Biochemistry of Pro-B-Type Natriuretic Peptide-Derived Peptides: The Endocrine Heart Revisited

Abstract

Background: Since the discovery of cardiac hormones almost 25 years ago, a vast amount of clinical research has identified the cardiac natriuretic peptides and their precursors as markers of heart failure. It even seems likely that the pro-B-type natriuretic peptide (proBNP)-derived peptides in plasma may become the most frequently measured peptides in the daily diagnosis and control of therapy. In contrast, the biochemistry of the peptides has received less attention. Methods: Published data available on the National Library of Medicine (NLM) were used as the basis for the review. Outcome: This review shows that the present understanding of the biochemistry of peptides is far from complete. In particular, cellular synthesis, including posttranslational precursor maturation, is poorly understood. Moreover, elimination of the precursor fragments is unknown. Elucidation of the molecular heterogeneity of proBNP products will therefore contribute to the understanding of the endocrine heart and may also have important diagnostic consequences. Above all, the different proBNP-derived peptides may not always be equal markers of the same pathophysiologic processes. A different metabolism and peripheral elimination may also impose new and peptide-specific limitations for diagnostic use. Conclusions: It is necessary to focus more on the biology of the proBNP-derived peptides. In turn, new insight into the biochemistry could pave the way for more sensitive and disease-specific assays in the clinical setting.

Effect of Plasma Protein Depletion on BNP-32 Recovery

“…BNP has emerged as a very important biomarker for the clinical diagnosis and management of heart failure (3 ). Despite the increasing clinical use of BNP, very little is known about the secretion, posttranslational processing, and receptor binding of BNP at the molecular level (4 ). This gap in knowledge between the diagnostic and prognostic utility of BNP and the basic understanding of the molecular form(s) and function(s) of BNP is presently hindering the advancement of heart failure research.…”

B‐Type Natriuretic Peptide: Application in the Community

“…9 The influence of renal function on NTproBNP is more significant, given its greater dependence on renal clearance, but the usefulness of this assay in renal dysfunction persists as demonstrated by data from the Pro-BNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. 10,11 Influence of Obesity of Natriuretic Peptide Levels. Patients with particularly high body mass index values (>35 kg/ m 2 ) may demonstrate lower than anticipated values of natriuretic peptides.…”

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

“…17 BNP binds to the natriuretic peptide receptor type A causing increased intracellular guanosine monophosphate production. 18,19 The biological effects of BNP include diuresis, vasodilatation, inhibition of renin and aldosterone production and of cardiac and vascular myocyte growth. Whether NT-proBNP has any biological effect on its own is currently unknown.…”