Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure
Tóm tắt
Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels increase in patients with heart failure with the progression of clinical symptoms and with the deterioration of hemodynamics; consequently, assay methods for these peptides may be useful in the follow-up of cardiac patients. Non-competitive immunoradiometric assay (IRMA) methods for ANP or BNP do not generally require preliminary extraction and/or purification of the plasma sample, and so may be more suitable than competitive immunoradiometric assay (RIA) methods for the routinary assay of plasma peptide concentrations. We evaluated the analytical characteristics and clinical usefulness of two IRMAs for plasma ANP and BNP, to verify whether these methods may be considered suitable for the follow-up of patients with heart failure. Both methods are based on the solid-phase sandwich IRMA system, which uses two monoclonal antibodies prepared against two sterically remote epitopes of peptide molecule; the first antibody was coated on the beads solid-phase and the second was radiolabeled with 125I. Blood samples were collected from a brachial vein in ice-chilled disposable polypropylene tubes containing aprotinin and EDTA after the patient had rested for at least 20 min in the recumbent position. Plasma samples were immediately separated by centrifugation and stored at −20 C until assay. The IRMA methods showed a better sensitivity and a wider working range sensitivity (about 2 ng/l) than those of RIA methods. Moreover, the normal range found with these methods (ANP= 16.1±8.6 ng/l, 5.2±2.8 pmol/l, BNP= 8.6±8.2 ng/l, 2.5±2.4 pmol/l) was similar to that generally reported using the most accurate methods, such as the other IRMAs or RIAs, using a preliminary extraction and purification of plasma samples with chromatographic procedures. Our results obtained in patients with different degrees of heart failure indicate that plasma ANP and BNP increase with the progression of clinical symptoms (NYHA class) (ANOVA p<0.0001). Indeed, circulating levels of ANP (R=− 0.701, no.=86) and BNP (R=−0.745, no.=55) were significantly (p<0.0001) and negatively correlated with the left ventricular ejection fraction values. Furthermore, a close curvilinear regression (R= 0.960, no.= 215) was found between ANP and BNP values, because plasma BNP progressively increases more than plasma ANP in patients with different stages of heart failure. In conclusion, IRMA methods are preferable for the measurement of plasma ANP and BNP for experimental studies and routine assay because they are more practicable, sensitive and accurate than RIA procedures. Finally, BNP assay appears to be better than ANP for discriminating between normal subjects and patients with different degrees of heart failure.
Tài liệu tham khảo
De Bold A.J. Atrial natriuretic factor: A hormone produced by the heart. Science 230: 161, 1985.
Ruskoaho H. Atrial natriuretic peptide: Synthesis, release, and metabolism. Pharmacol. Rev. 44: 479, 1992.
De Zeeuw D., Janssen W.M.T., De Jong P.E. Atrial natriuretic factor: its (patho)physiological significance in humans. Kidney Int. 41: 1115, 1992.
Espiner E.A Hormones of the cardiovascular system. In: Ed. 3. DeGroot L.J. (Ed.), Endocrinology. W.B. Saunders Company, USA, 1995, p. 2895.
Francis G.S., Benedict C., Johnstone D.E., Kirlin P.C., Nicklas J., Liang C., et al. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the studies of left ventricular dysfunction (SOLVD). Circulation 82: 1724, 1990.
Swedberg K., Eneroth P., Kjekshus J., Wilhelmsen L. Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. Circulation 82: 1730, 1990.
Clerico A., Iervasi G. Alterations in metabolic clearance of atrial natriuretic peptides in heart failure: How do they relate to the resistance to atrial natriuretic peptides? J. Cardiac Failure 1: 323, 1995.
Arakawa N., Nakamura M., Aoki H., Hiramori K. Plasma brain natriuretic peptide concentrations predict survival after acute myocardial infarction. Am. Coll. Cardiol. 27: 1656, 1996.
Omland T., Aakvaag A., Bonarjee V.V.S., Caidahl K., Terje Lie R., Nilsen D.W.T., Sundsfjord J.A., Dickstein K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and n-terminal proatrial natruretic peptide. Circulation 93: 1963, 1996.
Clerico A., Del Chicca M.G., Giganti M., Zucchelli G.C., Piffanelli A. Evaluation and comparison of the analytical performances of two RIA kits for the assay of atrial natriuretic peptides (ANP). J. Nucl. Med. All. Sci. 34: 81, 1990.
Clerico A., Opocher G., Pelizzola D., Panzali A.F., Andreone P., Del Chicca M.G., Giganti M., Zucchelli C.G., Mantero F., Albertini A., Piffanelli A. Evaluation of the analytical performance of RIA methods for measurement of Atrial Natriuretic Peptides (ANP): A multicentre study. J. Clin. Immunoassay 14: 251, 1991.
Clerico A., Iervasi G., Del Chicca M.G., Maffei S., Berti S., Sabatino L., Turchi S., Cazzuola F., Manfredi C., Biagini A. Analytical performance and clinical usefulness of a commercially available IRMA kit for the measurement of atrial natriuretic peptide in patients with heart failure. Clin. Chem. 42: 1627, 1996.
Gutkowska J., Genest J., Thibault G., Garcia R., Larochelle P., Cusson J.R., Kuchel O., Hamet P., De Léean A., Cantin M. Circulating forms and radioimmunoassay of atrial natriuretic factor. Endocrinol. Metab. Clin. North Am. 16: 183, 1987.
Yandle T.G., Espiner E.A., Nicholls M.G., Duff H. Radioimmunoassay and characterization of atrial natriuretic peptide in human plasma. J. Clin. Endocrinol. Metab. 63: 72, 1986.
Kato J., Kida O., Kita T., Nakamura S., Sasaki A., Kodama K., Tanaka K. Free and bound forms of atrial natriuretic peptide (ANP) in rat plasma: Preferential increase of free ANP in spontaneously hypertensive rats (SHR) and stroke-prone SHR (SHRSP). Biochem. Biophys. Res. Commun. 153: 1084, 1988.
Itoh H., Nakao K., Sugawara A., Saito Y., Mukoyama M., Morii N., Yamada T., Shiono S., Arai H., Hosoda K., Imura H. Atrial natriuretic polypeptide (gamma-ANP)-derived peptides in human plasma: Cosecretion of N-terminal gamma-ANP fragment and alpha-ANP. J. Clin. Endocrinol. Metab. 67; 429, 1988.
Gutkowska J., Bourassa M., Roy D., Thibault G., Garcia R., Cantin M., Genest J. Immunoreactive atrial natriuretic factor (IR-ANF) in human plasma. Biochem. Biophys. Res. Commun. 128: 1350, 1985.
Ohashi M., Fujio N., Nawata H., Kato K.I., Ibayashi H., Kangawa K., Matsuo H. High plasma concentrations of human atrial natriuretic polypeptide in aged men. J.Clin. Endocrinol. Metab. 64: 81, 1987.
Richards A.M., Tonolo G., McIntyre G.D., Leckie B.J., Robertson I. Radio-immunoassay for plasma alpha human atrial natriuretic peptide; a comparison of direct and pre-extracted method. J. Hypertens. 5: 227, 1987.
Polesi C., Rodella A., Mantero G., Cannella G., Ferrari R., Albertini A. Improved radioimmunoassay of atrial natriuretic peptide in plasma. Clin. Chem. 35: 1431, 1989.
Yandle T.G., Richards A.M., Gilbert A., Fisher S., Holmes S., Espiner E.A. Assay of brain natriuretic peptide (BNP) in human plasma: evidence for high molecular weight BNP as a major plasma component in heart failure. J. Clin. Endocrinol. Metab. 76: 832, 1993.
Davidson N.C., Naas A.A., Hanson J.K., Kennedy N.S.J., Coutie W.J., Struthers A.D. Comparison of atrial natriuretic peptide, B-type natriuretic peptide, and n-terminal proatrial natriuretic peptide as indicators of left ventricular systolic dysfunction. Am. J. Cardiol. 77: 828, 1996.
Lewis H.M., Ratcliffe W.A., Stott R.A.W., Wilkins M.R., Baylis P.H. Development and validation of a two-site immunoradiometric assay for human atrial natriuretic factor in unextracted plasma. Clin. Chem. 35: 953, 1989.
Tattersal J.E., Dawnay A., McLean C., Cattel W.R. Immunoradiometric assay of atrial natriuretic peptide in unextracted plasma. Clin. Chem. 36: 885, 1990.
Tsuji T., Masuda H., Imagawa K., Haraikawa M., Shibata K., Kono M., Inouye K., Uchida K. Stability of human atrial natriuretic peptide in blood samples. Clin. Chim. Acta 225: 171, 1994.
Kono M., Yamauchi A., Tsuji T., Misaka A., Igano K., Ueki K., Fusjishima M., Ueda A., Inouye K., Imura H. An immunoradiometric assay for brain natriuretic peptide in human plasma. Kaku Igaku 13: 2, 1993.
Iervasi G., Clerico A., Berti S., Pilo A., Vitek F., Biagini A., Baratto M.T., Bianchi R., Donato L. ANP kinetics in normal men: in vivo measurement by a tracer method and correlation with sodium intake. Am. J. Physiol. 264: F480, 1993.
Clerico A., Iervasi G., Berti S., Pilo A., Vitek F., Salvadori S., Marastoni M., Manfredi C., Del Chicca M.G., Iascone M.R., Biagini A. In vivo measurement of ANP overall turnover and identification of its main metabolic pathways under steady state conditions in humans. J. Endocrinol. Invest. 18: 194, 1995.
Iervasi G., Clerico A., Berti S., Pilo A., Biagini A., Bianchi R., Donato L. Altered tissue degradation and distribution of Atrial Natriuretic Peptide in patients with idiopathic dilated cardiomyopathy and its relationship with clinical severity of the disease and sodium handling. Circulation 91: 2018, 1995.
Pilo A., Zucchelli G.C., Malvano R., Masini S. Main features of computer algorithms for RIA data reduction. Comparison of some different approaches for the interpolation of dose-response curve. J. Nucl. Med. All. Sci. 26: 235, 1982.
Herbers J.E. Jr., Noel G.L. Diagnostic tests and clinical decisions. In: Moore W.T., Eastman E.C. (Eds.), Diagnostic Endocrinology, ed. 2. Mosby, St Louis, 1996, p. 1.
Clarkson P.M.B., Wheeldom N.M., MacFadyen R.J., Pringle S.D., MacDonald T.M. Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure. Circulation 93: 2037, 1966.
Yoshibayashi M., Saito Y., Nakao K. Brain natriuretic peptide versus atrial natriuretic peptide — physiological and pathophysiological significance in children and adults: A review. Eur. J. Endocrinol. 135: 265, 1966.
Omland T., Aakvaag A., Vik-Mo H. Plasma cardiac natriuretic peptide determination as a screening test for the detection of patients with mild left ventricular impairment. Heart 76: 232, 1996.
Struthers A.D. Plasma concentrations of brain natriuretic peptide: will this new test reduce the need for cardiac investigations? Br. Heart J. 70: 397, 1993.
Yamamoto K., Burnett J.C. Jr., Jougasaki M., Nishimura R.A., Bailey K.R., Saito Y., Nakao K., Redfield M.M. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hypertension 28: 988, 1996.
Cowie M.R., Struthers A.D., Wood D.A., Coats A.J.S., Thompson S.G., Poole-Wiulson P.A., Sutton G.C. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet 350: 1349, 1997.
Clerico A., Iervasi G. Immunoassay methods for the measurement of natriuretic cardiac hormones (ANP, BNP, and related peptides) in humans. Clinical Chemistry (in press).
Yoshimura M., Yashue H., Okumura K., Ogawa H., Jougasaki M., Mukoyama M., Nakao K., Imura H. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 87: 464, 1993.
Yasue H., Yoshimura M., Sumida H., Kikuta K., Kugiyama K., Jougasaki M., Ogawa H., Okumura K., Mukoyama M., Nakao K. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90: 195, 1994.
Hunt P.J., Espiner E.A, Nicholls M.G., Richards A.M., Yandle T.G. Differing biological effects of equimolar atrial and brain natriuretic peptide infusion in normal man. J. Clin. Endocrinol. Metab. 81: 3871, 1996.