ProBNP‐derived peptides in cardiac disease

Abstract

The natriuretic peptides constitute a family of structurally related peptides that regulate fluid homeostasis, vascular tonus and growth. After the discovery of an endocrine component of the heart almost 25 years ago, the cardiac natriuretic peptides have now been fully accepted as useful markers in diverse aspects of cardiology including as diagnostic, therapeutic and prognostic markers of cardiac disease. In humans, atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are mainly synthesized and secreted by the failing heart, whereas the related C-type natriuretic peptide (CNP) appears to be a local regulatory peptide secreted by the vascular endothelium. Accordingly, CNP is not a cardiac peptide. With the recent implementation of sensitive and specific immunoassays, increased plasma concentrations of proBNP-derived peptides have now been associated with several cardiac conditions, where the major application today seems related to ventricular dysfunction. Recently, focus has also turned to ischemic heart disease, since myocardial hypoxia increases the local BNP gene expression. This review recapitulates the established clinical applications of measuring proBNP-derived peptides in plasma. Furthermore, the evidence of increased cardiac BNP expression in ischemic heart disease will be emphasized. In turn, plasma measurement of proBNP-derived peptides may still hold new possibilities in screening for coronary artery disease.

During treatment protocol for univentricular heart serum levels of natriuretic peptides decrease☆☆☆

“…In healthy individuals, the main site of BNP gene expression is the atria, but in disease states, ventricular gene expression is up-regulated [20,21]. Ventricular wall stress stimulates synthesis and release of both atrial and brain natriuretic peptides, concentrations of which increase in heart failure [5,19]. Changes in wall stress may explain our differences in levels of natriuretic peptides during the treatment protocol in our study.…”

“…The natriuretic peptide system plays an important role in the regulation of diuresis and natriuresis, blood pressure and cardiomyocyte growth. This system functions to retard the progression of heart failure, the opposite of the effect of neurohumoral systems such as the renin-angiotensinaldosterone and the sympathetic nervous system [5,6].…”

Measurement of the pro-hormone of brain type natriuretic peptide (proBNP): methodological considerations and pathophysiological relevance

“…Recent studies reported that many B-type-related peptides circulate in human blood (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). In particular, large amounts of pro-hormone peptide (i.e., proBNP) can be detected in plasma of patients with HF (15-22, 25, 32).…”

Serum Levels of Natriuretic Peptides in Children before and after Treatment for an Atrial Septal Defect, a Patent Ductus Arteriosus, and a Coarctation of the Aorta—A Prospective Study

“…They have an important role in regulation of fluid homeostasis, blood pressure/vascular tone, and cardiomyocyte growth. This system functions to retard the progression of heart failure, opposite to the effect of neurohumoral systems like the renin-angiotensin-aldosterone system and the sympathetic nervous system [1, 2]. …”