title: Gene expression profiles and B-type natriuretic peptide elevation in heart transplantation: more than a hemodynamic marker.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) is chronically elevated in heart transplantation and reflects diastolic dysfunction, cardiac allograft vasculopathy, and poor late outcome. This investigation studied peripheral gene expression signatures of elevated BNP concentrations in clinically quiescent heart transplant recipients in an effort to elucidate molecular correlates beyond hemodynamic perturbations.
  
  
  RESULTS
  We performed gene microarray analysis in peripheral blood mononuclear cells of 28 heart transplant recipients with clinical quiescence (absence of dyspnea or fatigue; normal left ventricular ejection fraction [EF >55%]; ISHLT biopsy score 0 or 1A; and normal hemodynamics [RAP <7 mm Hg, PCWP < or = 15 mm Hg, and CI > or = 2.5 L/min per m2]). BNP levels were performed using the Triage B-type Natriuretic Peptide test (Biosite Diagnostics Inc, San Diego, Calif) and median BNP concentration was 165 pg/mL. Seventy-eight probes (of 7370) mapped to 54 unique genes were significantly correlated with BNP concentrations (P<0.001). Of these, the strongest correlated genes (P<0.0001) were in the domains of gelsolin (actin cytoskeleton), matrix metallopeptidases (collagen degradation), platelet function, and immune activity (human leukocyte antigen system, heat shock protein, mast cell, and B-cell lineage).
  
  
  CONCLUSIONS
  In the clinically quiescent heart transplant recipient, an elevated BNP concentration is associated with molecular patterns that point to ongoing active cardiac structural remodeling, vascular injury, inflammation, and alloimmune processes. Thus, these findings allude to the notion that BNP elevation is not merely a hemodynamic marker but should be considered reflective of integrated processes that determine the balance between active cardiac allograft injury and repair.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD 21201, USA. mmehra@medicine.umaryland.edu
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Uber
authors.forename: Dirk
authors.initials: D
authors.lastname: Walther
authors.forename: Mark
authors.initials: M
authors.lastname: Vesely
authors.forename: Jay G
authors.initials: JG
authors.lastname: Wohlgemuth
authors.forename: James
authors.initials: J
authors.lastname: Prentice
authors.forename: Darren
authors.initials: D
authors.lastname: Tayama
authors.forename: Margaret
authors.initials: M
authors.lastname: Billingham
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015331:Cohort Studies; D004699:Endocardium / Q000473:pathology; D005260:Female; D020869:Gene Expression Profiling; D006084:Graft Rejection / Q000097:blood / Q000235:genetics; D016027:Heart Transplantation / Q000276:immunology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood / Q000235:genetics; D020097:Natriuretic Peptide, Brain / Q000096:biosynthesis* / Q000097:blood / Q000235:genetics; D020411:Oligonucleotide Array Sequence Analysis; D011183:Postoperative Complications / Q000097:blood*; D020257:Ventricular Remodeling / Q000235:genetics / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain