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Cardiovascular Research 2004 64(2):308-314; doi:10.1016/j.cardiores.2004.07.004
© 2004 by European Society of Cardiology
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Copyright © 2004, European Society of Cardiology

Left ventricular assist device support reverses altered cardiac expression and function of natriuretic peptides and receptors in end-stage heart failure

Michaela Kuhna,*, Melanie Voßa, Danuta Mitkoa, Jörg Stypmannb, Christof Schmidc, Naomasa Kawaguchid, Florian Grabellusd and Hideo A. Babad

aInstitute of Pharmacology and Toxicology and Interdisciplinary Center for Clinical Research, Universitätsklinikum Münster, Domagkstrasse 12, D-48129 Münster, Germany
bDepartment of Cardiology and Angiology, Universitätsklinikum Münster, Germany
cDepartment of Thoracic and Cardiovascular Surgery, Universitätsklinikum Münster, Germany
dInstitute of Pathology, Universitätsklinikum der Universität Duisburg-Essen, Germany

* Corresponding author. Tel.: +49 251 83 52597; fax: +49 251 83 55501. Email address: mkuhn{at}uni-muenster.de

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.

Methods and 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.

Conclusion: 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.

KEYWORDS Natriuretic peptide; Heart failure; Transplantation

Time for primary review 21 days


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