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Karaca C, Bektas M, Dincer MT, Bakkaloglu OK, Cebeci Z, Bakir A, Seyahi N, Trabulus S, Tukek T. NT-proCNP levels predict higher atherosclerotic cardiovascular risk profile in patients with proliferative diabetic retinopathy. Acta Diabetol 2023:10.1007/s00592-023-02095-y. [PMID: 37085633 DOI: 10.1007/s00592-023-02095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
AIMS In this study, we aimed to demonstrate the effectiveness of serum amino-terminal proCNP (NT-proCNP) levels in predicting coronary heart disease (CHD) and cardiovascular risk in type 2 diabetes mellitus (T2DM) patients. METHODS We recruited 73 patients with T2DM in the study. Additionally, we grouped the patients according to their status of diabetic retinopathy (DR) as no DR, non-proliferative DR, or proliferative DR. Serum NT-proCNP levels of the patients were measured and their atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated. RESULTS There was no significant difference in terms of NT-proCNP levels between the groups (p = 0.3) and in terms of CHD and ASCVD risk scores (p = 0.4 and p = 0.4, respectively). In the correlation analysis, a significant correlation was observed between the NT-proCNP levels and the ASCVD risk score (r = 0.373; p = 0.008 among the entire cohort and r = 0.555; p = 0.01 in the non-proliferative-DR group), smoking status (r = 0.280; p = 0.03 among the entire cohort and r = 0.362; p = 0.035 in the non-proliferative-DR group), sBP (r = 0.278; p = 0.038 among the entire cohort), and dBP (r = 0.284; p = 0.034 among the entire cohort and r = 0.482; p = 0.004 in the proliferative-DR group). In the ROC analysis, we found that the NT-proCNP level predicted a high ASCVD risk score with 83.3% sensitivity and 70.8% specificity and a very high ASCVD risk score with 100% sensitivity and 69.2% specificity among the proliferative-DR patients. No cut-off value was calculated for the prediction of high and very-high ASCVD risk scores in patients with non-proliferative DR. Similarly, no cut-off value was revealed for the prediction of established coronary artery disease in all groups. CONCLUSIONS Our study revealed a significant association between NT-proCNP levels and high ASCVD risk scores in patients with proliferative DR.
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Affiliation(s)
- Cebrail Karaca
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34360, Istanbul, Turkey
| | - Murat Bektas
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mevlut T Dincer
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34360, Istanbul, Turkey
| | - Oguz K Bakkaloglu
- Division of Gastroenterohepatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zafer Cebeci
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alev Bakir
- Department of Social Pediatrics, Institute of Child Health, Istanbul University, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34360, Istanbul, Turkey
| | - Sinan Trabulus
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, 34360, Istanbul, Turkey.
| | - Tufan Tukek
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Cameron VA, Jones GT, Horwood LJ, Pilbrow AP, Martin J, Frampton C, Ip WT, Troughton RW, Greer C, Yang J, Epton MJ, Harris SL, Darlow BA. DNA methylation patterns at birth predict health outcomes in young adults born very low birthweight. Clin Epigenetics 2023; 15:47. [PMID: 36959629 PMCID: PMC10035230 DOI: 10.1186/s13148-023-01463-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
Background Individuals born very low birthweight (VLBW) are at increased risk of impaired cardiovascular and respiratory function in adulthood. To identify markers to predict future risk for VLBW individuals, we analyzed DNA methylation at birth and at 28 years in the New Zealand (NZ) VLBW cohort (all infants born < 1500 g in NZ in 1986) compared with age-matched, normal birthweight controls. Associations between neonatal methylation and cardiac structure and function (echocardiography), vascular function and respiratory outcomes at age 28 years were documented. Results Genomic DNA from archived newborn heel-prick blood (n = 109 VLBW, 51 controls) and from peripheral blood at ~ 28 years (n = 215 VLBW, 96 controls) was analyzed on Illumina Infinium MethylationEPIC 850 K arrays. Following quality assurance and normalization, methylation levels were compared between VLBW cases and controls at both ages by linear regression, with genome-wide significance set to p < 0.05 adjusted for false discovery rate (FDR, Benjamini-Hochberg). In neonates, methylation at over 16,400 CpG methylation sites differed between VLBW cases and controls and the canonical pathway most enriched for these CpGs was Cardiac Hypertrophy Signaling (p = 3.44E−11). The top 20 CpGs that differed most between VLBW cases and controls featured clusters in ARID3A, SPATA33, and PLCH1 and these 3 genes, along with MCF2L, TRBJ2-1 and SRC, led the list of 15,000 differentially methylated regions (DMRs) reaching FDR-adj significance. Fifteen of the 20 top CpGs in the neonate EWAS showed associations between methylation at birth and adult cardiovascular traits (particularly LnRHI). In 28-year-old adults, twelve CpGs differed between VLBW cases and controls at FDR-adjusted significance, including hypermethylation in EBF4 (four CpGs), CFI and UNC119B and hypomethylation at three CpGs in HIF3A and one in KCNQ1. DNA methylation GrimAge scores at 28 years were significantly greater in VLBW cases versus controls and weakly associated with cardiovascular traits. Four CpGs were identified where methylation differed between VLBW cases and controls in both neonates and adults, three reversing directions with age (two CpGs in EBF4, one in SNAI1 were hypomethylated in neonates, hypermethylated in adults). Of these, cg16426670 in EBF4 at birth showed associations with several cardiovascular traits in adults. Conclusions These findings suggest that methylation patterns in VLBW neonates may be informative about future adult cardiovascular and respiratory outcomes and have value in guiding early preventative care to improve adult health. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-023-01463-3.
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Affiliation(s)
- Vicky A. Cameron
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Gregory T. Jones
- grid.29980.3a0000 0004 1936 7830Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - L. John Horwood
- grid.29980.3a0000 0004 1936 7830Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Anna P. Pilbrow
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Julia Martin
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Chris Frampton
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Wendy T. Ip
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Richard W. Troughton
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Charlotte Greer
- grid.29980.3a0000 0004 1936 7830Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jun Yang
- grid.414299.30000 0004 0614 1349Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Michael J. Epton
- grid.414299.30000 0004 0614 1349Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Sarah L. Harris
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Brian A. Darlow
- grid.29980.3a0000 0004 1936 7830Department of Paediatrics, University of Otago, Christchurch, New Zealand
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Mavragani A, Pearson JF, Troughton RW, Kennedy MA, Espiner EA. The Predictive Value of A, B, and C-Type Natriuretic Peptides in People at Risk of Heart Disease: Protocol for a Longitudinal Observational Study. JMIR Res Protoc 2023; 12:e37011. [PMID: 36630163 PMCID: PMC9878369 DOI: 10.2196/37011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Heart disease and stroke are major and often unheralded causes of serious morbidity and premature death in middle age. Early detection of those most at risk is an urgent unmet need for instituting preventative measures. In an earlier community study (Canterbury Health, Ageing and Life Course [CHALICE]) of healthy people aged 50 years, contrary to previous reports, low levels of the heart hormone B-type natriuretic peptide (BNP) were associated with reduced measures of heart function and higher markers of vascular risk. A specific gene variant (rs198358) was found to be an independent contributor to higher BNP levels. A closely related vascular hormone (C-type natriuretic peptide [CNP]) showed opposite associations-higher levels were correlated with higher vascular risk and reduced cardiac function. To determine whether these novel findings predict serious heart or vascular disease in later life, this proposal re-examines the same CHALICE participants 15 years later. OBJECTIVE The primary objective is to determine the predictive value of (1) low plasma concentrations of the circulating cardiac hormones (atrial natriuretic peptide [ANP] and BNP) and (2) high levels of the vascular hormone CNP at age 50 years in detecting impaired cardiac and vascular function 15 years later. Secondary objectives are to determine specific associations of individual analytes (ANP, BNP, CNP, cyclic guanosine monophosphate [cGMP]) with echo-derived changes in cardiac performance at ages 50 years and 65 years. METHODS All of the 348 participants (205/348, 58.9% female; 53/348, 15.2% Māori or Pacifica ethnicity) participating in the original CHALICE study-free of history of heart or renal disease at age 50 years and who consented to further study-will be contacted, recruited, and restudied as previously described. Data will include intervening health history, physical examination, heart function (speckle-tracking echocardiography), vascular status (carotid intimal thickness), and genetic status (genome-wide genotyping). Laboratory measures will include fasting blood sampling and routine biochemistry, ANP, BNP, CNP, their downstream effector (cGMP), and their bio-inactive products. Humoral metabolic-cardiovascular risk factors will be measured after an overnight fast. Primary outcomes will be analyzed using multiple linear regression. RESULTS The study will commence in 2022 and be completed in 2024. CONCLUSIONS Proving our hypothesis-that low BNP and high CNP at any age in healthy people predict premature aging of heart and blood vessels, respectively-opens the way to early detection and improved outcomes for those most at risk. Confirmation of our hypotheses would improve current methods of screening and, in appropriate cases, enable interventions aimed at increasing natriuretic hormones and reducing risk of serious cardiovascular complications using drugs already available. Such advances in detection, and from interventional corrections, have the potential to not only improve health in the community but also reduce the high costs inevitably associated with heart failure. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37011.
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Affiliation(s)
| | - John F Pearson
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.,Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christcurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Eric A Espiner
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christcurch, New Zealand
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Darlow BA, Harris SL, Horwood LJ. Little evidence for long-term harm from antenatal corticosteroids in a population-based very low birthweight young adult cohort. Paediatr Perinat Epidemiol 2022; 36:631-639. [PMID: 35570644 PMCID: PMC9545416 DOI: 10.1111/ppe.12886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Antenatal corticosteroids (ACS) given to mothers with anticipated very preterm delivery are widely used and improve infant outcomes. Follow-up studies of the first trials of ACS have shown no adverse effects, but recently there have been concerns about possible longer-term harms. OBJECTIVES We aimed to assess the relationship of ACS therapy to a range of physical health and welfare measures in a cohort of very low birthweight (VLBW; <1500 g) young adults. METHODS Population-based cohort follow-up study. All VLBW infants born in New Zealand in 1986 were included in a prospective audit of retinopathy of prematurity. Perinatal data collection included information on ACS. At 26-30 years, 250 of 323 (77%) survivors participated, 58% having received ACS, with 229 assessed in one centre, including cardiovascular, metabolic, respiratory and neurocognitive measures. Differences in outcome between those receiving/not receiving ACS were summarised by the mean difference for continuous outcomes supplemented by Cohen's d as a standardised measure of effect size (ES), and risk ratios (RRI) for dichotomous outcomes, adjusted for relevant covariates using generalised linear regression methods. RESULTS There were no or minimal adverse effects of receipt of ACS versus no receipt across a range of health and welfare outcomes, both for the full cohort (adjusted ES range d = 0.01-0.23; adjusted RR range 0.78-2.03) and for individuals with gestation <28 weeks (extremely preterm; EP), except for a small increase in rates of major depression. In EP adults, receipt of ACS was associated with a higher incidence of hypertension, but might have a small benefit for IQ. CONCLUSIONS In this population-based VLBW cohort, we detected minimal adverse outcomes associated with exposure to ACS by the third decade of life, a similar result to the 30-year follow-up of participants in the first ACS trial. However, further follow-up is warranted.
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Affiliation(s)
- Brian A. Darlow
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | - Sarah L. Harris
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | - L. John Horwood
- Department of Psychological MedicineChristchurch Health and Development StudyUniversity of OtagoChristchurchNew Zealand
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Tomasiuk R. N-Terminal Pro-C-Type Natriuretic Peptide: The Novel Marker in Selected Disease Units. Protein Pept Lett 2021; 29:125-132. [PMID: 34823452 DOI: 10.2174/0929866528666211125104944] [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: 06/08/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Amino-terminal pro C type natriuretic peptide (NT proCNP) is the N terminal fragment of the CNP precursor. NT proCNP occurs in an equimolar concentration with CNP in human plasma and is considered to be a marker of the extent of CNP biosynthesis. A recent study has shown associations between plasma NT proCNP and blood pressure; it is also an independent predictor of death and cardiac readmission in people with unstable angina. Beyond that, recent studies have focused on the applicability of assessing NT proCNP peptide levels in the diagnosis of diseases with different etiologies but the same denominator, i.e., inflammation. METHODS This study reviewed recent results on the usability of NT proCNP peptide levels in the diagnosis of diseases accompanied by statistical analysis of previously reported results. RESULTS The data obtained confirmed the applicability of the assessment of NT proCNP levels in biological fluids in diseases, such as Parkinson's disease, sepsis, meningitis, and asthenozoospermia. CONCLUSION The reported results demonstrated that NT-proCNP is helpful in a variety of diseases. Furthermore, changes in serum or CSF levels of NT-proCNP reflect only inflammatory states related to general inflammation. Local inflammation does not trigger an increase in NT proCNP level.
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Affiliation(s)
- Ryszard Tomasiuk
- Kazimierz Pulaski University of Technology and Humanities Radom, Faculty of Medical Sciences and Health Sciences, Radom. Poland
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6
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Muñoz-Rodríguez A, Maciel-Ruiz JA, Salazar AM, Sordo M, Ostrosky-Wegman P, Limón-Pacheco JH, Nepomuceno-Hernández AE, Ayala-Yáñez R, Gonsebatt ME, Osorio-Yáñez C. Prenatal Particulate Matter (PM) Exposure and Natriuretic Peptides in Newborns from Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126546. [PMID: 34206994 PMCID: PMC8296353 DOI: 10.3390/ijerph18126546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: The aim of this study was to assess associations between particulate matter (PM) exposure and natriuretic peptide concentrations in cord blood from newborns. (2) Methods: we conducted a cross-sectional study in Mexico City with 101 pregnant women from CIMIGEN Hospital. Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) were measured in plasma from cord blood in 51 newborns by ELISA. We estimated PM exposure (PM2.5 and PM10) at first, second and third trimester of pregnancy. (3) Results: The median and interquartile range for ANP, BNP and CNP plasma concentrations were 66.71 (46.92-80.23), 98.23 (73.64-112.30) and 1129.11 (944.10-1452.02) pg/mL, respectively. PM2.5 and PM10 levels for the whole pregnancy period were 22.2 µg/m3 and 41.63 µg/m3, respectively. Employing multivariable linear regression models adjusted for maternal age, newborn sex, smoking before pregnancy, maternal occupation and newborns' length and height, we observed a 2.47 pg/mL (95%CI: -4.67, -0.27) decrease in BNP associated with PM2.5 exposure during second trimester. Adjusted for the same set of confounders, third trimester PM10 exposure was inversely associated with ANP concentrations (beta estimate: -0.90; 95% CI: -1.80, -0.03). Neither PM10 nor PM2.5 were associated with CNP at any trimester of pregnancy. (4) Conclusions: Prenatal exposure to particulate matter was associated with ANP and BNP decrease in newborns.
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Affiliation(s)
- Abigail Muñoz-Rodríguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Jorge Alfonso Maciel-Ruiz
- Instituto Nacional de Cancerología (INCan), Subdirección de Investigación Básica, Ciudad de México 14080, Mexico;
| | - Ana María Salazar
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Monserrat Sordo
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Patricia Ostrosky-Wegman
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Jorge H. Limón-Pacheco
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Andrés Eduardo Nepomuceno-Hernández
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento, Asociación Hispano Mexicana, Ciudad de México 09880, Mexico; (A.E.N.-H.); (R.A.-Y.)
| | - Rodrigo Ayala-Yáñez
- Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento, Asociación Hispano Mexicana, Ciudad de México 09880, Mexico; (A.E.N.-H.); (R.A.-Y.)
| | - María Eugenia Gonsebatt
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
| | - Citlalli Osorio-Yáñez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Apartado Postal 70228, Ciudad de México 04510, Mexico; (A.M.-R.); (A.M.S.); (M.S.); (P.O.-W.); (J.H.L.-P.); (M.E.G.)
- Correspondence: ; Tel.: +55-5622-3159
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Prickett TC, A Espiner E. Circulating products of C-type natriuretic peptide and links with organ function in health and disease. Peptides 2020; 132:170363. [PMID: 32634451 DOI: 10.1016/j.peptides.2020.170363] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
Paracrine actions of CNP and rapid degradation at source severely limit study of CNP's many roles in vivo. However provided sensitive and validated assays are used, there is increasing evidence that low concentrations of bioactive CNP in plasma, and the readily detectable concentrations of the bio-inactive processed product of proCNP (aminoterminal proCNP), can be used to advance understanding of the hormone's role in pathophysiology. Provided renal function is normal, concordant changes in both CNP and NTproCNP reflect change in tissue production of proCNP whereas change in CNP alone results from altered rates of bioactive CNP degradation and are reflected in the ratio of NTproCNP to CNP. As already shown in juveniles, where plasma concentration of CNP products are higher and are associated with concurrent endochondral bone growth, measurements of plasma CNP products in mature adults have potential to clarify organ response to stress and injury. Excepting the role of CNP in fetal-maternal welfare, this review examines evidence linking plasma CNP products with function of a wide range of tissues in adults, including the impact of extraneous factors such as nutrients, hormone therapy and exercise.
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Affiliation(s)
- Timothy Cr Prickett
- Department of Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand.
| | - Eric A Espiner
- Department of Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
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8
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Harris SL, Bray H, Troughton R, Elliott J, Frampton C, Horwood J, Darlow BA. Cardiovascular Outcomes in Young Adulthood in a Population-Based Very Low Birth Weight Cohort. J Pediatr 2020; 225:74-79.e3. [PMID: 32553866 DOI: 10.1016/j.jpeds.2020.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/03/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess differences in left heart structure and function, and endothelial function in a national cohort of very low birth weight (VLBW) young adults and term-born controls. STUDY DESIGN The New Zealand VLBW study is a prospective, population-based, longitudinal cohort study which included all infants born <1500 g in 1986. The VLBW cohort (n = 229; 71% of survivors) and term-born controls (n = 100), were assessed at age 26-30 years. Measures of left heart structure and function were evaluated by echocardiography, vascular function was assessed using blood pressure, reactive hyperemia index, and arterioventricular coupling by calculating left ventricular (LV) and arterial elastance. RESULTS Compared with controls, those born VLBW had smaller LVs, even when indexed for body surface area (mean LV mass, 89.7 ± 19.3 g/m2 vs 95.0 ± 22.3 g/m2 [P = .03]; LV end-diastolic volume, 58.3 ± 10.9 mL/m2 vs 62.4 ± 12.4 mL/m2 [P = .002]; and LV end-systolic volume, 20.8 ± 4.9 mL/m2 vs 22.6 ± 5.8 mL/m2 [P = .004]). VLBW participants had lower stroke volume (median, 37.2 mL/m2 [IQR, 33-42 mL/m2] vs median, 40.1 mL/m2 [IQR, 34-45 mL/m2]; P = .0059) and cardiac output (mean, 4.8 ± 1.2 L/min vs 5.1 ± 1.4 L/min; P = .03), but there was no difference in ejection fraction. The VLBW group had higher LV elastance (3.37 ± 0.88 mm Hg/mL vs 2.86 ± 0.75 mm Hg/mL; P < .0001) and arterial elastance (1.84 ± 0.4 vs 1.6 ± 0.4; P < .0001) and lower reactive hyperemia index (0.605 ± 0.28 vs 0.688 ± 0.31; P = .041). These measures were influenced by birth weight and sex, but we found limited associations with other perinatal factors. CONCLUSIONS Being born preterm and VLBW is associated with differences in cardiovascular structure and function in adulthood. This population may be more vulnerable to cardiovascular pathology as they age. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12612000995875.
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Affiliation(s)
- Sarah L Harris
- Department of Pediatrics, University of Otago, Christchurch, New Zealand.
| | - Helen Bray
- Christchurch Women's Hospital, Christchurch, New Zealand
| | - Richard Troughton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - John Elliott
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
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Berezin AE, Berezin AA. Circulating Cardiac Biomarkers in Diabetes Mellitus: A New Dawn for Risk Stratification-A Narrative Review. Diabetes Ther 2020; 11:1271-1291. [PMID: 32430864 PMCID: PMC7261294 DOI: 10.1007/s13300-020-00835-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this narrative review is to update the current knowledge on the differential choice of circulating cardiac biomarkers in patients with prediabetes and established type 2 diabetes mellitus (T2DM). There are numerous circulating biomarkers with unconfirmed abilities to predict clinical outcomes in pre-DM and DM individuals; the prognostication ability of the cardiac biomarkers reported here has been established, and they are still being studied. The conventional cardiac biomarkers, such as natriuretic peptides (NPs), soluble suppressor tumorigenisity-2, high-sensitivity circulating cardiac troponins and galectin-3, were useful to ascertain cardiovascular (CV) risk. Each cardiac biomarker has its strengths and weaknesses that affect the price of usage, specificity, sensitivity, predictive value and superiority in face-to-face comparisons. Additionally, there have been confusing reports regarding their abilities to be predictably relevant among patients without known CV disease. The large spectrum of promising cardiac biomarkers (growth/differential factor-15, heart-type fatty acid-binding protein, cardiotrophin-1, carboxy-terminal telopeptide of collagen type 1, apelin and non-coding RNAs) is discussed in the context of predicting CV diseases and events in patients with known prediabetes and T2DM. Various reasons have been critically discussed related to the variable findings regarding biomarker-based prediction of CV risk among patients with metabolic disease. It was found that NPs and hs-cTnT are still the most important tools that have an affordable price as well as high sensitivity and specificity to predict clinical outcomes among patients with pre-DM and DM in routine clinical practice, but other circulating biomarkers need to be carefully investigated in large trials in the future.
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Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, Ministry of Health of Ukraine, State Medical University, Zaporozhye, 69035, Ukraine.
| | - Alexander A Berezin
- Internal Medicine Department, Medical Academy of Post-Graduate Education, Ministry of Health of Ukraine, Zaporozhye, 69096, Ukraine
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10
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Effect of statin therapy on plasma C-type Natriuretic Peptides and Endothelin-1 in males with and without symptomatic coronary artery disease. Sci Rep 2020; 10:7927. [PMID: 32404888 PMCID: PMC7220949 DOI: 10.1038/s41598-020-64795-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
C-type Natriuretic Peptide (CNP) and Endothelin-1 (ET-1) have reciprocal roles in maintaining vascular homeostasis and are acutely modulated by statins in human cultured endothelial cells. Whether these actions of statins in vitro are reflected in studies in vivo is unknown. In a prospective study of 66 subjects with or without post- acute coronary syndrome (ACS), plasma concentrations of bioactive CNP and bio-inactive aminoterminal proCNP (NTproCNP), ET-1, B-type Natriuretic Peptide (BNP) and high sensitivity C Reactive Protein (hsCRP) were measured together with lipids before and at intervals of 1, 2 and 7 days after commencing atorvastatin 40 mg/day - and for a further period of 6months in those with ACS. Plasma lipids fell significantly in all subjects but plasma CNP, NTproCNP and ET-1 were unchanged by atorvastatin. In ACS, baseline hsCRP, BNP and CNP but not NTproCNP or ET-1 were significantly raised compared to values in age-matched controls. The ratio of NTproCNP to CNP was significantly lower in ACS throughout the study and was unaffected by statin therapy. We conclude that conventional doses of atorvastatin do not affect plasma CNP products or ET-1. Elevated CNP after cardiac injury likely results from regulated changes in clearance, not enhanced production.
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11
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Del Ry S, Cabiati M, Bianchi V, Randazzo E, Peroni D, Clerico A, Federico G. C-type natriuretic peptide plasma levels and whole blood mRNA expression show different trends in adolescents with different degree of endothelial dysfunction. Peptides 2020; 124:170218. [PMID: 31794787 DOI: 10.1016/j.peptides.2019.170218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
C-type natriuretic peptide (CNP) is an endogenous adipogenesis regulator whose plasma levels in childhood are known, while no data are available on its expression. Our aim was to evaluate both CNP plasma levels and CNP system expression in whole blood obtained from normal-weight (N, n = 24) and obese (O, n = 16) adolescents (age:13.5 ± 0.4 years). Endothelial function was assessed measuring reactive hyperemia index (RHI). CNP plasma levels, evaluated with specific RIA, resulted significantly lower in O than in N (6.1 ± 0.8 vs.15.2 ± 1.3 pg/mL; p < 0.0001), while CNP/NPR-B/NPR-C mRNA, measured by Real-Time PCR, resulted similar in N (4.1 ± 1.7; 5.0 ± 1.6; 2.2 ± 0.9) and in O (4.3 ± 1.6; 3.5 ± 1.1; 2.3 ± 0.8). RHI was significantly lower in O than in N (1.4 ± 0.08 vs.2.1 ± 0.04, p < 0.0001). Dividing all subjects according to the RHI median value, irrespective of the presence or absence of obesity (Group 1 > 1.9, n = 23, Group 2 < 1.9, n = 17), CNP plasma concentrations resulted significantly (p = 0.014) higher in Group 1 (14.6 ± 1.6) than in Group 2 (7.5 ± 1.0), showing a significant correlation with RHI (p = 0.0026), while CNP mRNA expression was, surprisingly, higher in Group 2 (7.0 ± 2.3) than in Group 1 (1.8 ± 0.4; p = 0.02). NPR-B mRNA resulted similar in both Groups (4.3 ± 1.6; 4.7 ± 1.3) and NPR-C significantly higher in Group 2 (p = 0.02). Our data suggest different trends between CNP plasma levels and expression, assessed for the first time in whole blood, that could reflect changes occurring both at CNP transcriptional level in activated leukocytes due to inflammation, and at circulating levels, due to CNP paracrine/autocrine activities. This could represent an interesting area for new therapies able to modulate endothelial dysfunction.
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Affiliation(s)
- Silvia Del Ry
- Laboratory of Biochemistry and Molecular Biology, Institute of Clinical Physiology, CNR, Pisa, Italy; Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Manuela Cabiati
- Laboratory of Biochemistry and Molecular Biology, Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Vanessa Bianchi
- Unit of Pediatric Endocrinology and Diabetes, Dep. Clinical and Experimental Medicine, University of Pisa, Italy
| | - Emioli Randazzo
- Unit of Pediatric Endocrinology and Diabetes, Dep. Clinical and Experimental Medicine, University of Pisa, Italy
| | - Diego Peroni
- Unit of Pediatric Endocrinology and Diabetes, Dep. Clinical and Experimental Medicine, University of Pisa, Italy
| | - Aldo Clerico
- Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giovanni Federico
- Unit of Pediatric Endocrinology and Diabetes, Dep. Clinical and Experimental Medicine, University of Pisa, Italy
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12
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Prickett TCR, Spittlehouse JK, Miller AL, Liau Y, Kennedy MA, Cameron VA, Pearson JF, Boden JM, Troughton RW, Espiner EA. Contrasting signals of cardiovascular health among natriuretic peptides in subjects without heart disease. Sci Rep 2019; 9:12108. [PMID: 31431677 PMCID: PMC6702214 DOI: 10.1038/s41598-019-48553-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/07/2019] [Indexed: 01/22/2023] Open
Abstract
Natriuretic Peptides (NP) are important in maintaining normal cardiac and metabolic status and have been used to predict cardiovascular events. Whether plasma concentrations of NP products within the normal range reflect cardio-metabolic health is unknown. Plasma NTproANP, NTproBNP and NTproCNP and their bioactive counterparts were measured in a random sample of 348 community dwellers aged 49-51 yr without heart disease and associations sought with established vascular risk factors, echocardiographic indices and a genetic variant previously linked with BNP. Stratified by sex, each of ten vascular risk factors were positively associated with NTproCNP whereas associations with NTproBNP and NTproANP were all negative. In both sexes, higher plasma NTproCNP was associated with higher arterial elastance, lower LV stroke volume and lower LV end diastolic volume. Exactly opposite associations were found with plasma NTproBNP or NTproANP. Sex specific differences were identified: positive association of NTproBNP with LV end systolic volume and the negative association with LV elastance were found only in males. The genetic variant rs198358 was independently associated with NTproBNP but not with NTproANP. In conclusion, higher NTproCNP is likely to be an adaptive response to impaired LV relaxation whereas genetic factors likely contribute to higher NTproBNP and improved cardio-metabolic health at midlife.
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Affiliation(s)
| | | | - Allison L Miller
- Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Yusmiati Liau
- Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Vicky A Cameron
- Departments of Medicine, University of Otago, Christchurch, New Zealand
| | - John F Pearson
- Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
- Biostatistics and Computational Biology Unit, University of Otago, Christchurch, New Zealand
| | - Joseph M Boden
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Eric A Espiner
- Departments of Medicine, University of Otago, Christchurch, New Zealand
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13
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Espiner E, Prickett T, Olney R. Plasma C-Type Natriuretic Peptide: Emerging Applications in Disorders of Skeletal Growth. Horm Res Paediatr 2019; 90:345-357. [PMID: 30844819 DOI: 10.1159/000496544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/30/2018] [Indexed: 11/19/2022] Open
Abstract
Although studies in experimental animals show that blood levels of C-type natriuretic peptide (CNP) and its bioinactive aminoterminal propeptide (NTproCNP) are potential biomarkers of long bone growth, a lack of suitable assays and appropriate reference ranges has limited the application of CNP measurements in clinical practice. Plasma concentrations of the processed product of proCNP, NTproCNP - and to a lesser extent CNP itself - correlate with concurrent height velocity throughout all phases of normal skeletal growth, as well as during interventions known to affect skeletal growth in children. Since a change in levels precedes a measurable change in height velocity during interventions, measuring NTproCNP may have predictive value in clinical practice. Findings from a variety of genetic disorders affecting CNP signaling suggest that plasma concentrations of both peptides may be helpful in diagnosis, provided factors such as concurrent height velocity, feedback regulation of CNP, and differential changes in peptide clearance are considered when interpreting values. An improved understanding of factors affecting plasma levels, and the availability of commercial kits enabling accurate measurement using small volumes of plasma, can be expected to facilitate potential applications in growth disorders including genetic causes -affecting the CNP signaling pathway.
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Affiliation(s)
- Eric Espiner
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Tim Prickett
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand,
| | - Robert Olney
- Division of Endocrinology, Nemours Children's Specialty Care, Jacksonville, Florida, USA
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14
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Markopoulou P, Papanikolaou E, Analytis A, Zoumakis E, Siahanidou T. Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis. J Pediatr 2019; 210:69-80.e5. [PMID: 30992219 DOI: 10.1016/j.jpeds.2019.02.041] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/30/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if preterm birth is associated with components of the metabolic syndrome in adult life. STUDY DESIGN A structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18 years of age) born preterm (<37 weeks of gestation) compared with adults born at term (37-42 weeks of gestation) and published through March 2018 were included. The major outcomes assessed were body mass index, waist circumference, waist-to-hip ratio, fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour SBP, 24-hour DBP, endothelium-dependent brachial artery flow-mediated dilation, carotid intima-media thickness, pulse wave velocity, fasting glucose and insulin, Homeostasis Model Assessment-Estimated Insulin Resistance Index, and lipid profiles. Quality appraisal was performed using a modified version of the Newcastle-Ottawa scale. A meta-analysis was performed for comparable studies which reported sufficient data. RESULTS Forty-three studies were included, including a combined total of 18 295 preterm and 294 063 term-born adults. Prematurity was associated with significantly higher fat mass (P = .03), SBP (P < .0001), DBP (P < .0001), 24-hour SBP (P < .001), and 24-hour DBP (P < .001). Furthermore, preterm-born adults presented higher values of fasting glucose (P = .01), insulin (P = .002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P = .05), and total cholesterol levels (P = .05) in comparison with adults born at term, in random effect models. No statistically significant difference was found between preterm and term-born adults for the other outcomes studied. CONCLUSIONS Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.
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Affiliation(s)
- Panagiota Markopoulou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Papanikolaou
- Laboratory of Biology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Analytis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Zoumakis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.
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15
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Prickett TCR, Doughty RN, Troughton RW, Frampton CM, Whalley GA, Ellis CJ, Espiner EA, Richards AM. C-Type Natriuretic Peptides in Coronary Disease. Clin Chem 2016; 63:316-324. [PMID: 28062626 DOI: 10.1373/clinchem.2016.257816] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/30/2016] [Indexed: 12/28/2022]
Abstract
AIMS C-type natriuretic peptide (CNP) is a paracrine growth factor expressed in the vascular endothelium. Although upregulated in atheromatous arteries, the predictive value of plasma CNP products for outcome in coronary disease is unknown. This study aimed to compare the prognostic value of plasma CNP products with those of other natriuretic peptides in individuals with coronary artery disease, and investigate their associations with cardiac and renal function. METHODS AND RESULTS Plasma concentrations of CNP and amino-terminal proCNP (NT-proCNP) were measured at baseline in 2129 individuals after an index acute coronary syndrome admission and related to cardiac and renal function, other natriuretic peptides [atrial NP (ANP) and B-type NP (BNP)] and prognosis (primary end point, mortality; secondary end point, cardiac readmission). Median follow-up was 4 years. At baseline, and in contrast to CNP, ANP, and BNP, plasma NT-proCNP was higher in males and weakly related to cardiac function but strongly correlated to plasma creatinine. All NPs were univariately associated with mortality. Resampling at 4 and 12 months in survivors showed stable concentrations of NT-proCNP whereas all other peptides declined. When studied by diagnosis (myocardial infarction, unstable angina) at index admission using a multivariate model, NT-proBNP predicted mortality and readmission in myocardial infarction. In unstable angina, only NT-proCNP predicted both mortality and cardiac readmission. CONCLUSIONS In contrast to the close association of NT-proBNP with cardiac function, and predictive value for outcome after myocardial infarction, plasma NT-proCNP is highly correlated with renal function and is an independent predictor of mortality and cardiac readmission in individuals with unstable angina.
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Affiliation(s)
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | | | - Chris M Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Chris J Ellis
- Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - Eric A Espiner
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Department of Medicine, University of Otago, Christchurch, New Zealand
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