Brain natriuretic peptide

Wikipedia open wikipedia design.

NPPB
Available structures
PDBHuman UniProt search: PDBe RCSB
Identifiers
AliasesNPPB, BNP, natriuretic peptide B, brain natriuretic peptide
External IDsOMIM: 600295 HomoloGene: 81698 GeneCards: NPPB
Gene location (Human)
Chromosome 1 (human)
Chr.Chromosome 1 (human)[1]
Chromosome 1 (human)
Genomic location for NPPB
Genomic location for NPPB
Band1p36.22Start11,857,464 bp[1]
End11,858,931 bp[1]
RNA expression pattern
PBB GE NPPB 206801 at fs.png
More reference expression data
Orthologs
SpeciesHumanMouse
Entrez
Ensembl
UniProt
RefSeq (mRNA)

NM_002521

n/a

RefSeq (protein)

NP_002512

n/a

Location (UCSC)Chr 1: 11.86 – 11.86 Mbn/a
PubMed search[2]n/a
Wikidata
View/Edit Human

Brain natriuretic peptide (BNP), also known as B-type natriuretic peptide, is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume. BNP is named as such because it was originally identified in extracts of pig brain.

The 32-amino acid polypeptide BNP is secreted attached to a 76–amino acid N-terminal fragment in the prohormone called NT-proBNP (BNPT), which is biologically inactive. Once released, BNP binds to and activates the atrial natriuretic factor receptor NPRA, and to a lesser extent NPRB, in a fashion similar to atrial natriuretic peptide (ANP) but with 10-fold lower affinity. The biological half-life of BNP, however, is twice as long as that of ANP, and that of NT-proBNP is even longer, making these peptides better targets than ANP for diagnostic blood testing.

The physiologic actions of BNP are similar to those of ANP and include decrease in systemic vascular resistance and central venous pressure as well as an increase in natriuresis. The net effect of these peptides is a decrease in blood pressure due to the decrease in systemic vascular resistance and, thus, afterload. Additionally, the actions of both BNP and ANP result in a decrease in cardiac output due to an overall decrease in central venous pressure and preload as a result of the reduction in blood volume that follows natriuresis and diuresis.[3]

Biosynthesis[edit]

BNP is synthesized as a 134-amino acid preprohormone (preproBNP), encoded by the human gene NPPB. Removal of the 25-residue N-terminal signal peptide generates the prohormone, proBNP, which is stored intracellularly as an O-linked glycoprotein; proBNP is subsequently cleaved between arginine-102 and serine-103 by a specific convertase (probably furin or corin) into NT-proBNP and the biologically active 32-amino acid polypeptide BNP-32, which are secreted into the blood in equimolar amounts.[4] Cleavage at other sites produces shorter BNP peptides with unknown biological activity.[5] Processing of proBNP may be regulated by O-glycosylation of residues near the cleavage sites.[6]

Physiologic effects[edit]

Since the actions of BNP are mediated via the ANP receptors, the physiologic effects of BNP are identical to those of ANP. Those will be reviewed here.

Receptor-agonist binding causes a reduction in renal sodium reabsorption, which results in a decreased blood volume. Secondary effects may be an improvement in cardiac ejection fraction and reduction of systemic blood pressure. Lipolysis is also increased.

Renal[edit]

Adrenal[edit]

  • Reduces aldosterone secretion by the zona glomerulosa of the adrenal cortex.

Vascular[edit]

Relaxes vascular smooth muscle in arterioles and venules by:

  • Membrane Receptor-mediated elevation of vascular smooth muscle cGMP
  • Inhibition of the effects of catecholamines

Promotes uterine spiral artery remodeling, which is important for preventing pregnancy-induced hypertension.[10]

Cardiac[edit]

  • Inhibits maladaptive cardiac hypertrophy
  • Mice lacking cardiac NPRA develop increased cardiac mass and severe fibrosis and die suddenly[11]
  • Re-expression of NPRA rescues the phenotype.

Adipose tissue[edit]

  • Increases the release of free fatty acids from adipose tissue. Plasma concentrations of glycerol and nonesterified fatty acids are increased by i.v. infusion of ANP in humans.
  • Activates adipocyte plasma membrane type A guanylyl cyclase receptors NPR-A
  • Increases intracellular cGMP levels that induce the phosphorylation of a hormone-sensitive lipase and perilipin A via the activation of a cGMP-dependent protein kinase-I (cGK-I)
  • Does not modulate cAMP production or PKA activity

Measurement[edit]

BNP and NT-proBNP are measured by immunoassay.[12]

Interpretation of BNP[edit]

  • The main clinical utility of either BNP or NT-proBNP is that a normal level helps to rule out chronic heart failure in the emergency setting. An elevated BNP or NT-proBNP should never be used exclusively to "rule in" acute or chronic heart failure in the emergency setting due to lack of specificity[dubious ].[13]
  • Either BNP or NT-proBNP can also be used for screening and prognosis of heart failure.[14]
  • BNP and NT-proBNP are also typically increased in patients with left ventricular dysfunction, with or without symptoms (BNP accurately reflects current ventricular status, as its half-life is 20 minutes, as opposed to 1–2 hours for NT-proBNP).[15]

A preoperative BNP can be predictive of a risk of an acute cardiac events during cardiac surgeries. A cutoff of 100 pg/ml has a sensitivity of approximately 100%, a negative predictive value of approximately 100%, a specificity of 90%, and a positive predictive value of 78% according to data from the United Kingdom.[16]

BNP is cleared by binding to natriuretic peptide receptors (NPRs) and neutral endopeptidase (NEP). Less than 5% of BNP is cleared renally. NT-proBNP is the inactive molecule resulting from cleavage of the prohormone Pro-BNP and is reliant solely on the kidney for excretion. The achilles heel of the NT-proBNP molecule is the overlap in kidney disease in the heart failure patient population.[17][18]

Low BNP was found to be a predictor of survival to age 90 in men.[19]

Some laboratories report in units ng per Litre (ng/L), which is equivalent to pg/mL

There is a diagnostic 'gray area', often defined as between 100 and 500 pg/mL, for which the test is considered inconclusive, but, in general, levels above 500 pg/ml are considered to be an indicator of heart failure. This so-called gray zone has been addressed in several studies, and using clinical history or other available simple tools can help make the diagnosis.[20][21]

BNP may be a reliable predictor of cardiovascular mortality in diabetics.[22]

BNP was found to have an important role in prognostication of heart surgery patients[23] and in the emergency department.[24] Bhalla et al. showed that combining BNP with other tools like ICG can improve early diagnosis of heart failure and advance prevention strategies.[25][26] Utility of BNP has also been explored in various settings like preeclampsia, ICU and shock and ESRD.[27][28][29]

The effect or race and gender on value of BNP and its utility in that context has been studied extensively.[30][31]

NT-proBNP levels (in pg/mL) by NYHA functional class [32]
NYHA I NYHA II NYHA III NYHA IV
5th Percentile 33 103 126 148
Mean 1015 1666 3029 3465
95th Percentile 3410 6567 10,449 12,188

The BNP test is used as an aid in the diagnosis and assessment of severity of heart failure. A recent meta-analysis concerning effects of BNP testing on clinical outcomes of patients presenting to the emergency department with acute dyspnea revealed that BNP testing led to a decrease in admission rates and decrease in mean length of stay, although neither was statistically significant. Effects on all cause hospital mortality was inconclusive.[33] The BNP test is also used for the risk stratification of patients with acute coronary syndromes.[34][35]

When interpreting an elevated BNP level, it is useful to remember that values may be elevated due to factors other than heart failure. Lower levels are often seen in obese patients.[36] Higher levels are seen in those with renal disease, in the absence of heart failure.

Therapeutic application[edit]

Recombinant BNP, nesiritide, has been suggested as a treatment for decompensated heart failure. However, a clinical trial[37] failed to show a benefit of nesiritide in patients with acute decompensated heart failure. Blockade of neprilysin, a protease known to degrade members of the natriuretic peptide family, has also been suggested as a possible treatment for heart failure. Dual administration of neprilysin inhibitors and angiotensin receptor blockers has been shown to be advantageous to ACE inhibitors, the current first-line therapy, in multiple settings.[38][39]

Synonyms[edit]

Other terms for BNP include B-type natriuretic peptide, ventricular natriuretic peptide and natriuretic peptide B')

See also[edit]

References[edit]

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  5. ^ Niederkofler EE, Kiernan UA, O'Rear J, Menon S, Saghir S, Protter AA, Nelson RW, Schellenberger U (November 2008). "Detection of endogenous B-type natriuretic peptide at very low concentrations in patients with heart failure". Circ Heart Fail. 1 (4): 258–64. doi:10.1161/CIRCHEARTFAILURE.108.790774. PMID 19808300.
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  8. ^ Reeves WB, Andreoli TE (2008). "Chapter 31 – Sodium Chloride Transport in the Loop of Henle, Distal Convoluted Tubule, and Collecting Duct". In Giebisch GH, Alpern RA, Herbert SC, Seldin DW. Seldin and Giebisch's the kidney: physiology and pathophysiology. Amsterdam: Elsevier/Academic Press. doi:10.1016/B978-012088488-9.50034-6. ISBN 0-12-088488-7.
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Further reading[edit]

  • Cosson S (2004). "Usefulness of B-type natriuretic peptide (BNP) as a screen for left ventricular abnormalities in diabetes mellitus". Diabetes Metab. 30 (4): 381–6. doi:10.1016/S1262-3636(07)70132-5. PMID 15525883.
  • Cauliez B, Berthe MC, Lavoinne A (2005). "[Brain natriuretic peptide: physiological, biological and clinical aspects]". Ann. Biol. Clin. Paris. 63 (1): 15–25. PMID 15689309.
  • Buchner S, Riegger G, Luchner A (2005). "[Clinical utility of the cardiac markers BNP and NT-proBNP]". Acta Med. Austriaca. 31 (4): 144–51. PMID 15732251.
  • LaPointe MC (2005). "Molecular regulation of the brain natriuretic peptide gene". Peptides. 26 (6): 944–56. doi:10.1016/j.peptides.2004.08.028. PMID 15911064.
  • Hoffmann U, Borggrefe M, Brueckmann M (2006). "New horizons: NT-proBNP for risk stratification of patients with shock in the intensive care unit". Critical care (London, England). 10 (2): 134. doi:10.1186/cc4883. PMC 1550883. PMID 16594987.
  • Suga S, Nakao K, Hosoda K, et al. (1992). "Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide". Endocrinology. 130 (1): 229–39. doi:10.1210/en.130.1.229. PMID 1309330.
  • Kambayashi Y, Nakao K, Mukoyama M, et al. (1990). "Isolation and sequence determination of human brain natriuretic peptide in human atrium". FEBS Lett. 259 (2): 341–5. doi:10.1016/0014-5793(90)80043-I. PMID 2136732.
  • Hino J, Tateyama H, Minamino N, et al. (1990). "Isolation and identification of human brain natriuretic peptides in cardiac atrium". Biochem. Biophys. Res. Commun. 167 (2): 693–700. doi:10.1016/0006-291X(90)92081-A. PMID 2138890.
  • Sudoh T, Maekawa K, Kojima M, et al. (1989). "Cloning and sequence analysis of cDNA encoding a precursor for human brain natriuretic peptide". Biochem. Biophys. Res. Commun. 159 (3): 1427–34. doi:10.1016/0006-291X(89)92269-9. PMID 2522777.
  • Seilhamer JJ, Arfsten A, Miller JA, et al. (1990). "Human and canine gene homologs of porcine brain natriuretic peptide". Biochem. Biophys. Res. Commun. 165 (2): 650–8. doi:10.1016/S0006-291X(89)80015-4. PMID 2597152.
  • Arden KC, Viars CS, Weiss S, et al. (1995). "Localization of the human B-type natriuretic peptide precursor (NPPB) gene to chromosome 1p36". Genomics. 26 (2): 385–9. doi:10.1016/0888-7543(95)80225-B. PMID 7601467.
  • Weir ML, Pang SC, Flynn TG (1993). "Characterization of binding sites in rat for A, B and C-type natriuretic peptides". Regul. Pept. 47 (3): 291–305. doi:10.1016/0167-0115(93)90396-P. PMID 7901875.
  • Totsune K, Takahashi K, Satoh F, et al. (1996). "Urinary immunoreactive brain natriuretic peptide in patients with renal disease". Regul. Pept. 63 (2–3): 141–7. doi:10.1016/0167-0115(96)00035-3. PMID 8837222.
  • Totsune K, Takahashi K, Murakami O, et al. (1996). "Immunoreactive brain natriuretic peptide in human adrenal glands and adrenal tumors". Eur. J. Endocrinol. 135 (3): 352–6. doi:10.1530/eje.0.1350352. PMID 8890728.
  • Matsuo K, Nishikimi T, Yutani C, et al. (1999). "Diagnostic value of plasma levels of brain natriuretic peptide in arrhythmogenic right ventricular dysplasia". Circulation. 98 (22): 2433–40. doi:10.1161/01.CIR.98.22.2433. PMID 9832489.
  • Wiese S, Breyer T, Dragu A, et al. (2001). "Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin II and diastolic fiber length". Circulation. 102 (25): 3074–9. doi:10.1161/01.CIR.102.25.3074. PMID 11120697.
  • Shimizu H, Masuta K, Aono K, et al. (2002). "Molecular forms of human brain natriuretic peptide in plasma". Clin. Chim. Acta. 316 (1–2): 129–35. doi:10.1016/S0009-8981(01)00745-8. PMID 11750283.
  • Ogawa K, Oida A, Sugimura H, et al. (2002). "Clinical significance of blood brain natriuretic peptide level measurement in the detection of heart disease in untreated outpatients: comparison of electrocardiography, chest radiography and echocardiography". Circ. J. 66 (2): 122–6. doi:10.1253/circj.66.122. PMID 11999635.
  • Asakawa H, Fukui T, Tokunaga K, Kawakami F (2002). "Plasma brain natriuretic peptide levels in normotensive Type 2 diabetic patients without cardiac disease and macroalbuminuria". J. Diabetes Complicat. 16 (3): 209–13. doi:10.1016/S1056-8727(01)00173-8. PMID 12015190.
  • Bordenave L, Georges A, Bareille R, et al. (2003). "Human bone marrow endothelial cells: a new identified source of B-type natriuretic peptide". Peptides. 23 (5): 935–40. doi:10.1016/S0196-9781(02)00004-9. PMID 12084525.

External links[edit]



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