the central region (NG-C). Intraassay and interassay CVs were <15%; limits of detection were <21 ng/L; and samples diluted in parallel. RESULT Applying these assays and an NT-proBNP assay to plasma samples from 106 healthy volunteers and 238 HF patients determined that concentrations [median (interquartile range)] of proBNP, NG-T71, and NT-proBNP were greater in HF patients compared with controls [300 (44-664), 114 (18-254), and 179 (880-3459) ng/L vs 36 (18-229), 36 (18-175), and 40 (17-68) ng/L, respectively; all P < 0.012]. NG-C was undetectable in most samples. ProBNP concentrations in HF patients with BMI more or less than 30 kg/m2 were not different (P = 0.85), whereas HF patients with BMI >30 kg/m2 had lower NT-proBNP and NG-T71 concentrations (P < 0.003) and higher proBNP/NT-proBNP and proBNP/NG-T71 ratios (P = 0.001 and P = 0.02, respectively) than those with BMI <30 kg/m2. CONCLUSIONS Increased BMI is associated with decreased concentrations of proBNP not glycosylated at T71. Decreased proBNP substrate amenable to processing could partially explain the lower NT-proBNP and BNP concentrations observed in obese individuals, including those presenting with HF.
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Affiliation(s)
- Lynley K Lewis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand;
| | - Sara D Raudsepp
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Timothy C R Prickett
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Timothy G Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Robert N Doughty
- Cardiovascular Research Group, University of Auckland, Auckland, New Zealand
| | - Christopher M Frampton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher J Pemberton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand.,Cardiac Department, Cardiovascular Research Institute, National University Heart Centre, National University of Singapore, Singapore, Singapore
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Richards AM, Pemberton C, Yandle T. How does neprilysin inhibition in heart failure work? Eur J Heart Fail 2019; 21:606-608. [PMID: 30884077 DOI: 10.1002/ejhf.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | | | - Tim Yandle
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
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Rodriguez-Gonzalez M, Perez-Reviriego AA, Castellano-Martinez A, Cascales-Poyatos HM. N-terminal probrain natriuretic peptide as biomarker for diagnosis of Kawasaki disease. Biomark Med 2019; 13:307-323. [PMID: 30900472 DOI: 10.2217/bmm-2018-0324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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16
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Xiao P, Li H, Li X, Song D. Analytical barriers in clinical B-type natriuretic peptide measurement and the promising analytical methods based on mass spectrometry technology. ACTA ACUST UNITED AC 2018; 57:954-966. [DOI: 10.1515/cclm-2018-0956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/22/2018] [Indexed: 12/28/2022]
Abstract
Abstract
B-type natriuretic peptide (BNP) is a circulating biomarker that is mainly applied in heart failure (HF) diagnosis and to monitor disease progression. Because some identical amino acid sequences occur in the precursor and metabolites of BNP, undesirable cross-reactions are common in immunoassays. This review first summarizes current analytical methods, such as immunoassay- and mass spectrometry (MS)-based approaches, including the accuracy of measurement and the inconsistency of the results. Second, the review presents some promising approaches to resolve the current barriers in clinical BNP measurement, such as how to decrease cross-reactions and increase the measurement consistency. Specific approaches include research on novel BNP assays with higher-specificity chemical antibodies, the development of International System of Units (SI)-traceable reference materials, and the development of structure characterization methods based on state-of-the-art ambient and ion mobility MS technologies. The factors that could affect MS analysis are also discussed, such as biological sample cleanup and peptide ionization efficiency. The purpose of this review is to explore and identify the main problems in BNP clinical measurement and to present three types of approaches to resolve these problems, namely, materials, methods and instruments. Although novel approaches are proposed here, in practice, it is worth noting that the BNP-related peptides including unprocessed proBNP were all measured in clinical BNP assays. Therefore, approaches that aimed to measure a specific BNP or proBNP might be an effective way for the standardization of a particular BNP form measurement, instead of the standardization of “total” immunoreactive BNP assays in clinical at present.
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Affiliation(s)
- Peng Xiao
- Division of Chemical Metrology and Analytical Science , National Institute of Metrology , Beijing 100029 , P.R. China , Phone: +86-10-64228896, Fax: +86-10-64271639
| | - Hongmei Li
- Division of Chemical Metrology and Analytical Science , National Institute of Metrology , Beijing 100029 , P.R. China , Phone: +86-10-64228896, Fax: +86-10-64271639
| | - Xianjiang Li
- Division of Chemical Metrology and Analytical Science , National Institute of Metrology , Beijing , P.R. China
| | - Dewei Song
- Division of Chemical Metrology and Analytical Science , National Institute of Metrology , Beijing , P.R. China
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17
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Fu S, Ping P, Zhu Q, Ye P, Luo L. Brain Natriuretic Peptide and Its Biochemical, Analytical, and Clinical Issues in Heart Failure: A Narrative Review. Front Physiol 2018; 9:692. [PMID: 29922182 PMCID: PMC5996066 DOI: 10.3389/fphys.2018.00692] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a primary cause of morbidity and mortality worldwide. As the most widely studied and commonly applied natriuretic peptide (NP), B-type natriuretic peptide (BNP) has the effects of diuresis, natriuresis, vasodilation, anti-hypertrophy, and anti-fibrosis and it inhibits the renin-angiotensin-aldosterone and sympathetic nervous systems to maintain cardiorenal homeostasis and counteract the effects of HF. Both BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP) are applied as diagnostic, managing, and prognostic tools for HF. However, due to the complexity of BNP system, the diversity of BNP forms and the heterogeneity of HF status, there are biochemical, analytical, and clinical issues on BNP not fully understood. Current immunoassays cross-react to varying degrees with pro B-type natriuretic peptide (proBNP), NT-proBNP and various BNP forms and cannot effectively differentiate between these forms. Moreover, current immunoassays have different results and may not accurately reflect cardiac function. It is essential to design assays that can recognize specific forms of BNP, NT-proBNP, and proBNP to obtain more clinical information. Not only the processing of proBNP (corin/furin) and BNP (neprilysin), but also the effects of glycosylation on proBNP processing and BNP assays, should be targeted in future studies to enhance their diagnostic, therapeutic, and prognostic values.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Ping
- Department of Pharmaceutical Care, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiwei Zhu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Leiming Luo
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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Standardization of BNP and NT-proBNP Immunoassays in Light of the Diverse and Complex Nature of Circulating BNP-Related Peptides. Adv Clin Chem 2018; 85:1-30. [PMID: 29655458 DOI: 10.1016/bs.acc.2018.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brain natriuretic peptide (BNP) and the N-terminal fragment of the BNP precursor (NT-proBNP) are widely used as heart failure (HF) biomarkers. Since the discovery of BNP in 1988, much effort has been allocated to the precise detection of BNP and NT-proBNP levels for reliable HF diagnostics. As a result, measurements of these biomarkers are globally accepted and used in clinical practice for the diagnosis of acute and chronic HF, risk stratification, and monitoring response to therapy. Several immunoassays specific for BNP and NT-proBNP are currently commercially available. Recent comparative studies show that there are marked differences between different BNP and NT-proBNP assays and platforms, and the results of measurements are not comparable enough. The lack of equivalence between the assays complicates the interpretation of the results and renders the cut-off points for diagnostic decisions to be method dependent. Presently, there is no agreement on what kind of BNP or NT-proBNP standard should be used for calibration, and a certified reference material as well as reference measurement procedures are lacking. The aim of this chapter is to summarize the available data on the complex nature of BNP-related peptides, specificity for existing BNP and NT-proBNP immunoassays, and to discuss potential approaches for standardization of BNP and NT-proBNP measurements.
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Clerico A, Zaninotto M, Passino C, Plebani M. New issues on measurement of B-type natriuretic peptides. Clin Chem Lab Med 2017; 56:32-39. [PMID: 28809748 DOI: 10.1515/cclm-2017-0433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/16/2017] [Indexed: 12/11/2022]
Abstract
The measurement of the active hormone of B-type natriuretic peptide (BNP) system actually has several analytical limitations and difficulties in clinical interpretations compared to that of inactive peptide N-terminal proBNP (NT-proBNP) because of the different biochemical and pathophysiological characteristics of two peptides and quality specifications of commercial immunoassay methods used for their measurement. Because of the better analytical characteristics of NT-proBNP immunoassays and the easier pathophysiological and clinical interpretations of variations of NT-proBNP levels in patients with heart failure (HF), some authors claimed to measure the inactive peptide NT-proBNP instead of the active hormone BNP for management of HF patients. The measurement of the active peptide hormone BNP gives different, but complementary, pathophysiological and clinical information compared to inactive NT-proBNP. In particular, the setup of new more sensitive and specific assays for the biologically active peptide BNP1-32 should give better accurate information on circulating natriuretic activity. In conclusion, at present time, clinicians should accurately consider both the clinical setting of patients and the analytical characteristics of BNP and NT-proBNP immunoassays in order to correctly interpret the variations of natriuretic peptides measured by commercially available laboratory methods, especially in patients treated with the new drug class of angiotensin receptor-neprilysin inhibitors.
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