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Meems LMG, Andersen IA, Pan S, Harty G, Chen Y, Zheng Y, Harders GE, Ichiki T, Heublein DM, Iyer SR, Sangaralingham SJ, McCormick DJ, Burnett JC. Design, Synthesis, and Actions of an Innovative Bispecific Designer Peptide. Hypertension 2019; 73:900-909. [PMID: 30798663 DOI: 10.1161/hypertensionaha.118.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite optimal current therapies, cardiovascular disease remains the leading cause for death worldwide. Importantly, advances in peptide engineering have accelerated the development of innovative therapeutics for diverse human disease states. Additionally, the advancement of bispecific therapeutics targeting >1 signaling pathway represents a highly innovative strategy for the treatment of cardiovascular disease. We, therefore, engineered a novel, designer peptide, which simultaneously targets the pGC-A (particulate guanylyl cyclase A) receptor and the MasR (Mas receptor), potentially representing an attractive cardiorenoprotective therapeutic for cardiovascular disease. We engineered a novel, bispecific receptor activator, NPA7, that represents the fusion of a 22-amino acid sequence of BNP (B-type natriuretic peptide; an endogenous ligand of pGC-A) with Ang 1-7 (angiotensin 1-7)-the 7-amino acid endogenous activator of MasR. We assessed NPA7's dual receptor activating actions in vitro (second messenger production and receptor interaction). Further, we performed an intravenous peptide infusion comparison study in normal canines to study its biological actions in vivo, including in the presence of an MasR antagonist. Our in vivo and in vitro studies demonstrate the successful synthesis of NPA7 as a bispecific receptor activator targeting pGC-A and MasR. In normal canines, NPA7 possesses enhanced natriuretic, diuretic, systemic, and renal vasorelaxing and cardiac unloading properties. Importantly, NPA7's actions are superior to that of the individual native pGC-A or MasR ligands. These studies advance NPA7 as a novel, bispecific designer peptide with potential cardiorenal therapeutic benefit for the treatment of cardiovascular disease, such as hypertension and heart failure.
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Affiliation(s)
- Laura M G Meems
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Ingrid A Andersen
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Shuchong Pan
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Gail Harty
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Yang Chen
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Ye Zheng
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Gerald E Harders
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Tomoki Ichiki
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Seethalakshmi R Iyer
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Physiology and Bioengineering (S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
| | - Daniel J McCormick
- Department of Biochemistry and Molecular Biology (D.J.M.), Mayo Clinic, Rochester, MN
| | - John C Burnett
- From the Cardiorenal Research Laboratory (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Cardiovascular Medicine (L.M.G.M., I.A.A., S.P., G.H., Y.C., Y.Z., G.E.H., T.I., D.M.H., S.R.I., S.J.S., J.C.B.), Mayo Clinic, Rochester, MN.,Department of Physiology and Bioengineering (S.J.S., J.C.B.), Mayo Clinic, Rochester, MN
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Ichiki T, Schirger JA, Wanek JR, Heublein DM, Scott CG, Sangaralingham SJ, Chen HH, Burnett JC. P6528Cardiorenal protection by subcutaneous cenderitide in experimental heart failure: a novel and safe therapeutic for humans with LVAD support. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Ichiki
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J A Schirger
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J R Wanek
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - D M Heublein
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - C G Scott
- Mayo Clinic, Department of Biomedical Statistics and Informatics, Rochester, United States of America
| | - S J Sangaralingham
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - H H Chen
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J C Burnett
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
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Ichiki T, Iyer SR, Scott CG, Heublein DM, Sangaralingham SJ, Cannone V, Bailey KR, Rodeheffer R, Goetze JP, Burnett JC. P615Circulating corin in the general community: link to gender and metabolic dysfunction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Ichiki
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - S R Iyer
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - C G Scott
- Mayo Clinic, Department of Biomedical Statistics and Informatics, Rochester, United States of America
| | - D M Heublein
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - S J Sangaralingham
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - V Cannone
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - K R Bailey
- Mayo Clinic, Department of Biomedical Statistics and Informatics, Rochester, United States of America
| | - R Rodeheffer
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J P Goetze
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry, Copenhagen, Denmark
| | - J C Burnett
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry, Copenhagen, Denmark
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Chen Y, Harty GJ, Huntley BK, Iyer SR, Heublein DM, Harders GE, Meems L, Pan S, Sangaralingham SJ, Ichiki T, Burnett JC. CRRL269: a novel designer and renal-enhancing pGC-A peptide activator. Am J Physiol Regul Integr Comp Physiol 2017; 314:R407-R414. [PMID: 29187381 DOI: 10.1152/ajpregu.00286.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The natriuretic peptides (NPs) B-type NP (BNP) and urodilatin (URO) exert renal protective properties via the particulate guanylyl cyclase A receptor (pGC-A). As a potential renal-enhancing strategy, we engineered a novel designer peptide that we call CRRL269. CRRL269 was investigated in human cell lines and in normal canines to define potential cardiorenal enhancing actions. The mechanism of its cardiorenal selective properties was also investigated. In vitro NP receptor activity was quantified with guanosine 3',5'-cyclic monophosphate generation. In vivo effects were determined in normal canine acute infusion studies. We observed that CRRL269 demonstrated enhanced pGC-A activity in renal compared with nonrenal cell lines. CRRL269 exerted enhanced resistance to neprilysin compared with URO. Importantly, CRRL269 exhibited significant and greater increases in urinary sodium excretion and diuresis, with less blood pressure reduction, than BNP or URO in normal canines. CRRL269 retained potent renin-angiotensin-aldosterone system (RAAS) suppressing properties shared by URO and BNP. Also, CRRL269 exerted less arterial relaxation and higher cAMP cardiomyocytes generation than BNP. CRRL269 possessed superior renal and pGC-A activating properties compared with BNP or URO in vitro. CRRL269 exerted enhanced renal actions while suppressing RAAS in vivo and with less hypotension compared with URO or BNP. Together, our study suggests that CRRL269 is a promising innovative renal-enhancing drug, with favorable protective actions targeting cardiorenal disease states through the pGC-A receptor.
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Affiliation(s)
- Yang Chen
- Mayo Graduate School and Graduate Program in Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minneapolis , Minnesota.,Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Gail J Harty
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Brenda K Huntley
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Seethalakshmi R Iyer
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Denise M Heublein
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Gerald E Harders
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Laura Meems
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Shuchong Pan
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - S Jeson Sangaralingham
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - Tomoko Ichiki
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota
| | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minneapolis , Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minneapolis , Minnesota
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5
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Sugihara S, Ichiki T, Chen Y, Harty GJ, Heublein DM, Iyer SR, Huntley BK, Sangaralingham SJM, McCormick DJ, Buglioni A, Burnett JC. MANP: Structural Insights of a Novel GC-A Receptor and cGMP Activator with Cardiorenal Enhancing and Aldosterone Suppressing Actions in Vivo. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Burnett JC, Heublein DM, Huntley BK, Harders GE, Chen Y, Pan S, Ichiki T, Sangaralingham SJ. C53: A Novel CNP-Based Therapeutic Strategy Targeting Cardiac Fibrosis and Heart Failure. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ichiki T, Burnett JC, Scott CG, Heublein DM, Miyata M, Kinugawa K, Inoue T, Tei C. Neurohumoral Modulation During Waon Therapy in Chronic Heart Failure - Subanalysis of Waon-CHF Study. Circ J 2017; 81:709-716. [PMID: 28202884 DOI: 10.1253/circj.cj-16-1117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Heart failure (HF) is a disease of neurohumoral dysfunction and current pharmacological therapies for HF have not improved mortality rates, thus requiring additional new strategies. Waon therapy for HF patients may be a complementary strategy with peripheral vasodilation via nitric oxide. We hypothesized that Waon therapy would improve neurohumoral factors, such as natriuretic peptides (NP) and the renin-angiotensin-aldosterone system (RAAS) in HF.Methods and Results:Plasma samples were collected from patients enrolled in the WAON-CHF Study (Waon therapy (n=77) or control (n=73)) before and after the treatment. B-type NP (BNP), C-type NP (CNP), and aldosterone (Aldo) levels were measured by respective specific radioimmunoassays. Although clinical parameters significantly improved in the Waon group compared with the control group, BNP, Aldo, and CNP levels were not statistically different between groups. On subanalysis with patient variables, BNP levels were improved in the Waon group treated with angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker or spironolactone. In addition, Aldo levels were improved in the Waon group patients with diabetes mellitus, hypertension, and inotrope use, and CNP levels were improved in Waon group patients with estimated glomerular filtration rate <60 mL/min/1.73 m2. These changes were not observed in the control group. CONCLUSIONS Waon therapy may accelerate the favorable actions of RAAS modulators in HF. (WAON-CHF Study: UMIN000006705).
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Affiliation(s)
- Tomoko Ichiki
- Cardiorenal Research Laboratory, Department of Cardiovascular Diseases, Mayo Clinic
| | - John C Burnett
- Cardiorenal Research Laboratory, Department of Cardiovascular Diseases, Mayo Clinic
| | | | - Denise M Heublein
- Cardiorenal Research Laboratory, Department of Cardiovascular Diseases, Mayo Clinic
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Hospital
| | - Koichiro Kinugawa
- Internal Medicine II, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University
| | - Chuwa Tei
- Department of Cardiovascular Medicine, Dokkyo Medical University.,Waon Therapy Research Institute
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Ichiki T, Sangaralingham SJ, Harty GJ, Huntley BK, Harders GE, Heublein DM, Burnett JC. Chronic Administration with Cenderitide Goes Beyond Enalapril in Cardiorenal Function and Anti-Remodeling Through Reverse Activation of Gene Pathways in Experimental Heart Failure. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hiemstra JA, Lee DI, Chakir K, Gutiérrez-Aguilar M, Marshall KD, Zgoda PJ, Cruz Rivera N, Dozier DG, Ferguson BS, Heublein DM, Burnett JC, Scherf C, Ivey JR, Minervini G, McDonald KS, Baines CP, Krenz M, Domeier TL, Emter CA. Saxagliptin and Tadalafil Differentially Alter Cyclic Guanosine Monophosphate (cGMP) Signaling and Left Ventricular Function in Aortic-Banded Mini-Swine. J Am Heart Assoc 2016; 5:e003277. [PMID: 27098966 PMCID: PMC4843537 DOI: 10.1161/jaha.116.003277] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Cyclic guanosine monophosphate‐protein kinase G‐phosphodiesterase 5 signaling may be disturbed in heart failure (HF) with preserved ejection fraction, contributing to cardiac remodeling and dysfunction. The purpose of this study was to manipulate cyclic guanosine monophosphate signaling using the dipeptidyl‐peptidase 4 inhibitor saxagliptin and phosphodiesterase 5 inhibitor tadalafil. We hypothesized that preservation of cyclic guanosine monophosphate cGMP signaling would attenuate pathological cardiac remodeling and improve left ventricular (LV) function. Methods and Results We assessed LV hypertrophy and function at the organ and cellular level in aortic‐banded pigs. Concentric hypertrophy was equal in all groups, but LV collagen deposition was increased in only HF animals. Prevention of fibrotic remodeling by saxagliptin and tadalafil was correlated with neuropeptide Y plasma levels. Saxagliptin better preserved integrated LV systolic and diastolic function by maintaining normal LV chamber volumes and contractility (end‐systolic pressure‐volume relationship, preload recruitable SW) while preventing changes to early/late diastolic longitudinal strain rate. Function was similar to the HF group in tadalafil‐treated animals including increased LV contractility, reduced chamber volume, and decreased longitudinal, circumferential, and radial mechanics. Saxagliptin and tadalafil prevented a negative cardiomyocyte shortening‐frequency relationship observed in HF animals. Saxagliptin increased phosphodiesterase 5 activity while tadalafil increased cyclic guanosine monophosphate levels; however, neither drug increased downstream PKG activity. Early mitochondrial dysfunction, evident as decreased calcium‐retention capacity and Complex II‐dependent respiratory control, was present in both HF and tadalafil‐treated animals. Conclusions Both saxagliptin and tadalafil prevented increased LV collagen deposition in a manner related to the attenuation of increased plasma neuropeptide Y levels. Saxagliptin appears superior for treating heart failure with preserved ejection fraction, considering its comprehensive effects on integrated LV systolic and diastolic function.
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Affiliation(s)
- Jessica A Hiemstra
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Dong I Lee
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Khalid Chakir
- Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Manuel Gutiérrez-Aguilar
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Kurt D Marshall
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Pamela J Zgoda
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Noelany Cruz Rivera
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Daniel G Dozier
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | - Brian S Ferguson
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | | | | | - Carolin Scherf
- Department of Veterinary Pathobiology, University of Missouri-Columbia, Columbia, MO
| | - Jan R Ivey
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
| | | | - Kerry S McDonald
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO
| | - Christopher P Baines
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Maike Krenz
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri-Columbia, Columbia, MO
| | - Timothy L Domeier
- Department of Medical Pharmacology and Physiology, University of Missouri-Columbia, Columbia, MO
| | - Craig A Emter
- Department of Biomedical Science, University of Missouri-Columbia, Columbia, MO
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10
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Buglioni A, Cannone V, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Sarzani R, Burnett JC. Aldosterone Predicts Cardiovascular, Renal, and Metabolic Disease in the General Community: A 4-Year Follow-Up. J Am Heart Assoc 2015; 4:e002505. [PMID: 26702078 PMCID: PMC4845260 DOI: 10.1161/jaha.115.002505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/25/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND We recently reported that normal aldosterone levels are associated with cardiovascular, renal, and metabolic disease in a sample of the US general community (Visit 1). For the current analyses we used the same cohort in a new 4-year follow-up study (Visit 2). METHODS AND RESULTS We measured aldosterone at Visit 1 and analyzed its predictive role for new diseases at Visit 2 (n=1140). We measured aldosterone at Visit 2 and investigated its associations with disease at Visit 2 (n=1368). We analyzed aldosterone continuously and we also dichotomized the variable as whether subjects were in the third tertile versus second and first tertiles. As continuous variable at Visit 1, aldosterone predicted new onset hypertension (HTN) (OR=1.36, CI=1.13-1.63, P=0.001), central obesity (OR=1.36, CI=1.07-1.73, P=0.011), and use of lipid-lowering drugs (OR=1.25, CI=1.05-1.48, P=0.012) at Visit 2, after adjustment for age, sex, and body mass index. When in the third tertile (8.5-88.6 ng/dL), aldosterone predicted type 2 diabetes (T2DM, OR=1.96, CI=1.03-3.70, P=0.039). At Visit 2, aldosterone remained associated with HTN, obesity, and chronic kidney disease (CKD), as reported for Visit 1. However, aldosterone was not associated with heart failure (HF) at Visit 1 and 2, nor was aldosterone a predictor of HF between visits. CONCLUSIONS Aldosterone predicts new HTN, central obesity, T2DM, and use of lipid-lowering drugs in the general community and remains associated with HTN, obesity, and CKD over 4 years. Aldosterone is not associated nor predicts HF. Further studies are warranted to evaluate aldosterone as therapeutic target in the general community.
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Affiliation(s)
- Alessia Buglioni
- Cardiorenal Research LaboratoryCollege of Medicine Mayo ClinicRochesterMN
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
| | - Valentina Cannone
- Cardiorenal Research LaboratoryCollege of Medicine Mayo ClinicRochesterMN
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
| | - S. Jeson Sangaralingham
- Cardiorenal Research LaboratoryCollege of Medicine Mayo ClinicRochesterMN
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
| | - Denise M. Heublein
- Cardiorenal Research LaboratoryCollege of Medicine Mayo ClinicRochesterMN
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
| | - Christopher G. Scott
- Department of Health Sciences ResearchCollege of Medicine Mayo ClinicRochesterMN
| | - Kent R. Bailey
- Department of Health Sciences ResearchCollege of Medicine Mayo ClinicRochesterMN
| | - Richard J. Rodeheffer
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics and “Hypertension Excellence Centre” of the European Society of HypertensionDepartment of Clinical and Molecular SciencesUniversity “Politecnica delle Marche”AnconItaly
- Italian National Research Centre on Aging “U. Sestilli”IRCCS‐INRCAAnconItaly
| | - John C. Burnett
- Cardiorenal Research LaboratoryCollege of Medicine Mayo ClinicRochesterMN
- Division of Cardiovascular DiseasesDepartment of MedicineCollege of Medicine Mayo ClinicRochesterMN
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11
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Andersen IA, Huntley BK, Sandberg SS, Heublein DM, Burnett JC. Elevation of circulating but not myocardial FGF23 in human acute decompensated heart failure. Nephrol Dial Transplant 2015; 31:767-72. [PMID: 26666498 DOI: 10.1093/ndt/gfv398] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/28/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Elevated plasma fibroblast growth factor 23 (FGF23) is a prognostic marker in chronic kidney disease. Recently, FGF23 was reported to also be a predictive factor in chronic congestive heart failure (HF). To date however, plasma levels in acute decompensated HF (ADHF) have not been reported and myocardial production and distribution of FGF23 in HF is poorly defined. We aimed to determine plasma levels and myocardial production of FGF23 in ADHF. METHODS Plasma FGF23, N-terminal pro B-type natriuretic peptide (NT-proBNP) and estimated glomerular filtration rate (eGFR) were assessed in 21 ADHF patients and 19 controls. Myocardial gene expression and distribution of FGF23 was determined on left ventricular samples from HF patients and normal controls. RESULTS Plasma FGF23 was markedly higher in ADHF patients compared with controls (1498 ± 1238 versus 66 ± 27 RU/mL, P < 0.0001). There were no correlations between FGF23 and eGFR, NT-proBNP, ejection fraction or age. ADHF subjects with eGFR >60 mL/min/1.73 m(2) had FGF23 levels of 1526 ± 1601 RU/mL versus 55 ± 20 RU/mL in controls (P = 0.007). Quantified myocardial FGF23 gene expression was similar between HF patients and controls. Myocardial FGF23 immunostaining was similar between HF patients and controls, with equal distribution throughout cardiomyocytes. CONCLUSION Patients with ADHF had markedly elevated plasma FGF23 levels. Myocardial FGF23 gene expression was present in HF at a similar level as normal controls, and immunohistochemistry showed similar cellular distribution of FGF23 in HF and controls, suggesting that the myocardium does not contribute to the elevated circulating FGF23 in HF.
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Affiliation(s)
| | - Brenda K Huntley
- Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA
| | | | | | - John C Burnett
- Cardiorenal Research Laboratory, Mayo Clinic, Rochester, MN, USA
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Sangaralingham SJ, McKie PM, Ichiki T, Scott CG, Heublein DM, Chen HH, Bailey KR, Redfield MM, Rodeheffer RJ, Burnett JC. Circulating C-type natriuretic peptide and its relationship to cardiovascular disease in the general population. Hypertension 2015; 65:1187-94. [PMID: 25895587 DOI: 10.1161/hypertensionaha.115.05366] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
Abstract
C-type natriuretic peptide (CNP) is an endothelium-derived peptide that is released as a protective mechanism in response cardiovascular injury or disease. However, no studies have investigated circulating CNP, identifying clinical factors that may influence CNP and its relationship to cardiovascular disease in the general population. We studied 1841 randomly selected subjects from Olmsted County, MN (mean age, 63±11 years; 48% men). Plasma CNP was measured by a well-established radioimmunoassay and echocardiography, clinical characterization, and detailed medical record review were performed. We report that CNP circulates at various concentrations (median, 13 pg/mL), was unaffected by sex, was weakly associated by age, and that highest quartile of CNP identified a high-risk phenotype. Subjects with CNP in the highest quartile were associated with increased risk of myocardial infarction (multivariable-adjusted hazard ratio, 1.51; 95% confidence interval, 1.09-2.09; P=0.01) but not heart failure, cerebrovascular accidents, or death during a follow-up of 12 years. Addition of the highest quartile of CNP to clinical variables led to a modest increase in the integrated discrimination improvement for risk of myocardial infarction. In a large community-based cohort, elevated circulating CNP identified a high-risk phenotype that included cardiovascular comorbidities and left ventricular dysfunction, and provided evidence that highest concentrations of CNP potentially has prognostic value in predicting future risk of myocardial infarction. Together, these data from the general population highlight the potential value of CNP and support the need for additional studies to evaluate whether mechanisms regulating CNP could improve outcomes.
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Affiliation(s)
- S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN.
| | - Paul M McKie
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Tomoko Ichiki
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Horng H Chen
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Margaret M Redfield
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
| | - John C Burnett
- From the Cardiorenal Research Laboratory (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., J.C.B.), Divisions of Cardiovascular Diseases (S.J.S., P.M.M., T.I., D.M.H., H.H.C., M.M.R., R.J.R., J.C.B.), and Biomedical Statistics and Informatics (C.G.S., K.R.B.), Mayo Clinic, Rochester, MN
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Arora P, Reingold J, Baggish A, Guanaga DP, Wu C, Ghorbani A, Song Y, Chen-Tournaux A, Khan AM, Tainsh LT, Buys ES, Williams JS, Heublein DM, Burnett JC, Semigran MJ, Bloch KD, Scherrer-Crosbie M, Newton-Cheh C, Kaplan LM, Wang TJ. Weight loss, saline loading, and the natriuretic peptide system. J Am Heart Assoc 2015; 4:e001265. [PMID: 25595796 PMCID: PMC4330054 DOI: 10.1161/jaha.114.001265] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background In epidemiologic studies, obesity has been associated with reduced natriuretic peptide (NP) concentrations. Reduced NP production could impair the ability of obese individuals to respond to salt loads, increasing the risk of hypertension and other disorders. We hypothesized that weight loss enhances NP production before and after salt loading. Methods and Results We enrolled 15 obese individuals (mean BMI 45±5.4 kg/m2) undergoing gastric bypass surgery. Before and 6 months after surgery, subjects were admitted to the clinical research center and administered a large‐volume intravenous saline challenge. Echocardiography and serial blood sampling were performed. From the pre‐operative visit to 6 months after surgery, subjects had a mean BMI decrease of 27%. At the 6‐month visit, N‐terminal pro‐atrial NP (Nt‐proANP) levels were 40% higher before, during, and after the saline infusion, compared with levels measured at the same time points during the pre‐operative visit (P<0.001). The rise in Nt‐pro‐ANP induced by the saline infusion (≈50%) was similar both before and after surgery (saline, P<0.001; interaction, P=0.2). Similar results were obtained for BNP and Nt‐proBNP; resting concentrations increased by 50% and 31%, respectively, after gastric bypass surgery. The increase in NP concentrations after surgery was accompanied by significant decreases in mean arterial pressure (P=0.004) and heart rate (P<0.001), and an increase in mitral annular diastolic velocity (P=0.02). Conclusion In obese individuals, weight loss is associated with a substantial increase in the “setpoint” of circulating NP concentrations. Higher NP concentrations could contribute to an enhanced ability to handle salt loads after weight loss.
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Affiliation(s)
- Pankaj Arora
- Cardiology Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (P.A.)
| | - Jason Reingold
- Atlanta Cardiology and Primary Care, Saint Joseph's Research Institute, Atlanta, GA (J.R.)
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Derek P Guanaga
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Connie Wu
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Anahita Ghorbani
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Yanna Song
- Department of Biostatistics, Vanderbilt University, Nashville, TN (Y.S.)
| | | | - Abigail May Khan
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (A.M.K.)
| | - Laurel T Tainsh
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Emmanuel S Buys
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, MA (J.S.W.)
| | | | - John C Burnett
- Division of Cardiology, Mayo Clinic, Rochester, MN (D.M.H., J.C.B.)
| | - Marc J Semigran
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Kenneth D Bloch
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.) Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Boston, MA (C.W., L.T.T., E.S.B., K.D.B.)
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Christopher Newton-Cheh
- Division of Cardiology, Massachusetts General Hospital, Boston, MA (A.B., D.P.G., A.G., M.J.S., K.D.B., M.S.C., C.N.C.)
| | - Lee M Kaplan
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA (L.M.K.)
| | - Thomas J Wang
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.)
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14
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Buglioni A, Cannone V, Cataliotti A, Sangaralingham SJ, Heublein DM, Scott CG, Bailey KR, Rodeheffer RJ, Dessì-Fulgheri P, Sarzani R, Burnett JC. Circulating aldosterone and natriuretic peptides in the general community: relationship to cardiorenal and metabolic disease. Hypertension 2014; 65:45-53. [PMID: 25368032 DOI: 10.1161/hypertensionaha.114.03936] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to investigate the role of aldosterone as a mediator of disease and its relationship with the counter-regulatory natriuretic peptide (NP) system. We measured plasma aldosterone (n=1674; aged≥45 years old) in a random sample of the general population from Olmsted County, MN. In a multivariate logistic regression model, aldosterone analyzed as a continuous variable was associated with hypertension (odds ratio [OR]=1.75; 95% confidence interval [CI]=1.57-1.96; P<0.0001), obesity (OR=1.34; 95% CI=1.21-1.48; P<0.0001), chronic kidney disease (OR=1.39; 95% CI=1.22-1.60; P<0.0001), central obesity (OR=1.47; 95% CI=1.32-1.63; P<0.0001), metabolic syndrome (OR=1.41; 95% CI=1.26-1.58; P<0.0001), high triglycerides (OR=1.23; 95% CI=1.11-1.36; P<0.0001), concentric left ventricular hypertrophy (OR=1.22; 95% CI=1.09-1.38; P=0.0007), and atrial fibrillation (OR=1.24; 95% CI=1.01-1.53; P=0.04), after adjusting for age and sex. The associations with hypertension, central obesity, metabolic syndrome, triglycerides, and concentric left ventricular hypertrophy remained significant after further adjustment for body mass index, NPs, and renal function. Furthermore, aldosterone in the highest tertile correlated with lower NP levels and increased mortality. Importantly, most of these associations remained significant even after excluding subjects with aldosterone levels above the normal range. In conclusion, we report that aldosterone is associated with hypertension, chronic kidney disease, obesity, metabolic syndrome, concentric left ventricular hypertrophy, and lower NPs in the general community. Our data suggest that aldosterone, even within the normal range, may be a biomarker of cardiorenal and metabolic disease. Further studies are warranted to evaluate a therapeutic and preventive strategy to delay the onset and progression of disease, using mineralocorticoid antagonists or chronic NP administration in high-risk subjects identified by plasma aldosterone.
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Affiliation(s)
- Alessia Buglioni
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.).
| | - Valentina Cannone
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Alessandro Cataliotti
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Christopher G Scott
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Kent R Bailey
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Richard J Rodeheffer
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Paolo Dessì-Fulgheri
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - Riccardo Sarzani
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
| | - John C Burnett
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Departments of Medicine and Health Sciences Research, College of Medicine Mayo Clinic, Rochester, MN (A.B., V.C., A.C., S.J.S., D.M.H., C.G.S., K.R.B., R.J.R., J.C.B.); and Internal Medicine and Geriatrics, Department of Clinical and Molecular Science, University "Politecnica delle Marche" and Italian National Research Centre on Aging, IRCCS/INRCA, Ancona, Italy (A.B., P.D.-F., R.S.)
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Abstract
BACKGROUND We have reported that pro-B-type natriuretic peptide (BNP)-1-108 circulates and is processed to mature BNP1-32 in human blood. Building on these findings, we sought to determine whether proBNP1-108 processed forms in normal circulation are biologically active and stimulate cGMP, and whether proBNP1-108 processing and activity are altered in human heart failure (HF) compared with normal. Because BNP1-32 is deficient whereas proBNP1-108 is abundant in HF, we hypothesize that proBNP1-108 processing and degradation are impaired in HF patients ex vivo. METHODS AND RESULTS We measured circulating molecular forms, including BNP1-32, proBNP1-108, and N-terminal-proBNP, and all were significantly higher in patients with HF when compared with that in normals. Fresh serum samples from normals or patients with HF were incubated with or without exogenous nonglycosylated proBNP1-108 tagged with 6 C-terminal Histidines to facilitate peptide isolation. His-tag proBNP1-108 was efficiently processed into BNP1-32/3-32 at 5 minutes in normal serum, persisted for 15 minutes, then disappeared. Delayed processing of proBNP1-108 was observed in HF samples, and the degradation pattern differed depending on left ventricular function. The 5-minute processed forms from both normal and HF serums were active and generated cGMP via guanylyl cyclase-A receptors; however, the 180-minute samples were not active. The proBNP1-108 processing enzyme corin and BNP-degrading enzyme dipeptidyl peptidase-4 were reduced in HF versus normal, perhaps contributing to differential BNP metabolism in HF. CONCLUSIONS Exogenous proBNP1-108 is processed into active BNP1-32 and ultimately degraded in normal circulation. The processing and degradation of BNP molecular forms were altered but complete in HF, which may contribute to the pathophysiology of HF.
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Affiliation(s)
- Brenda K Huntley
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Sharon M Sandberg
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Denise M Heublein
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - S Jeson Sangaralingham
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - John C Burnett
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Tomoko Ichiki
- From the Cardiorenal Research Laboratory, Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN.
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16
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Cannone V, Huntley BK, Olson TM, Heublein DM, Scott CG, Bailey KR, Redfield MM, Rodeheffer RJ, Burnett JC. Atrial natriuretic peptide genetic variant rs5065 and risk for cardiovascular disease in the general community: a 9-year follow-up study. Hypertension 2013; 62:860-5. [PMID: 24041948 DOI: 10.1161/hypertensionaha.113.01344] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We analyzed the phenotype associated with the atrial natriuretic peptide (ANP) genetic variant rs5065 in a random community-based sample. We also assessed and compared the biological action of 2 concentrations (10(-10) mol/L, 10(-8) mol/L) of ANP and ANP-RR, the protein variant encoded by the minor allele of rs5065, on activation of the guanylyl cyclase (GC)-A and GC-B receptors, production of the second messenger 3',5'-cGMP in endothelial cells, and endothelial permeability. rs5065 genotypes were determined in a cross-sectional adult cohort from Olmsted County, MN (n=1623). Genotype frequencies for rs5065 were 75%, 24%, and 1% for TT, TC, and CC, respectively. Multivariate analysis showed that the C allele was associated with increased risk of cerebrovascular accident (hazard ratio, 1.43; 95% confidence interval, 1.09-1.86; P=0.009) and higher prevalence of myocardial infarction (odds ratio, 1.82; 95% confidence interval, 1.07-3.09; P=0.026). ANP-RR 10(-8) mol/L activated the GC-A receptor (83.07±8.31 versus no treatment 0.18±0.04 per 6 wells; P=0.006), whereas ANP-RR 10(-10) mol/L did not. Neither 10(-8) mol/L nor 10(-10) mol/L ANP-RR activated GC-B receptor (P=0.10, P=0.35). ANP 10(-8) mol/L and ANP-RR 10(-8) mol/L stimulated 3',5'-cGMP production in endothelial cells similarly (P=0.58). Both concentrations of ANP-RR significantly enhanced human aortic endothelial cell permeability (69 versus 29 relative fluorescence units [RFUs], P=0.012; 58 versus 39 RFUs, P=0.015) compared with ANP. The minor allele of rs5065 was associated with increased cardiovascular risk. ANP-RR activated the GC-A receptor, increased 3',5'-cGMP in endothelial cells, and when compared with ANP, augmented endothelial cell permeability.
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Affiliation(s)
- Valentina Cannone
- Cardiorenal Research Laboratory, Guggenheim 915, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905.
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Ichiki T, Ingrid AA, Huntley BK, Sangaralingham SJ, Harty GJ, Sandberg SM, Heublein DM, Burnett JC. Pro-Atrial Natriuretic Peptide In Vitro and In Vivo Normal Canines: A Selective Renal Enhancing Therapeutic. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Cannone V, McKie PM, Cefalu AB, Noto D, Cavera G, Pagano M, Sapienza M, Olson TM, Heublein DM, Scott CG, Bailey KR, Averna M, Burnett JC. Genetic variants of ANP and cardiometabolic protection: from populations to novel therapeutics. BMC Pharmacol Toxicol 2013. [PMCID: PMC3765652 DOI: 10.1186/2050-6511-14-s1-o7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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McKie PM, Heublein DM, Scott CG, Gantzer ML, Mehta RA, Rodeheffer RJ, Redfield MM, Burnett JC, Jaffe AS. Defining High-Sensitivity Cardiac Troponin Concentrations in the Community. Clin Chem 2013; 59:1099-107. [DOI: 10.1373/clinchem.2012.198614] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND
High-sensitivity cardiac troponin (hs-cTn) assays are now available that can detect measurable troponin in significantly more individuals in the general population than conventional assays. The clinical use of these hs-cTn assays depends on the development of proper reference values. Therefore, our objective was to define hs-cTnI reference values and determinants in the general community, in a healthy reference cohort, and in subsets with diseases.
MATERIALS AND METHODS
A well-characterized community-based cohort of 2042 study participants underwent clinical assessment and echocardiographic evaluation. Baseline hs-cTnI measurements were obtained in 1843 individuals. A healthy reference cohort (n = 565) without cardiac, renal, or echocardiographic abnormalities was identified.
RESULTS
Measurable hs-cTnI was identified in 1716 (93%) of the community-based study cohort and 499 (88%) of the healthy reference cohort. Parameters that significantly contributed to higher hs-cTnI concentrations in the healthy reference cohort included age, male sex, systolic blood pressure, and left ventricular mass. Glomerular filtration rate and body mass index were not independently associated with hs-cTnI in the healthy reference cohort. Individuals with diastolic and systolic dysfunction, hypertension, and coronary artery disease (but not impaired renal function) had significantly higher hs-cTnI values than the healthy reference cohort.
CONCLUSIONS
We assessed an hs-cTnI assay with the aid of echocardiographic imaging in a large, well-characterized community-based cohort. hs-cTnI is remarkably sensitive in the general population, and there are important sex and age differences among healthy reference individuals. These results have important implications for defining hs-cTnI reference values and identifying disease.
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Affiliation(s)
- Paul M McKie
- Cardiorenal Research Laboratory
- Division of Cardiovascular Diseases, Department of Internal Medicine, and
| | | | - Christopher G Scott
- Division of Biostatistics, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN
| | | | - Ramila A Mehta
- Division of Biostatistics, Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN
| | - Richard J Rodeheffer
- Cardiorenal Research Laboratory
- Division of Cardiovascular Diseases, Department of Internal Medicine, and
| | - Margaret M Redfield
- Cardiorenal Research Laboratory
- Division of Cardiovascular Diseases, Department of Internal Medicine, and
| | - John C Burnett
- Cardiorenal Research Laboratory
- Division of Cardiovascular Diseases, Department of Internal Medicine, and
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Department of Internal Medicine, and
- Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, MN
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Costello-Boerrigter LC, Lapp H, Boerrigter G, Lerman A, Bufe A, Macheret F, Heublein DM, Larue C, Burnett JC. Secretion of prohormone of B-type natriuretic peptide, proBNP1-108, is increased in heart failure. JACC Heart Fail 2013; 1:207-12. [PMID: 24621871 DOI: 10.1016/j.jchf.2013.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Using a novel, specific assay for proBNP(1-108), this study tested the hypotheses that proBNP(1-108) is secreted by both nonfailing and failing human hearts and that proBNP(1-108) secretion is increased in failing hearts. BACKGROUND The prohormone of B-type natriuretic peptide (proBNP(1-108)) is a 108-amino acid peptide produced primarily by the heart and cleaved into biologically active BNP(1-32) and the biologically inactive NT-proBNP(1-76). It is unknown to what extent increased cardiac proBNP1-108 secretion compared to reduced peripheral processing is responsible for elevated proBNP(1-108) levels in patients with heart failure (HF) compared to subjects without HF. METHODS The transcardiac gradient of proBNP(1-108) was determined by collecting arterial blood and blood from the coronary sinus (CS). Samples from subjects without overt heart disease (n = 9) were collected during cardiac catheterization after coronary artery disease had been excluded. Samples from HF patients (n = 21) were collected during implantation of a biventricular pacemaker. ProBNP(1-108) was measured with a new assay. Values are medians (25th/75th percentiles). RESULTS The gradient of proBNP(1-108) across the nonfailing hearts was 8 (2/20) ng/l (aorta: 15 [1/25] ng/l; CS: 24 [8/41] ng/l; p = 0.018). The transcardiac gradient of proBNP(1-108) in the failing hearts was 326 (96/482) ng/l (arterial: 381 [201/586] ng/l; CS: 709 [408/1,087] ng/l; p<0.001). The transcardiac gradient was greater in failing than nonfailing hearts (p = 0.001). CONCLUSIONS ProBNP(1-108) is secreted by nonfailing and failing human hearts, but more so in the latter. It remains to be established where peripheral processing of proBNP(1-108) occurs and how this is affected by disease.
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Affiliation(s)
| | - Harald Lapp
- Helios Clinic, Erfurt, Germany; Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
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Cannone V, Huntley BK, Heublein DM, Sandberg SM, Harders GE, Sangaralingham JS, Martin FL, Burnett JC. MANP: A Novel Designer Natriuretic Peptide for Cardiometabolic Disease. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kurklinsky AK, Heublein DM, Stockland AH, Bjarnason H, Misra S, Mcphail IR, Friese JL, Andrews JC, Oderich GS, Burnett JC. Abstract 270: Decrease of BNP Concentrations in Blood Perfusing Extremities of Patients with Advanced Peripheral Arterial Disease. Arterioscler Thromb Vasc Biol 2012. [DOI: 10.1161/atvb.32.suppl_1.a270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale:
The role of cardiac natriuretic peptides (NPs) in peripheral arterial disease (PAD) or thromboangiitis obliterans (TA) is unknown. Recent studies in mice suggested that BNP may be produced outside the heart in the ischemic limbs contributing to peripheral angiogenesis.
Objective:
Determine if synthesis or consumption/degradation of NPs occur in the ischemic legs of patients with PAD or TA.
Methods:
32 patients with critical limb ischemia (CLI) or claudication (PAD n=31; TA n=1; 20 males; mean age 72.9 years) underwent diagnostic angiography or revascularization. We determined differences of concentrations of BNP, NT-proBNP, and CNP in the blood of proximal veins and arteries of both legs. Concentrations differences were then compared between the more ischemic target and the contralateral self-control legs.
Results:
Values are means ± SD. P values <0.05 were considered significant.
In the PAD group, in the target extremity, concentration step-ups of NT-proBNP (11±68; p=0.40) and CNP (0.45±6.22; p=0.71) were not significant from the arterial to venous blood. In the contralateral self-control legs, NT-proBNP and CNP concentrations drops were also not significant (-37±160, p=0.7; -0.89±4.09, p=0.23). Venous BNP concentrations were significantly lower than arterial both in the target (-66±153, p<0.001) and self-control legs (-59±107, p<0.001). BNP concentrations drops were greater in the CLI than claudication cases driving the overall significance. In the patient with TA, whose only identifiable PAD risk factor was smoking, arterial concentrations of NPs were generally low (NT-proBNP 81; BNP 46; CNP 8.2), but higher than venous concentrations (80; 41; 6.7).
Conclusion:
Significantly lower venous BNP concentrations suggest possible BNP consumption/degradation in the ischemic legs. Concentrations of NT-proBNP, that has a longer half-life than BNP, were more stable suggesting no significant local production or conversion to BNP. CNP concentrations were stable. Recognizing the angiogenic properties of NPs and lack of evidence of peripheral production, studies are warranted in humans with PAD to determine the potential angiogenic properties of exogenous NPs supplementation in what could be considered a local NPs deficiency state.
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Sangaralingham JS, Heublein DM, Grande JP, Cataliotti A, Rule AD, McKie PM, Martin FL, Burnett JC. C-Type natriuretic peptide: a potential urinary biomarker for renal remodeling and fibrosis during aging. BMC Pharmacol 2011. [PMCID: PMC3363257 DOI: 10.1186/1471-2210-11-s1-p60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Cannone V, Boerrigter G, Cataliotti A, Costello-Boerrigter LC, Olson TM, McKie PM, Heublein DM, Lahr BD, Bailey KR, Averna M, Redfield MM, Rodeheffer RJ, Burnett JC. A genetic variant of the atrial natriuretic peptide gene is associated with cardiometabolic protection in the general community. J Am Coll Cardiol 2011; 58:629-36. [PMID: 21798427 DOI: 10.1016/j.jacc.2011.05.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/14/2011] [Accepted: 05/15/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to define the cardiometabolic phenotype associated with rs5068, a genetic variant of the atrial natriuretic peptide (ANP) gene. BACKGROUND The ANP and B-type natriuretic peptide play an important role in cardiorenal homeostasis but also exert metabolic actions. METHODS We genotyped 1,608 randomly selected residents from Olmsted County, Minnesota. Subjects were well-characterized. RESULTS Genotype frequencies were: AA 89.9%, AG 9.7%, and GG 0.4%; all subsequent analyses were AA versus AG+GG. The G allele was associated with increased plasma levels of N-terminal pro-atrial natriuretic peptide (p = 0.002), after adjustment for age and sex. The minor allele was also associated with lower body mass index (BMI) (p = 0.006), prevalence of obesity (p = 0.002), waist circumference (p = 0.021), lower levels of C-reactive protein (p = 0.027), and higher values of high-density lipoprotein cholesterol (p = 0.019). The AG+GG group had a lower systolic blood pressure (p = 0.011) and lower prevalence of myocardial infarction (p = 0.042). The minor allele was associated with a lower prevalence of metabolic syndrome (p = 0.025). The associations between the G allele and high-density lipoprotein cholesterol, C-reactive protein values, myocardial infarction, and metabolic syndrome were not significant, after adjusting for BMI; the associations with systolic blood pressure, BMI, obesity, and waist circumference remained significant even after adjusting for N-terminal pro-atrial natriuretic peptide. CONCLUSIONS In a random sample of the general U.S. population, the minor allele of rs5068 is associated with a favorable cardiometabolic profile. These findings suggest that rs5068 or genetic loci in linkage disequilibrium might affect susceptibility for cardiometabolic diseases and support the possible protective role of natriuretic peptides by their favorable effects on metabolic function. Replication studies are needed to confirm our findings.
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Affiliation(s)
- Valentina Cannone
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Sangaralingham SJ, Heublein DM, Grande JP, Cataliotti A, Rule AD, McKie PM, Martin FL, Burnett JC. Urinary C-type natriuretic peptide excretion: a potential novel biomarker for renal fibrosis during aging. Am J Physiol Renal Physiol 2011; 301:F943-52. [PMID: 21865266 DOI: 10.1152/ajprenal.00170.2011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal aging is characterized by structural changes in the kidney including fibrosis, which contributes to the increased risk of kidney and cardiac failure in the elderly. Studies involving healthy kidney donors demonstrated subclinical age-related nephropathy on renal biopsy that was not detected by standard diagnostic tests. Thus there is a high-priority need for novel noninvasive biomarkers to detect the presence of preclinical age-associated renal structural and functional changes. C-type natriuretic peptide (CNP) possesses renoprotective properties and is present in the kidney; however, its modulation during aging remains undefined. We assessed circulating and urinary CNP in a Fischer rat model of experimental aging and also determined renal structural and functional adaptations to the aging process. Histological and electron microscopic analysis demonstrated significant renal fibrosis, glomerular basement membrane thickening, and mesangial matrix expansion with aging. While plasma CNP levels progressively declined with aging, urinary CNP excretion increased, along with the ratio of urinary to plasma CNP, which preceded significant elevations in proteinuria and blood pressure. Also, CNP immunoreactivity was increased in the distal and proximal tubules in both the aging rat and aging human kidneys. Our findings provide evidence that urinary CNP and its ratio to plasma CNP may represent a novel biomarker for early age-mediated renal structural alterations, particularly fibrosis. Thus urinary CNP could potentially aid in identifying subjects with preclinical structural changes before the onset of symptoms and disease, allowing for the initiation of strategies designed to prevent the progression of chronic kidney disease particularly in the aging population.
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Affiliation(s)
- S Jeson Sangaralingham
- Cardiorenal Research Laboratory, Div. of Cardiovascular Diseases, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
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Costello EC, Lapp H, Lerman A, Boerrigter G, Macheret F, Martin F, Bufe A, Larue C, Heublein DM, Burnett JC. The Prohormone of B-Type Natriuretic Peptide, proBNP1-108, Is Secreted by the Failing and Non-Failing Human Heart. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Costello E, Boerrigter G, Canossa-Terris MA, Heublein DM, Larue C, Kurlansky PA, Burnett JC. IMPACT OF ETHNICITY ON PROBNP1-108, BNP1-32 AND NTPROBNP1-76 LEVELS IN HYPERTENSIVE CAUCASIANS AND HISPANICS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Costello-Boerrigter LC, Boerrigter G, Ameenuddin S, Mahoney DW, Slusser JP, Heublein DM, Redfield MM, Rodeheffer RJ, Olson TM, Burnett JC. The effect of the brain-type natriuretic peptide single-nucleotide polymorphism rs198389 on test characteristics of common assays. Mayo Clin Proc 2011; 86:210-8. [PMID: 21364112 PMCID: PMC3046941 DOI: 10.4065/mcp.2010.0708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess in a US general adult population the effect of the functional single-nucleotide polymorphism rs198389 in the promoter region of the gene of brain-type natriuretic peptide (BNP) on 3 commonly used BNP assays, clinical phenotype, disease prevalence, overall survival, and diagnostic test characteristics of BNP as a biomarker. PATIENTS AND METHODS We genotyped for rs198389 in a random sample of the general population (aged ≥ 45 years; n = 1970; enrolled between June 1, 1997, and September 30, 2000) from Olmsted County, Minnesota. Patients were characterized biochemically, clinically, echocardiographically, and regarding BNP molecular forms (2 assays for BNP and 1 assay for amino-terminal proBNP). Median follow-up was 9 years. RESULTS Genotype frequencies were in Hardy-Weinberg equilibrium (P = .98): TT genotype, n = 645 (32.7%); TC genotype, n = 983 (49.9%); and CC genotype, n = 342 (17.4%). The C allele independently predicted higher BNP forms (P<.001 for all assays). Genotypes did not differ with regard to clinical and echocardiographic phenotype or overall survival. When previously reported genotype-unadjusted cut points for the detection of left ventricular ejection fraction less than or equal to 40% (n = 37 [1.9%]) and less than or equal to 50% (n = 116 [6.0%]) were used, sensitivity generally increased with the number of C alleles, whereas specificity decreased, both on average by more than 10% for the TT vs CC genotype. CONCLUSION The C allele of rs198389 is common in the general US population and is associated with higher concentrations of BNP molecular forms but not with cardiovascular phenotype or survival. The C allele confounds the test characteristics of commonly used assays.
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Affiliation(s)
- Lisa C Costello-Boerrigter
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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Ichiki T, Huntley BK, Heublein DM, Sandberg SM, McKie PM, Martin FL, Jougasaki M, Burnett JC. Corin is present in the normal human heart, kidney, and blood, with pro-B-type natriuretic peptide processing in the circulation. Clin Chem 2010; 57:40-7. [PMID: 21075870 DOI: 10.1373/clinchem.2010.153908] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP), which is activated in heart failure (HF), is processed to an active form by corin. The corin gene is expressed in the human heart and kidney, but corin protein expression in the heart, kidney, and circulation, along with whether proBNP is processed by circulating corin, remains unknown. METHODS We examined corin protein expression by immunostaining and Western blot in human heart and kidney, and we assessed the circulating corin concentration by ELISA. We examined histidine-tagged (His-tag) proBNP(1-108) processing in serum and plasma by immunoprecipitation and Western blot and sequenced the processed form. RESULTS Normal human heart and kidney displayed the presence of corin, especially in cells around the vasculature. Both corin and proBNP(1-108) were present in the plasma of healthy human subjects, with circulating corin significantly higher in men than women (P < 0.0001) and a positive correlation of corin to age (P = 0.0497, r = 0.27). In fresh normal plasma and serum, His-tag proBNP(1-108) was processed to a lower molecular weight form confirmed to be BNP. Processed BNP was higher in men than women (P = 0.041) and was positively correlated to plasma corin concentrations (P = 0.041, r = 0.65). CONCLUSIONS Our results support the concept that proBNP(1-108) may be processed outside of the heart in the circulation where the proprotein convertase is present. Moreover, sex may impact this process, since corin concentrations are higher in men. These findings may have important physiologic and pathophysiologic implications for the proBNP/corin system in the human.
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Affiliation(s)
- Tomoko Ichiki
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, MN 55905, USA.
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Ichiki T, Huntley BK, Heublein DM, Sandberg SM, McKie PM, Jougasaki M, Burnett JC. Circulating Pronatriuretic Peptide Convertase Corin Is Present in Normal and Heart Failure Patients and Processes proBNP1-108 in Human Blood. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cannone V, Boerrigter G, Costello-Boerrigter LC, Cataliotti A, Bailey KR, Lahr B, Heublein DM, Rodeheffer RJ, Olson TM, Burnett JC. A Genetic Variant of the ANP Gene Is Associated With a Lower Cardiometabolic Risk Profile in the General USA Population. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Costello-Boerrigter LC, Boerrigter G, Ameenuddin S, Mahoney DW, Susser JP, Heublein DM, Redfield MM, Rodeheffer RJ, Olson TM, Burnett JC. B-type natriuretic peptide single nucleotide polymorphism rs198389 is highly prevalent and impacts test characteristics of common assays. BMC Pharmacol 2009. [PMCID: PMC3313398 DOI: 10.1186/1471-2210-9-s1-p9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lisa C Costello-Boerrigter
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Guido Boerrigter
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Syed Ameenuddin
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Douglas W Mahoney
- Division of Epidemiology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joshua P Susser
- Division of Biostatistics, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Denise M Heublein
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Margaret M Redfield
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Richard J Rodeheffer
- Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Timothy M Olson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John C Burnett
- Cardiorenal Research Laboratory and Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Boerrigter G, Costello-Boerrigter LC, Ameenuddin S, Mahoney DW, Slusser JP, Heublein DM, Redfield MM, Rodeheffer RJ, Olson TM, Burnett JC. B-type natriuretic peptide single nucleotide polymorphism rs198389 and survival in the general community. BMC Pharmacol 2009. [PMCID: PMC3313352 DOI: 10.1186/1471-2210-9-s1-p4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Costello-Boerrigter LC, Boerrigter G, Ameenuddin S, Mahoney DW, Slusser JP, Heublein DM, Redfield MM, Rodeheffer RJ, Olson TM, Burnett JC. B-Type Natriuretic Peptide Single Nucleotide Polymorphism rs198389 Impacts Test Characteristics of Common Assays. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boerrigter G, Costello-Boerrigter LC, Ameenuddin S, Mahoney DW, Slusser JP, Heublein DM, Redfield MM, Rodeheffer RJ, Olson TM, Burnett JC. B-Type Natriuretic Peptide Single Nucleotide Polymorphism rs198389 and Survival in the General Community. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ichiki T, Huntley BK, Heublein DM, Sangaralingham SJ, Martin FL, Schirger JA, Macheret F, Jougasaki M, Burnett JC. Determinants of Circulating Corin in Healthy Subjects. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Costello-Boerrigter LC, Boerrigter G, Ameenuddin S, Olson TM, Redfield MM, Rodeheffer RJ, Heublein DM, Burnett JC. The B-Type Natriuretic Peptide T–381C Polymorphism Is Associated with Increased BNP Plasma Immunoreactivity and Higher Prevalence of Type 2 Diabetes Mellitus and Atrial Fibrillation. J Card Fail 2008. [DOI: 10.1016/j.cardfail.2008.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martin FL, Sandberg SM, Heublein DM, McKie PM, Chen HH, Cataliotti A, Harders GE, Burnett JC. Is Cystatin C a Biomarker for Proatherogenic Factors and Early Renal Insufficiency in Human Coronary Artery Disease without Systolic Dysfunction? J Card Fail 2008. [DOI: 10.1016/j.cardfail.2008.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hodgson-Zingman DM, Karst ML, Zingman LV, Heublein DM, Darbar D, Herron KJ, Ballew JD, de Andrade M, Burnett JC, Olson TM. Atrial natriuretic peptide frameshift mutation in familial atrial fibrillation. N Engl J Med 2008; 359:158-65. [PMID: 18614783 PMCID: PMC2518320 DOI: 10.1056/nejmoa0706300] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atrial fibrillation is a common arrhythmia that is hereditary in a small subgroup of patients. In a family with 11 clinically affected members, we mapped an atrial fibrillation locus to chromosome 1p36-p35 and identified a heterozygous frameshift mutation in the gene encoding atrial natriuretic peptide. Circulating chimeric atrial natriuretic peptide (ANP) was detected in high concentration in subjects with the mutation, and shortened atrial action potentials were seen in an isolated heart model, creating a possible substrate for atrial fibrillation. This report implicates perturbation of the atrial natriuretic peptide-cyclic guanosine monophosphate (cGMP) pathway in cardiac electrical instability.
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Boerrigter G, Costello-Boerrigter LC, Abraham WT, Sutton MGSJ, Heublein DM, Kruger KM, Hill MRS, McCullough PA, Burnett JC. Cardiac resynchronization therapy improves renal function in human heart failure with reduced glomerular filtration rate. J Card Fail 2008; 14:539-46. [PMID: 18722318 DOI: 10.1016/j.cardfail.2008.03.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 03/06/2008] [Accepted: 03/27/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal dysfunction is an important independent prognostic factor in heart failure (HF). Cardiac resynchronization therapy (CRT) improves functional status and left ventricular (LV) function in HF patients with ventricular dyssynchrony, but the impact of CRT on renal function is less defined. We hypothesized that CRT would improve glomerular filtration rate as estimated by the abbreviated Modification of Diet in Renal Disease equation (eGFR). METHODS AND RESULTS The Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study evaluated CRT in HF patients with NYHA Class III-IV, ejection fraction <or=35%, and QRS >or=130 ms. Patients were evaluated before and 6 months after randomization to control (n = 225) or CRT (n = 228). Patients were categorized according to their baseline eGFR: >or=90 (category A), 60 <or=eGFR <90 (category B), and 30 <or=eGFR <60 (category C) mL/min per 1.73 m(2). CRT improved LV function in all categories. Compared with control, CRT increased eGFR (-2.4 +/- 1.2 vs. +2.7 +/- 1.2 mL/min per 1.73 m(2); P = .003) and reduced blood urea nitrogen (+6.4 +/- 2.4 vs. -1.1 +/- 1.5 mg/mL; P = .008) in category C, whereas no differences were observed in categories A and B. CONCLUSIONS CRT increased eGFR and reduced blood urea nitrogen in HF patients with moderately reduced baseline eGFR. By improving cardiac function, CRT can indirectly improve renal function, underscoring the importance of cardiorenal interaction and providing another mechanism for the beneficial effects of CRT.
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Affiliation(s)
- Guido Boerrigter
- Cardiorenal Research Laboratory, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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41
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Martin FL, Huntley BK, Harders GE, Sandberg SM, Heublein DM, Burnett JC. Heart – Kidney Connection: Myocardial Infarction Induces Widespread Changes in Renal Cortical and Medullary Gene Expression together with Cortical and Medullary Fibrosis. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.970.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chen HH, Sundt TM, Cook DJ, Heublein DM, Burnett JC. Low dose nesiritide and the preservation of renal function in patients with renal dysfunction undergoing cardiopulmonary-bypass surgery: a double-blind placebo-controlled pilot study. Circulation 2007; 116:I134-8. [PMID: 17846293 DOI: 10.1161/circulationaha.106.697250] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Renal insufficiency is associated with increased morbidity and mortality after cardiopulmonary bypass cardiac surgery. B-type natriuretic peptide is a cardiac hormone that enhances glomerular filtration rate and inhibits aldosterone. Cystatin has been shown to be a better endogenous marker of renal function than creatinine. METHODS AND RESULTS We performed a double-blinded placebo-controlled proof of concept pilot study in patients (n=40) with renal insufficiency preoperatively (defined as an estimated creatinine clearance of <60 mL/min determined by the Cockroft-Gault formula), undergoing cardiopulmonary bypass cardiac surgery. Patients were randomized to placebo (n=20) or i.v. low dose nesiritide (n=20; 0.005 microg/Kg/min) for 24 hours started after the induction of anesthesia and before cardiopulmonary bypass. Patients in the nesiritide group had an increase of plasma B-type natriuretic peptide and its second messenger cGMP with a decrease in plasma cystatin levels at the end of the 24-hour infusion. These changes were not observed in the placebo group. There was a significant activation of aldosterone in the placebo group at the end of the 24-hour infusion, but not in the nesiritide group. At 48 and 72 hours, there was a decrease in estimated creatinine clearance and an increase in plasma cystatin as compared with end of the 24-hour infusion in the placebo group. In contrast, renal function was preserved in the nesiritide group with no significant change in estimated creatinine clearance and a trend for plasma cystatin to increase as compared with end of the 24-hour infusion. CONCLUSION This proof of concept pilot study supports the conclusion that perioperative administration of low dose nesiritide is biologically active and decreases plasma cystatin in patients with renal insufficiency undergoing cardiopulmonary bypass cardiac surgery. Further studies are warranted to determine whether these physiological observations can be translated into improved clinical outcomes.
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Affiliation(s)
- Horng H Chen
- Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA.
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43
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Boerrigter G, Costello-Boerrigter LC, Abraham WT, St. John-Sutton MG, Heublein DM, Kruger KM, Hill MR, McCullough PA, Burnett JC. Cardiac Resynchronization Therapy Improves Renal Function in Heart Failure Patients with Reduced Glomerular Filtration Rate. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Heublein DM, Huntley BK, Boerrigter G, Cataliotti A, Sandberg SM, Redfield MM, Burnett JC. Immunoreactivity and guanosine 3',5'-cyclic monophosphate activating actions of various molecular forms of human B-type natriuretic peptide. Hypertension 2007; 49:1114-9. [PMID: 17372040 DOI: 10.1161/hypertensionaha.106.081083] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies support the speculation that different molecular forms of the cardiac hormone BNP with differential biological activity may circulate in heart failure and be detected by conventional assays. In the current study we determined the ability of 3 widely used conventional assays to detect these different forms thought to circulate in heart failure. We also evaluated the ability of pro-BNP (1-108), N-terminal peptide (NT)-pro-BNP (1-76), and BNP 3-32, the latter a cleavage product of BNP 1-32 by dipeptidyl peptidase IV, on an equimolar basis to activate cGMP in cultured cardiac fibroblasts and cardiomyocytes compared with the biologically active mature BNP 1-32. Specifically, we observed that the Roche NT-pro-BNP assay detected both NT-pro-BNP 1-76 and pro-BNP 1-108 and that Biosite Triage and Shionogi detected both mature BNP 1-32 and the shortened BNP 3-32. Moreover, in cultured cardiac fibroblasts and cardiomyocytes, BNP 1-32 (10(-6) mol/L) activated cGMP. BNP 3-32 demonstrated a similar cGMP activating property in both cardiac cell types. In contrast, the cGMP response to pro-BNP 1-108 and NT-pro-BNP 1-76 was not significantly greater than no treatment alone. We conclude that widely used commercial assays for NT-pro-BNP 1-76 and BNP 1-32 cannot differentiate among pro-, processed, or degraded forms and, thus, may not thoroughly identify circulating BNP forms in heart failure patients. These findings also demonstrate differential cGMP activating properties of BNP forms and, importantly, that pro-BNP 1-108 and NT-pro-BNP 1-76 have reduced cGMP activity in vitro that may have biological relevance to human heart failure.
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Affiliation(s)
- Denise M Heublein
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Heublein DM, Huntley BK, Boerrigter G, Cataliotti A, Sandberg SM, Redfield MM, Burnett JC. Differential Biological Actions and Assay Detection of Altered Forms of BNP In Vitro. J Card Fail 2006. [DOI: 10.1016/j.cardfail.2006.06.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cataliotti A, Heublein DM, James KD, Burnett JC. Biological Actions of a Novel Oral Human BNP in an Experimental Model of Acute Hypertension. J Card Fail 2006. [DOI: 10.1016/j.cardfail.2006.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Belluardo P, Cataliotti A, Bonaiuto L, Giuffrè E, Maugeri E, Noto P, Orlando G, Raspa G, Piazza B, Babuin L, Chen HH, Martin FL, McKie PM, Heublein DM, Burnett JC, Malatino LS. Lack of activation of molecular forms of the BNP system in human grade 1 hypertension and relationship to cardiac hypertrophy. Am J Physiol Heart Circ Physiol 2006; 291:H1529-35. [PMID: 16648193 DOI: 10.1152/ajpheart.00107.2006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We evaluated relationships among two circulating molecular forms of brain natriuretic peptide (BNP32 and NT-proBNP), severity of hypertension (HTN), and cardiac hypertrophy in subjects with mild, moderate, and severe HTN. We prospectively studied 78 patients (43 males; mean age 51.4 +/- 11 yr) with essential HTN and 28 age- and sex-matched controls. BNP32 and NT-proBNP were measured by radioimmunoassay. In grade 1 HTN, BNP32 was not elevated and NT-proBNP was reduced (P = 0.030) compared with controls. However, log-transformed values of BNP32 and NT-proBNP were both increased with severity of HTN from grade 1 to 3 (P <0.0001 and P = 0.003, respectively). By multivariate analysis, log BNP32 was independently predicted by age (beta = 0.210, P = 0.026) and HTN grade (beta = 0.274, P = 0.004), whereas log NT-proBNP was independently predicted by sex (beta = 0.235, P = 0.012) and HTN grade (beta = 0.218, P = 0.0023). Two forms of BNP were measured in normal subjects and patients with essential HTN. In grade 1 HTN, BNP32 was unchanged and NT-proBNP was significantly reduced compared with controls. As severity increased in humans with grade 1 to 3 HTN, both BNP32 and NT-proBNP levels were increased while not being affected by the presence of left ventricular hypertrophy. The lack of activation of BNP32 together with the reduction of NT-proBNP in grade 1 HTN may represent an impaired response of the BNP system in the early phase of HTN. The later activation of both forms of BNP may be a late compensatory effect, because it correlates with severity of HTN rather than cardiac hypertrophy/remodeling.
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Affiliation(s)
- Paola Belluardo
- Cardiorenal Research Laboratory, 200 First St., SW, Rochester, MN 55905, USA.
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48
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Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW, Jacobsen SJ, Heublein DM, Burnett JC. Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. J Am Coll Cardiol 2006; 47:345-53. [PMID: 16412859 PMCID: PMC2647136 DOI: 10.1016/j.jacc.2005.09.025] [Citation(s) in RCA: 288] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 08/26/2005] [Accepted: 09/08/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to characterize factors influencing amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and to evaluate the ability of NT-proBNP to detect left ventricular (LV) dysfunction in a large community sample. BACKGROUND Secretion of BNP increases in cardiac disease, making BNP an attractive biomarker. Amino-terminal proBNP, a fragment of the BNP prohormone, is a new biomarker. We evaluated factors influencing NT-proBNP in normal patients and compared the ability of NT-proBNP and BNP to detect LV dysfunction in a large community sample. METHODS Amino-terminal pro-BNP was determined in plasma samples of a previously reported and clinically and echocardiographically characterized random sample (n = 1,869, age > or =45 years) of Olmsted County, Minnesota. RESULTS In normal patients (n = 746), female gender and older age were the strongest independent predictors of higher NT-proBNP. Test characteristics for detecting an LV ejection fraction < or =40% or < or =50% were determined in the total sample with receiver operating characteristic curves. Amino-terminal pro-BNP had significantly higher areas under the curve for detecting an LV ejection fraction < or =40% or < or =50% than BNP in the total population and in several male and age subgroups, whereas areas were equivalent in female subgroups. Age- and gender-adjusted cutpoints improved test characteristics of NT-proBNP. Both assays detected patients with systolic and/or moderate to severe diastolic dysfunction to a similar degree, which was less robust than the detection of LV systolic dysfunction alone. CONCLUSIONS Amino-terminal pro-BNP in normal patients is affected primarily by gender and age, which should be considered when interpreting values. Importantly, in the entire population sample NT-proBNP performed at least equivalently to BNP in detecting LV dysfunction and was superior in some subgroups in detecting LV systolic dysfunction.
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Affiliation(s)
- Lisa C Costello-Boerrigter
- Cardiorenal Research Laboratory, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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49
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Hawkridge AM, Heublein DM, Bergen HR, Cataliotti A, Burnett JC, Muddiman DC. Quantitative mass spectral evidence for the absence of circulating brain natriuretic peptide (BNP-32) in severe human heart failure. Proc Natl Acad Sci U S A 2005; 102:17442-7. [PMID: 16293687 PMCID: PMC1297688 DOI: 10.1073/pnas.0508782102] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2005] [Indexed: 11/18/2022] Open
Abstract
C-terminal brain (B-type) natriuretic peptide (BNP)-32 is a widely used clinical biomarker for the diagnosis, prognosis, and treatment of heart failure (HF). The 32-aa peptide is synthesized primarily in the atrial and ventricular myocardium and constitutes the mature biologically active form of immature BNP (pro-BNP). There has been mounting evidence that suggests BNP circulates in different structural forms that impact HF diagnosis and in vivo activity. Herein, we have developed and used an immunoaffinity purification assay to isolate endogenous BNP-32 from New York Heart Association class IV patient plasma for subsequent analysis by nano-liquid chromatography (LC) electrospray ionization Fourier transform ion cyclotron resonance (FT-ICR) MS. We have introduced stable isotope-labeled BNP-32 to the assayed plasma to enable quantification of endogenous levels of BNP-32. Unlike the chemically nonspecific point-of-care tests (POCTs) and RIAs used worldwide to quantify BNP-32 from plasma, FT-ICR-MS (unprecedented mass measurement accuracy) coupled with LC (retention time) affords extraordinary molecular specificity, and when combined with the use of internal standards is able to confidently identify and quantify BNP-32. The significance of this work is despite exceedingly high circulating levels of BNP-32 in the New York Heart Association class IV patients as determined by POCTs (>290 fmol/ml) nano-LC-electrospray ionization-FT-ICR-MS data did not reveal any endogenous BNP-32. These results provide molecularly specific evidence for the absence of circulating BNP-32 in advanced-stage HF patients and suggest the existence of altered forms of BNP that are contributing to the POCT values.
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Affiliation(s)
- Adam M Hawkridge
- W. M. Keck FT-ICR Mass Spectrometry Laboratory and Mayo Proteomics Research Center, Division of Cardiovascular Diseases, Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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50
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Cataliotti A, Schirger JA, Martin FL, Chen HH, McKie PM, Boerrigter G, Costello-Boerrigter LC, Harty G, Heublein DM, Sandberg SM, James KD, Miller MA, Malkar NB, Polowy K, Burnett JC. Oral human brain natriuretic peptide activates cyclic guanosine 3',5'-monophosphate and decreases mean arterial pressure. Circulation 2005; 112:836-40. [PMID: 16061734 DOI: 10.1161/circulationaha.105.538520] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to address the feasibility and the biological activity of orally administered human brain natriuretic peptide (hBNP). Proprietary technology has been developed in which short, amphiphilic oligomers are covalently attached to peptides. The conjugated peptides are intended to have an improved pharmacokinetic profile and to enable oral administration. We hypothesized that novel oral conjugated hBNP (CONJ-hBNP) increases plasma hBNP, activates cGMP, and reduces mean arterial pressure (MAP). METHODS AND RESULTS This randomized crossover-designed study tested the biological activity of oral CONJ-hBNP compared with oral native hBNP in normal conscious dogs. Measurements of MAP, plasma hBNP, and cGMP were made at baseline (BL) and repeated at 10, 30, 60, 120, 180, and 240 minutes after oral administration. Plasma hBNP was not detectable in dogs at BL. Plasma hBNP was detected after native hBNP and CONJ-HBNP administration. However, plasma hBNP concentration was significantly higher after CONJ-hBNP than after native hBNP administration (P=0.0374 between groups). Plasma cGMP increased after CONJ-hBNP for 60 minutes (from 10.8+/-3 to 36.8+/-26 pmol/mL; P<0.05), whereas it did not change after native hBNP (P=0.001 between groups). MAP decreased at 10 minutes and remained decreased for 60 minutes after CONJ-hBNP (from 113+/-8 to 101+/-12 mm Hg after 10 minutes to 97.5+/-10 mm Hg after 30 minutes to 99+/-13 mm Hg after 60 minutes) while remaining unchanged after native hBNP (P=0.0387 between groups). CONCLUSIONS This study reports for the first time that novel conjugated oral BNP activates cGMP and significantly reduces MAP, thus implying an efficacious coupling of CONJ-hBNP to the natriuretic receptor-A. These data advance a new concept of orally administered chronic BNP therapy for cardiovascular diseases.
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Affiliation(s)
- Alessandro Cataliotti
- Department of Physiology and Internal Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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