Abstract Natriuretic peptides have emerged as important candidates for the development of diagnostic tools in cardiovascular disease. Their increased concentrations have been found to be useful for ruling out disease of cardiac origin, as prognostic indicators, and in the follow-up of patients with heart failure. In order for natriuretic peptides to be efficient biomarkers, analytical problems in assay specificity and calibration need to be resolved. The aim of the present study was to elucidate circulating molecular components of N-terminal fragments of A- and B-type natriuretic peptides (NT-proANP and NT-proBNP) in human blood, and to develop reliable and novel assays for their measurement with clinical application. Reliable immunoassays for NT-proANP and NT-proBNP were set up based on recombinant calibrators and antisera against different epitopes. A novel immunoassay for detecting the activation of A- and/or B-type natriuretic peptide systems, referred to as NT-proXNP, was also developed. The chromatographic results of human plasma and serum samples indicated that NT-proANP and especially NT-proBNP are heterogeneous in human circulation. They are truncated at both termini, causing a serious risk of preanalytical errors. Further studies with recombinant peptides confirmed that the central parts of NT-proANP and NT-proBNP are stable in plasma and serum even at harsh storage conditions. Thus the most reliable assays are directed at the central portions of the molecule only. All developed assays were applicable to clinical samples of cardiac patients. NT-proXNP showed a diagnostic efficiency equal to or slightly better compared to individual NT-proANP and NT-proBNP assays. Furthermore, the prognostic value of NT-proANP and NT-proBNP was investigated in a population-based sample of men. Both peptides were strong predictors of mortality and its co-morbidities, adding to the prognostic value of conventional risk factors.

Philosophiae Doctor - PhD / Plant natriuretic peptides (PNPs) are a novel class of extracellular, systemically mobile molecules that elicit a number of plant responses important in homeostasis and growth. Natriuretic peptides were first identified in vertebrates where they play a role in the regulation of salt and water balance. Subsequent experimental investigations have identified the presence of a natriuretic peptide hormone system in plants. While PNPs have been implicated in various physiological responses such as stomatal guard cell movements and regulation of net water uptake, its biological role has remained elusive. Here we have used co-expression and promoter content analysis tools to understand the biological role of the Arabidopsis thaliana PNP (AtPNP-A). The analysis of AtPNP-A and its co-expressed genes revealed that genes annotated as part of the systemic acquired resistance (SAR) pathway were over-represented, thus suggesting that AtPNP-A may function as a component of plant defense responses and specifically, SAR. The results further show that AtPNP-A shares many characteristics with pathogenesis related (PR) proteins in that its transcription is strongly induced in response to pathogen challenges, thus implying a newly described role for AtPNP-A in pathogen attack. Additional tissue expression analysis also indicated distinct localization of PNP activity in sepals and transcriptional meta-analysis showed that AtPNP-A may play a role in starch breakdown. Therefore, together with the finding that AtPNP-A plays a role in regulating phloem transport, we also hypothesize that AtPNP-A may play a role in phloem unloading in sepals to assist processes such as seed formation in plants. In plants, the second messenger, guanosine 3’,5’-cyclic monophosphate (cGMP) mediates a whole range of important processes including salinity tolerance, disease resistance, drought tolerance and responses to light. Since PNPs regulate water and salt homeostasis via a cGMP-dependent signaling pathways, it is thus important to analyse the transcriptome induced by the second messenger (cGMP) in Arabidopsis thaliana to give a better understanding of its mechanism of action. This study was also supplemented by the analysis of the gibberellic acid (GA) dependent transcriptome, since cGMP also plays a role its transcription pathway. This data analysis, together with promoter content investigation, revealed that genes upregulated after cGMP treatment and down-regulated in the GA insensitive mutant (ga1-3) were enriched with a GA response element (GARE), while no GARE enrichment were observed in genes up-regulated in the ga1-3 mutant. These findings suggest that GARE is indicative of GA-induced and cGMP-dependent transcriptional up-regulation. Gene ontology analysis confirmed previous reports that cGMP is involved in ion homeostasis and indicated that the transcriptional cGMP response is bi-polar in the sense that both genes up- and down-regulated in response to cGMP is involved in cation transport. Additionally, ab initio analysis of genes transcriptionally dependent on cGMP identified CHX8 as a hub gene and promoter content of CHX8 co-expressed genes show enrichment of the GARE motif. The fact that CHX8 has its highest expression levels during male gametogenesis and pollen tube growth, together with our findings, suggest that GA-induced and cGMP- dependent genes may play a key role in ion and water homeostasis in the male gametophyte. Finally, we propose that the type of analysis undertaken here can yield new insights into gene regulation networks and inform experimental strategies to unravel complex transcription regulatory systems under different developmental and stimulus specific conditions. / South Africa

Atrial natriuretic peptide (ANP) of atrial myocyte origin, has been shown to play a role in the diuresis, natriuresis, and antagonism of angiotensin and vasopressin. However, it is now apparent that in addition to the production of the peptide in the heart and in its role in fluid and electrolyte homeostasis, it is also produced in the central nervous system participating in the regulation of pituitary hormone secretion. Administration of ANP through both central and peripheral routes has been shown to inhibit secretion of luteinizing hormone (LH) in the gonadectomized rat model. A better understanding of the modulatory role of ANP on LH secretion and its possible mechanisms will add to our knowledge of the effects of neuropeptides on reproductive function. Brain natriuretic peptide (BNP) is a bioactive peptide of 26 amino acid residues recently identified in porcine brain. The peptide exerts potent diuretic-natriuretic and vasorelaxant effects, in a manner similar to that of ANP. BNP has a remarkable high sequence homology to ANP, especially in the 17 amino acid ring formed by an intramolecular disulfide linkage which is required for biological activity. The presence of BNP with ANP in the mammalian brain and remarkable resemblance in their molecular structures and physiological functions implies that BNP may also exert an inhibitory effect on LH secretion like ANP. This research focused on the effects of centrally administered ANP and BNP on pulsatile LH secretion and their possible mechanisms of action in ovariectomized rats. After third ventricle infusion of ANP or BNP, inhibition of mean plasma LH level, LH pulse amplitude and pulse frequency was observed. In searching for the possible mechanisms of inhibitory effect of ANP or BNP on pulsatile LH secretion, the effect of inhibiting the endogenous opiate system with naloxone on the action of centrally administered ANP or BNP was tested. Application of naloxone reversed the inhibitory effect of ANP and BNP on mean plasma LH level and LH pulse amplitude, but in terms of pulse frequency, naloxone treatment failed to reverse the inhibitory effect of ANP or BNP. In separate experiments, pretreatment with pimozide, a dopaminergic receptor blocker, prevented the inhibitory action of ANP and BNP on LH secretion. After infusion of ANP or BNP, there were no significant decrease in mean plasma LH level, pulse amplitude and pulse frequency in the pimozide-pretreated rats. In summary, the present study shows that both ANP and BNP inhibit pulsatile LH secretion, suggesting that the inhibitory effects on LH secretion once thought to be mediated by ANP alone may be regulated through a dual mechanism involving both ANP and BNP. Furthermore, the inhibitory mechanisms may involve the interactions of ANP and BNP with central opiate system and dopaminergic system on LH secretion. / Medicine, Faculty of / Obstetrics and Gynaecology, Department of / Graduate

Background: Patients older than 75 years with heart failure (HF) are at increased risk for mortality and hospital admissions. Echocardiography and brain natriuretic peptides (BNP, NTproBNP) are important diagnostic tools but sparsely evaluated in elderly PHC patients. Aims: Validate the clinical diagnosis of HF, investigate the types of HF and underlying cardiovascular disorders with focus on sex and age differences. Explore the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of BNP and NT-proBNP in patients with systolic HF. Study the associations of HF or NTproBNP on all-cause and cardiovascular mortality. Study the prognostic value of different biomarkers and HF, on all-cause and cardiovascular hospitalizations. Methods: Patients with suspected HF were recruited from one selected PHC and registered on a prespecified record and referred for an echocardiographic examination and a final cardiologist consultation. Blood samples for natriuretic peptides were stored frozen at – 70° C. Death certificates were used to register all-cause mortality and cardiovascular mortality. To register hospitalisations, medical records were used and classification was defined according to ICD-10. Results The GPs identified 121 women and 49 men with suspected HF of whom 39% (51 women and 16 men) were above 80 years. Myocardial infarction (OR:4,3 CL: 1,8-10,6) hypertension (OR:3,4 CI:1,6-6,9) atrial fibrillation (OR:2,8 CL:1,0-7,9) predicted a confirmed diagnosis of HF. Confirmed HF was verified in 45% of the patients and was significantly more common in men than women (p=0,02). The best NPV was 88 % for NT-proBNP (200 ng/L) and 87 % for BNP (20 pg/ml). Age and male gender were independently associated with higher levels of NT-proBNP. During the 10-year follow up, 71 out of 144 patients died. In univariate Cox regression analysis, significant associations were found for overall HF (hazard ratio [HR]: 1.86; 95% confidence interval [CI]:1.15- 3.01), isolated systolic HF (HR:1.95; 95% CI:1.06-3.61), and combined (systolic and diastolic) HF (HR:3.28; 95% CI:1.74-6.14) with all-cause mortality, but not for isolated diastolic HF. In multivariable analysis, age (HR: 1.11; 95% CI: 1.06-1.17), kidney dysfunction (HR:1.91; 95% CI:1.11- 3.29), smoking (HR:3.70; 95% CI:2.02-6.77), and NTproBNP (HR:1.01; 95% CI:1.00-1.02), but not any type of HF, significantly predicted all-cause mortality. During ten years, 136 (80%) patients were hospitalised with 660 and 207 for all-cause and cardiovascular hospitalisations, respectively. Age (OR:1.1; 95% CI:1.01-1.15) and underlying heart disease (OR:3.5; 95% CI:1.00-11.89), significantly predicted all-cause hospitalisation. Overall HF (HR:1.8; 95% CI:1.06-2.94) significantly predicted time to first all-cause hospitalisations. For cardiovascular hospitalisations age (OR:1.1;95%CI:1.01-1.12), underlying heart disease (OR:3.4;95%CI:1.04-11.40) and NTproBNP ≥800 ng/L (OR:4,3;95%CI:1.5-12.50) were significant predictors. Conclusion: A confirmed diagnosis of HF was present in 45% of the patients. NPV was high, but not as high as in younger patients with HF. Patients with systolic HF had a higher mortality than patients with diastolic HF compared to patients with no HF. Patients with combined HF were at even higher risk for all-cause mortality and cardiovascular mortality. Age, kidney dysfunction, NTproBNP and smoking predicted mortality. Age and underlying heart diseases were predictors for all-cause hospitalisations and together with NTproBNP they also predicted cardiovascular hospitalisations.

A proteína S100B é considerada um marcador bioquímico para lesão cerebral. Entretanto, foi demonstrado que há liberação de S100B em coração isolado de rato. Neste estudo, investigou-se os níveis séricos de S100B em pacientes portadores de cardiomiopatia dilatada (CMD). Métodos e Resultados: Foram selecionados 21 pacientes com CMD, excluindo qualquer condição que pudesse influenciar os níveis séricos de S100B. O grupo controle foi composto por 21 indivíduos pareados por sexo e idade. Ambos os grupos foram submetidos à avaliação clínica, ecocardiográfica, mensuração da proteína S100B e de NT-proBNP (expressos como mediana [variação interquartil]). Os níveis de NT-proBNP no grupo de pacientes (1462 pg/ml [426 - 3591]) foram maiores do que no grupo controle (35 pg/ml [29 - 55]); P<0.001. Os níveis de S100B foram maiores no grupo de pacientes (0.051µg/L [0.022 - 0.144]) do que no grupo controle (0.017µg/L [0.003 - 0.036]); P=0.009. Houve correlação positiva entre os níveis séricos de S100B e NT-proBNP somente no grupo de pacientes (Coeficiente de Spearman r=0.534; P=0.013). Conclusão: A proteína S100B está aumentada na CMD. Embora não possamos excluir a influência de dano cerebral, houve uma correlação positiva entre os níveis séricos de S100B e NT-proBNP em pacientes com CMD / The S100B protein is considered a biochemical marker for brain injuries. However, the isolated rat heart releases S100B. In this study, the serum levels of S100B was investigated in dilated cardiomyopathy (DCM) patients in order to evaluate its levels in heart disease. Methods and Results: It was selected DCM patients, excluding any condition that could influence S100B serum levels. Control individuals were sex and age matched. Both groups were submitted to clinical evaluation and echocardiography. The S100B and NT-proBNP serum levels (expressed as median [interquartile range]) were measured. NT-proBNP levels in patients group (1462 pg/ml [426 - 3591]) were higher than in controls (35 pg/ml [29 - 55]); P<0.001. S100B serum levels were higher in patients group (0.051µg/L [0.022 - 0.144]) than in controls (35 pg/ml [29 - 55]); P<0.001. S100B serum levels were higher in patients group (0.051µg/L [0.022 - 0.144]) than in controls (0.017µg/L [0.003 - 0.036]); P=0.009. Additionally, a positive correlation between S100B and NT-proBNP serum levels only in patients group (Spearman\'s coefficient r=0.534; P=0.013) was found . Conclusions: Although the influence of S100B from brain cannot rule out, the positive correlation between S100B and NT-proBNP levels in DCM patients points to the myocardium as the main source for the rise in S100B serum levels

No description available.

Background: Acute coronary syndrome is known for its effect on cardiac function and can lead to impaired segmental and even global myocardial function. Evidence exists that myocardial revascularisation whether pharmacological, interventional or surgical results in improvement of systolic and diastolic left ventricular (LV) function, particularly that of the long axis which represents the sub-endocardial function, known as the most sensitive layer to ischaemia. Objective: We sought to gain more insight into the early effect of pharmacological and interventional myocardial revascularisation on various aspects of cardiac function including endocrine, electrical, segmental, twist, right ventricular (RV) and left atrial (LA) function. In particular, we aimed to assess the response of ventricular electromechanical function to thrombolysis and its relationship with peptides levels. We also investigated the behaviour of RV function in the setting of LV inferior myocardial infarction (IMI) during the acute insult and early recovery. In addition, we aimed to assess in detail LA electrical and mechanical function in such patients. Finally, we studied the early effect of surgical revascularisation on the LV mechanics using the recent novel of speckle tracking echocardiography technology to assess rotation, twist and torsion and the strain deformation parameters as a tool of identifying global ventricular function. Methods: We used conventionally Doppler echocardiographic transthoracic techniques including M-mode, 2-Dimentional, myocardial tissue Doppler, and speckle tracking techniques. Commercially available SPSS as a software was used for statistical analysis. Results: 1-The elevated peptide levels at 7 days post-myocardial infarction correlated with the reduced mechanical activity of the adjacent non-infarcted segment thus making natriuretic peptides related to failure of compensatory hyperdynamic activity of the non-infarcted area rather than the injured myocardial segments. 2-RV segmental and global functions were impaired in acute IMI, and recovered in 87% of patients following thrombolysis. In the absence of clear evidence for RV infarction the disturbances in the remaining 13% may represent stunned myocardium with its known delayed recovery. 3-LA electromechanical function was impaired in acute inferior STEMI and improved after thrombolysis. The partial functional recovery suggests either reversible ischaemic pathology or a response to a non-compliant LV segment. The residual LA electromechanical and pump dysfunction suggest intrinsic pathology, likely to be ischaemic in origin. 4-LV function was maintained in a group of patients with multivessel coronary artery disease who underwent coronary artery bypass graft (CABG) surgery. Surgical myocardial revascularisation did not result in any early detectable change in the three functional components of the myocardium, including twist and torsion, as opposite to conventional percutaneous coronary intervention (PCI). Conclusion: The studied different materials in this thesis provide significant knowledge on various aspects of acute ischaemic cardiac pathology and early effect of revascularisation. The use of non-invasive imaging, particularly echocardiography with its different modalities, in studying such patients should offer immediate thorough bed-side assessment and assist in offering optimum management.

Atrial fibrillation (AF) confers an independent increased risk of stroke and death. The stroke risk is very heterogeneous and current risk stratification models based on clinical variables, such as the CHADS2 and CHA2DS2VASc score, only offer a modest discriminating value. The aims of this thesis were to study cardiac biomarkers, cardiac troponin and natriuretic peptides e.g. N-terminal prohormone-B-type natriuretic peptide (NT-proBNP), and describe levels in AF patients, investigate the association with stroke or systemic embolism, cardiovascular event, major bleeding and mortality, and to assess how levels of cardiac biomarkers change over time. Cardiac troponin was analyzed with contemporary assays and high sensitivity assays. The study populations consisted of patients with atrial fibrillation and one risk factor for stroke included in the RE-LY (n=6189) and the ARISTOTLE (n=14892) biomarker substudies. Median follow-up time was 2.2 years and 1.9 years, respectively. In a subset of participants (n=2514) data from repeated measurements was available at three months. Cardiac troponin was detectable in 57.0% with the contemporary assay and 99.4% with the high sensitivity assay. NT-proBNP was elevated in approximately three quarters of the participants. In Cox models adjusted for established risk factors the cardiac biomarkers levels was independently associated with stroke or systemic embolism, cardiovascular events, and mortality. Only cardiac troponin was associated with major bleeding. In ROC analyses the prediction of stroke or systemic embolism, cardiovascular events, and mortality increased significantly by addition of cardiac troponin or NT-proBNP to the models. Persistent detectable cardiac troponin (contemporary assay) and elevated NT-proBNP levels were found in a large number of participants. Persistent detectable or elevated levels conferred significantly higher risk for stroke or systemic embolism, cardiovascular events, and mortality. By using both cardiac biomarkers simultaneously the risk stratification improved even further for all outcomes. In conclusion the analyses for the first time display that elevation of troponin I and NT-proBNP are common in patients with AF and independently related to increased risks of stroke, cardiovascular events and mortality. Persistent elevation of troponin and NT-proBNP indicate a worse prognosis than transient elevations or no elevations of either marker. The cardiac biomarkers added substantial improvements to existing risk stratification models.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Bei Patienten mit akut dekompensierter Herzinsuffizienz beziehungsweise kardiogenem Schock ist die Kurz- und die Langzeitprognose stark reduziert. Ziel dieser prospektiv klinischen Studie war die Feststellung des Maximums des NTproBNP-Wertes in der Akutphase innerhalb der ersten zwölf Stunden nach Krankenhausaufnahme sowie die Untersuchung der NTproBNP-Spiegel als Prädiktor der 18-Monatsmortalität in dieser Patientengruppe. Es wurden insgesamt 148 Patienten in zwei Studienabschnitten eingeschlossen, wobei die Kurz- und Langzeitverläufe aller Patienten zu den Zeitpunkten 0, 12, 24 und 48 Stunden, 7 und 14 Tagen sowie 1, 3 und 18 Monaten untersucht wurden. Bei 32 Patienten wurden zusätzlich regelmäßige zweistündliche Untersuchungen der NTproBNP-Werte innerhalb der ersten zwölf Stunden (2, 4, 6, 8 und 10 Stunden nach Aufnahme) durchgeführt. Für Patienten mit akut dekompensierter Herzinsuffizienz bzw. kardiogenem Schock ohne akuten Myokardinfarkt fanden sich innerhalb der ersten zwölf Stunden keine siginifikant erhöhten NTproBNP-Plasmaspiegel im Vergleich zum Aufnahmewert, eine statistische Signifikanz bezüglich der 18-Monatsmortalität fand sich in dieser Gruppe innerhalb der ersten 48 Stunden nur zum Zeitpunkt 12 Stunden nach Aufnahme. In der Gruppe der Patienten mit dekompensierter Herzinsuffizienz bzw. kardiogenem Schock im Rahmen eines akuten Myokardinfarktes dagegen fanden sich statistisch signifikant steigende NTproBNP-Werte zu allen Zeitpunkten innerhalb der ersten zwölf Stunden im Vergleich zum Aufnahmewert, wobei nach zwölf Stunden der Maximalwert erreicht wurde. Weiterhin zeigten in dieser Gruppe die NTproBNP-Werte eine statistische Signifikanz in Hinsicht auf die 18-Monatsmortalität zu fast allen Zeitpunkten außer 4 Stunden nach Aufnahme. Zusammenfassend kann somit mit Bestimmung der NTproBNP-Werte 12 Stunden nach Krankenhausaufnahme unabhängig von der Genese der akuten kardialen Dekompensation eine Kurz- und Langzeitprognoseabschätzung erfolgen.