Left ventricular assist device support reverses altered cardiac expression and function of natriuretic peptides and receptors in end-stage heart failure.
OBJECTIVE
Atrial (ANP) and B-type natriuretics peptides (BNP) via their guanylyl cyclase-A (GC-A) receptor not only regulate arterial blood pressure and volume but also exert local antihypertrophic, antifibrotic and lusitropic effects in the heart. To elucidate whether cardiac hypertrophy/insufficiency and reversal is associated with changes in the local responsiveness to NPs, we compared the mRNA expression of ANP, BNP and receptors and the responsiveness of GC-A to ANP in left ventricular tissue obtained from 10 patients with congestive heart failure (CHF) before and after hemodynamic unloading by left ventricular assist device (LVAD) support.


RESULTS
Quantitative "real time" RT-PCR demonstrated that the mRNA expression levels of ANP, BNP and the NP-metabolizing NPR-C receptor were both markedly increased in human failing hearts. GC-A mRNA expression levels were not different from nonfailing hearts, but cGMP production by GC-A in response to ANP was nearly abolished. Reversal of cardiomyocyte hypertrophy during LVAD support was accompanied by normalization of ANP, BNP and NPR-C mRNA levels and a significant recovery of GC-A responsiveness to ANP.


CONCLUSIONS
In CHF patients, increased local clearance by NPR-C receptors and diminished responsiveness of cardiac GC-A might impair the local antihypertrophic effects of natriuretic peptides and contribute to the progression of cardiac hypertrophy and insufficiency. Reverse remodeling during LVAD support reverses these changes and can thereby recuperate the local protective effects of ANP and BNP.
Institute of Pharmacology and Toxicology and Interdisciplinary Center for Clinical Research, Universitätsklinikum Münster, Domagkstrasse 12, D-48129 Münster, Germany. mkuhn@uni-muenster.de
Michaela
M
Kuhn
Melanie
M
Voss
Danuta
D
Mitko
Jörg
J
Stypmann
Christof
C
Schmid
Naomasa
N
Kawaguchi
Florian
F
Grabellus
Hideo A
HA
Baba
D000293:Adolescent; D000328:Adult; D009320:Atrial Natriuretic Factor / Q000235:genetics; D048429:Cell Size; D006162:Guanylate Cyclase / Q000378:metabolism; D006333:Heart Failure / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D032383:Myocytes, Cardiac / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000235:genetics; D045265:Natriuretic Peptides / Q000235:genetics / Q000378:metabolism*; D012333:RNA, Messenger / Q000032:analysis; D017461:Receptors, Atrial Natriuretic Factor / Q000235:genetics / Q000378:metabolism*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D020257:Ventricular Remodeling
D045265:Natriuretic Peptides; D012333:RNA, Messenger; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D006162:Guanylate Cyclase; D017461:Receptors, Atrial Natriuretic Factor; C073616:atrial natriuretic factor receptor C