title: Novel protein therapeutics for systolic heart failure: chronic subcutaneous B-type natriuretic peptide.
abstract: OBJECTIVE
  The purpose of the present study was to translate our laboratory investigations to establish safety and efficacy of 8 weeks of chronic SC B-type natriuretic peptide (BNP) administration in human Stage C heart failure (HF).
  
  
  BACKGROUND
  B-Type natriuretic peptide is a cardiac hormone with vasodilating, natriuretic, renin-angiotensin inhibiting, and lusitropic properties. We have previously demonstrated that chronic cardiac hormone replacement with subcutaneous (SC) administration of BNP in experimental HF resulted in improved cardiovascular function.
  
  
  METHODS
  We performed a randomized double-blind placebo-controlled proof of concept study comparing 8 weeks of SC BNP (10 μg/kg bid) (n = 20) with placebo (n = 20) in patients with ejection fraction <35% and New York Heart Association functional class II to III HF. Primary outcomes were left ventricular (LV) volumes and LV mass determined by cardiac magnetic resonance imaging. Secondary outcomes include LV filling pressure by Doppler echo, humoral function, and renal function.
  
  
  RESULTS
  Eight weeks of chronic SC BNP resulted in a greater reduction of LV systolic and diastolic volume index and LV mass index as compared with placebo. There was a significantly greater improvement of Minnesota Living with Heart Failure score, LV filling pressure as demonstrated by the reductions of E/e' ratio, and decrease in left atrial volume index as compared with placebo. Glomerular filtration rate was preserved with SC BNP, as was the ability to activate plasma 3',5'-cyclic guanosine monophosphate (p < 0.05 vs. placebo).
  
  
  CONCLUSIONS
  In this pilot proof of concept study, chronic protein therapy with SC BNP improved LV remodeling, LV filling pressure, and Minnesota Living with Heart Failure score in patients with stable systolic HF on optimal therapy. Renin-angiotensin was suppressed, and glomerular filtration rate was preserved. Subcutaneous BNP represents a novel, safe, and efficacious protein therapeutic strategy in human HF. Further studies are warranted to determine whether these physiologic observations can be translated into improved clinical outcomes and ultimately delay the progression of HF. (Cardiac Hormone Replacement With BNP in Heart Failure: A Novel Therapeutic Strategy; NCT00252187).
authors.affiliation: Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. chen.horng@mayo.edu
authors.forename: Horng H
authors.initials: HH
authors.lastname: Chen
authors.forename: James F
authors.initials: JF
authors.lastname: Glockner
authors.forename: John A
authors.initials: JA
authors.lastname: Schirger
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cataliotti
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: John C
authors.initials: JC
authors.lastname: Burnett
mesh_terms: D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage* / Q000627:therapeutic use; D010865:Pilot Projects; D020257:Ventricular Remodeling / Q000187:drug effects / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain