Brain natriuretic peptide
| Natriuretic peptide precursor B | |||||||||||
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| Symbols | NPPB ; BNP | ||||||||||
| External IDs | Template:OMIM5 HomoloGene: 81698 | ||||||||||
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| Template:GNF Ortholog box | |||||||||||
| Species | Human | Mouse | |||||||||
| Entrez | n/a | n/a | |||||||||
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| RefSeq (mRNA) | n/a | n/a | |||||||||
| RefSeq (protein) | n/a | n/a | |||||||||
| Location (UCSC) | n/a | n/a | |||||||||
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Synonyms and Key Words: BNP, B-type natriuretic peptide or GC-B.
Overview
Brain natriuretic peptide (also known as B-type natriuretic peptide or "GC-B") is a 32 amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of myocytes (heart muscles cells) in the ventricles. At the time of release, a co-secreted 76 amino acid N-terminal fragment (NT-proBNP) is also released with BNP. BNP binds to and activates NPRA in a similar fashion 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. Both ANP and BNP have limited ability to bind and activate NPRB.
Brain natriuretic peptide was originally identified in extracts of porcine brain, but in humans it is produced mainly in the cardiac ventricles.
Physiologic actions of BNP and ANP include decrease in systemic vascular resistance and central venous pressure as well as an increase in natriuresis. Thus, the resulting effect of these peptides is a increase in cardiac output and a decrease in blood volume.
Clinical significance
Tests showing raised levels of BNP or NT-proBNP in the blood are used as a diagnosis of heart failure and may be useful to establish prognosis in heart failure, as both markers are typically higher in patients with worse outcome.[1]
Both BNP and NT-proBNP have been approved as a marker for acute congestive heart failure (CHF). The plasma concentrations of both BNP are increased in patients with asymptomatic and symptomatic left ventricular dysfunction.
There is no level of BNP that perfectly separates patients with and without heart failure [2]:
BNP < 100 pg per milliliter
- sensitivity = 90%
- specificity = 76%
BNP < 50 pg per milliliter
- sensitivity = 97%
- specificity = 62%
For patients with CHF, values will generally be above 100 pg per milliliter; however, a more conservative interpretation of the BNP is that normal values are less than 50 pg per milliliter in order to achieve adequate sensitivity. There is a diagnostic 'gray area', often defined as between 100 and 500, for which the test is considered inconclusive. Values above 500 are generally considered to be positive.
BNP can also be elevated in renal failure (as BNP is excreted renally) and it can be decreased in obesity.
BNP is also marketed as nesiritide for the treatment of acute decompensated congestive heart failure [3].
References
- ↑ Bhatia V, Nayyar P, Dhindsa S (2003). "Brain natriuretic peptide in diagnosis and treatment of heart failure". J Postgrad Med. 49 (2): 182–5. PMID 12867703. Full text.
- ↑ Maisel A, Krishnaswamy P, Nowak R, McCord J, Hollander J, Duc P, Omland T, Storrow A, Abraham W, Wu A, Clopton P, Steg P, Westheim A, Knudsen C, Perez A, Kazanegra R, Herrmann H, McCullough P (2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". N Engl J Med. 347 (3): 161–7. doi:10.1056/NEJMoa020233. PMID 12124404.
- ↑ Bibbins-Domingo K, Gupta R, Na B, Wu A H B, Schiller N B, Whooley M A (2007). "N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP), Cardiovascular Events, and Mortality in Patients With Stable Coronary Heart Disease". 297 (2): 169–176. PMID 17213400. Unknown parameter
|jornal=ignored (help) JAMA Abstract.
Further reading
- 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. PMID 12084525.
External links
- Brain+Natriuretic+Peptide at the US National Library of Medicine Medical Subject Headings (MeSH)