Therapeutic hypothermia after cardiac arrest increases the plasma level of B-type natriuretic peptide

Abstract

Natriuretic peptides (NPs) regulate blood pressure and fluid homeostasis and exert various effects on the cardiovascular system. Recently, the relationship between NPs and the energy metabolism has been reported, and using a cell culture experiment system, we previously showed that NP activated brown cells in a low temperature environment while also suppressing a decrease in the cell temperature. However, few reports have described the secretion of NPs in cold environments, and there have been almost no studies of B-type natriuretic peptide (BNP) in humans. We investigated how NPs respond to cold environments in 21 patients who underwent therapeutic hypothermia (TH) after cardiac arrest. The plasma BNP levels were significantly increased (more than fivefold) during TH (logarithmically from 1.98 ± 0.79 to 2.63 ± 0.59, P < 0.01). During TH, diastolic pulmonary artery pressure (PAP) significantly decreased, and there were no significant changes in the stroke volume index (SVI). This increase of BNP was not associated with any hemodynamic changes. In contrast to our findings for BNP, the change in A-type NP (ANP) was quite small. We detected a significant increase in the plasma BNP levels during TH, unrelated to hemodynamics. This elevation of BNP levels seems to be potential influenced by hypothermia.

Treatment With Atrial Natriuretic Peptide Induces Adipose Tissue Browning and Exerts Thermogenic Actions in Vivo.

“…We found that circulating NPs levels are elevated during cold exposure, which is consistent with the ndings of previous studies, including our own [6,7,10]. Several possible mechanisms have been proposed.…”

“…In addition, our clinical study using the cardiac catheter database showed that an impaired cardiac function is associated with a decrease in body temperature, whereas plasma BNP elevation is associated with an increase in body temperature, suggesting the adaptive heat-retaining property of NP when the body temperature falls owing to unfavorable hemodynamic conditions [4]. Conversely, it has also been reported in both experimental [6,7] and clinical [10] studies that cold exposure induces the elevation of NP levels, which supports the idea that NPs induce the activation of the adipose tissue thermogenic program in response to cold stimuli as a compensatory mechanism [5,14]. A series of these studies indicated that NPs play a central role in "myocardial-adipose crosstalk".…”

“…A-type natriuretic peptide (ANP) as well as B-type natriuretic peptide (BNP), which are hormones produced in the heart, regulate blood pressure and uid homeostasis through vasodilatory and diuretic actions, and improve cardiac remodeling [1][2][3][4]. In addition to these classical actions of hemodynamic regulation on the renal and cardiovascular systems, growing evidence suggests that natriuretic peptides (NPs) also regulate the energy balance and glucose homeostasis as well as thermogenesis through interorgan metabolic crosstalk with adipose tissues, in which NP receptors (NPR-A) are expressed [4][5][6][7][8][9][10][11][12].…”

Close Linkage Between Natriuretic Peptides and Obesity ― Impact of Sex on the Interorgan Metabolic Crosstalk ―

“…8,9 In addition to the classical actions of hemodynamic regulation, growing evidence suggests that NPs also regulate energy balance and glucose homeostasis as well as thermogenesis through interorgan metabolic crosstalk with adipose tissue, in which NP receptors are expressed (Figure). [8][9][10][11][12][13] Recent studies have shown that NPs stimulate triglyceride lipolysis and promote the uncoupling of mitochondrial respiration through induction of adipose tissue browning, which results in improved insulin resistance as well as activation of the thermogenic program. 10-12, 14 In fact, we recently reported that an increase in BNP level improves insulin resistance and promotes glucose utilization, particularly in patients with acute coronary syndrome, in which glucose is the preferred substrate for energy metabolism.…”

Close linkage between blood total ketone body levels and B-type natriuretic peptide levels in patients with cardiovascular disorders

“…However, it is currently believed that NPs have a variety of other effects. Recently, many researchers have focused on the relationship between NPs and energy metabolism 16 – 18 , and we reported several investigations about this relationship 19 – 23 . However, in patients with cardiovascular disorders, the direct relationship between NPs and ketone bodies has not been fully elucidated.…”