利钠肽家族基因与心血管疾病研究新进展

利钠肽家族是一组由心肌细胞分泌的激素, 主要包括A型、B型和C型利钠肽, 具有相似的基因结构和生理学效应, 可对心血管系统产生血压调节、抗心肌肥厚、抗心肌纤维化和抗心肌弛缓等保护作用。利钠肽受体A、B和C亦介导多种生理活性, 调节心血管稳态。利钠肽受体A选择性结合A型、B型利钠肽。利钠肽受体B结合C型利钠肽。利钠肽受体C结合各型利钠肽, 通过受体介导的内化和退化作用清除血液循环中利钠肽。对利钠肽家族及其受体基因单核甘酸多态性及功能研究显示, 其与多种心血管疾病(房颤、高血压、心力衰竭等)的易感性相关。利钠肽家族及其受体基因缺失的转基因小鼠表现为心肌肥厚、心肌纤维化, 与高血压、心肌病及心力衰竭的发生发展相关。各种导致心肌肥厚和缺血性损伤的刺激均参与利钠肽及其受体基因的表达调控。临床将脑钠肽作为左室功能障碍和心力衰竭失代偿的一个预测指标。静脉注射重组脑钠肽已经成为治疗急性心力衰竭的有效手段。深入了解利钠肽家族基因变异及其信号调控有助于探索心血管疾病的病理生理机制, 为临床诊疗开辟新思路。     

C型利钠利尿肽与心血管疾病

C型利钠利尿肽（CNP）是利钠利尿肽家族的第三个成员,CNP主要是由血管内皮分泌,与血管平滑肌细胞NRP－B受体结合激活颗粒型鸟苷酸环化酶,促进细胞内cGMP水平升高而起作用。除能舒张血管外还具有抑制平滑肌细胞增殖、迁移和细胞外基质形成等心血管效应,并以自分泌和旁分泌的方式参与血管重逆,在心血管疾病的发生发展中具有重要的病生理意义,可能是内源性抗损伤因素之一。     

B型利钠肽在心衰应用的研究进展

利钠肽（natriuretic peptides，NPs）的发现已有30年历史，其中B型利钠肽（B-type natriuretic peptide，BNP）及氨基末端脑钠肽前体（ N-terminal pro-B type natriuretic peptide，NT-proBNP）的临床应用对心血管疾病诊治具有里程碑意义，特别是对心衰的综合价值最高。BNP具备强大的心血管保护效应，但心衰后BNP水平大幅升高，却没展现出相应的活性，被称为“利钠肽悖论”。近几年，随着质谱、核磁共振技术的运用，逐渐从代谢途径和检测技术上解开了“利钠肽悖论”这一谜题：外周循环中存在多种不同生物活性的BNP亚型且心衰后的BNP代谢与生理状态下不同。所以，纵然检测到心衰后BNP大幅升高，但本质上是由于传统检测技术的瓶颈，使各类BNP亚型与检测试剂交叉反应，活性成分被高估而造成假阳性。因此，要加强对BNP在病理生理等不同情况下的认识，还要借助生物化学手段建立具有敏感性和特异性的检测方法来识别BNP_1-32、BNP_1-30、BNP_3-32及B型利钠肽原（pro-B-type natriuretic peptide，proBNP）等特殊形式。从而有助于探索心衰更深层次的病理生理机制，还可协助临床对心衰的诊断及预后做出更准确的判断。     

利钠肽的结构、受体与生理作用

利钠肽 (ｎａｔｒｉｕｒｅｔｉｃｐｅｐｔｉｄｅ ,ＮＰ)是近 2 0年才发现的一类多肽 .到目前为止 ,人类共发现了 5种利钠肽 ,即心房利钠肽 (ａｔｒｉａｌｎａｔｒｉｕｒｅｔｉｃｐｅｐｔｉｄｅ ,ＡＮＰ )、脑利钠肽(ｂｒａｉｎｎａｔｒｉｕｒｅｔｉｃ ｐｅｐｔｉｄｅ,ＢＮＰ)、Ｃ型利钠肽 (Ｃ ｔｙｐｅｎａｔｒｉｕｒｅｔｉｃｐｅｐｔｉｄｅ ,ＣＮＰ)、Ｖ型利钠肽 (ｖｅｎｔｒｉｃｌｅｎａｔｒｉｕｒｅｔｉｃｐｅｐｔｉｄｅ,ＶＮＰ)和Ｄ型利钠肽 (ｄｅｎｄｒｏａｓｐｉｓｎａｔｒｉｕｒｅｔｉｃｐｅｐｔｉｄｅ ,ＤＮＰ) .ＶＮＰ和ＤＮＰ至今…     

C型利钠利尿肽对犬冠脉循环的作用

Ｃ型利钠利尿肽（ＣＮＰ）是新近发现的一种由内皮细胞分泌的利钠利尿肽,本研究采用冠脉内给药方法对比观察了ＣＮＰ、心房利钠尿肽（ＡＮＰ）对犬正常及心肌缺血后冠脉循环的作用,并应用常规离体血管灌流的方法测定了离体冠脉对ＣＮＰ、ＡＮＰ的舒张反应。结果显示：（１）对正常犬,ＣＮＰ、ＡＮＰ均可降低平均动脉压（ＭＡＰ）、远端小冠脉压和大、小冠脉阻力,增加冠脉流量,而不影响心率;（２）心肌缺血后,ＣＮＰ的上述作用依然存在,但ＡＮＰ降低ＭＡＰ的作用基本消失。（３）离体心外膜冠状动脉对ＣＮＰ、ＡＮＰ均呈剂量依赖性舒张反应。结果提示ＣＮＰ、ＡＮＰ均可舒张冠状动脉而改善冠脉循环,并可能对急性心肌缺血的治疗有益     

利钠肽在急性心力衰竭预后评估及指导治疗中的作用

利钠肽(BNP与NT-proBNP)是预测急性心衰预后及评估急性心衰治疗效果可靠的指标.日常临床决策加用利钠肽检测提高了急性心衰高危患者的发现率,而这些患者往往需要加强追踪及强化治疗.现就利钠肽在评估急性心衰预后及指导心衰治疗中的价值作如下综述.     

C型利钠利尿肽（CNP）——一种新的心血管活性物质

新发现的Ｃ型利钠利尿肽（ＣＮＰ）是心房利钠利尿肽（ＡＮＰ）家族中的一员,由内皮细胞产生,和血管平滑肌细胞ＡＮＰＲ－Ｂ受体结合,使外周静脉扩张和回心血量减少,导致心脏充盈压和心输出量降低,这是降压的主要机理,该肽无利钠利尿作用。ＣＮＰ的作用机制与ｃＧＭＰ（第二信使）没有关系。心衰时,血管对ＣＮＰ的反应性不变。因此,ＣＮＰ在来源、作用部位、作用特点、作用机制及病理状态下的反应性等与熟知的ＡＮＰ均有显著不同。     

C型利钠肽在糖尿病下肢动脉硬化中的研究进展CSCD

糖尿病血管病变是糖尿病患者致死率和致残率增高的主要原因,糖尿病下肢动脉硬化是血管病变中的一种,血管内皮功能紊乱是造成糖尿病动脉硬化的根本所在。C型利钠肽(CNP)是利钠肽家族第三个成员,具有较强的抑制血管重构和一定的扩血管作用。本文重点对CNP在糖尿病下肢动脉硬化形成过程中的意义作一综述。     

脑利钠肽后处理对兔急性心肌梗死的保护作用

目的：脑利钠肽后处理对兔急性心肌梗死的保护作用及可能机制。方法：30 只兔随机分为3 组,每组10 只,左冠状动脉的左 室支缺血30 分钟,再灌注120 分钟。AMI（急性心肌梗死）组：再灌注期间静脉滴注生理盐水;BNP（脑利钠肽）组：再灌注期间静脉 滴注rhBNP(重组人脑利钠肽);BNP+GLY（脑利钠肽+格列苯脲）组：再灌注期间静脉滴注rhBNP,同时舌下静脉注射GLY 。连续 监测心电变化,统计再灌注120 min 室性心动过速(VT)、心室颤动(VF)的发生率。心肌再灌注120 min 后,分别测定SOD(超氧化 物歧化酶)、MDA（丙二醛）、cTnI（肌钙蛋白I）、CK-MB（肌酸激酶同工酶）。各组随机抽取2 只兔,分别于再灌注1 小时和2 小时末 取心尖组织,HE 染色。结果：（1）再灌注心律失常：BNP 组与AMI组比较,VT 和VF发生率均明显升高（均为P<0.01）;BNP+GLY 组与BNP 组比较,VT 和VF 发生率均明显升高（均为P<0.01）。（2）SOD、MDA、cTnI 和CK-MB 水平：BNP 组与AMI 组比较, MDA、cTnI 和CK-MB 均明显降低（均为P<0.01）,而SOD 明显升高（P<0.01）;BNP+GLY 组与BNP 组比较,MDA、cTnI 和 CK-MB 均明显升高（分别为P<0.01,P<0.05和P<0.01）,而SOD明显降低（P<0.01）。（3）心肌HE 染色：AMI组和BNP+GLY 组心 肌损伤明显,BNP 组心肌损伤轻微。结论：脑利钠肽后处理对兔急性心肌梗死（缺血- 再灌注损伤）具有保护作用,可能与KATP 通道相关。     

Cloning and functional expression of the bovine natriuretic peptide receptor-B (natriuretic factor R1c subtype)

We describe the isolation of a 3,276 base pair cDNA for the bovine natriuretic peptide receptor-B (NPR-B). Expression of this clone in Cos-P cells demonstrates that it encodes an agonist-dependent guanylyl cyclase. Porcine CNP stimulates the activity of this receptor up to 200-fold with an ED₅₀ of 12±2 nM, whereas brain natriuretic peptide C-type natriuretic peptide (CNP) and atrial natriuretic factor (ANF) are less efficacious. In addition, ligand binding studies indicate that this receptor exhibits the pharmacology appropriate for the bovine NPR-B. CNP binds to Cos-P cell membranes expressing this clone with a K_d of 13±1 pM, and natriuretic peptides compete for [¹²⁵I]-CNP binding with a rank order of pCNP>pBNP>rANF. Thus, the expressed receptor-guanylyl cyclase exhibits the expected pharmacological profile for ligand binding and cyclase activation of the bovine NPR-B receptor.Abbreviations BSA bovine serum albumin - dNTP deoxynucleotide triphosphate - SDS sodium dodecyl sulfate - DEAE-dextran diethylaminoethyl-dextran - EDTA ethylenediamine tetraacetic acid - Tris Tris(hydroxymethyl)aminomethane - DMSO dimethyl sulfoxide - RP-HPLC reverse phase-high performance liquid chromatography - AMV avian myeloblastosis virus - Arg arginine - Lys lysine     

Recent advances in natriuretic peptide research

The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular and renal homeostasis. They have recently emerged as potentially important clinical biomarkers in heart failure. Natriuretic peptides, particularly brain natriuretic peptide (BNP) and the inactive N-terminal fragment of BNP, NT-proBNP, that has an even greater half-life than BNP, are elevated in heart failure and therefore considered to be excellent predictors of disease outcome. Nesiritide, a recombinant human BNP, has been shown to provide symptomatic and haemodynamic improvement in acute decompensated heart failure, although recent reports have suggested an increased short-term risk of death with nesiritide use. This review article describes: the current use of BNP and its inactive precursor NT-proBNP in diagnosis, screening, prognosis and monitoring of therapy for congestive heart failure, the renoprotective actions of natriuretic peptides after renal failure and the controversy around the therapeutic use of the recombinant human BNP nesiritide.     

Glycosylation is critical for natriuretic peptide receptor-B function

Co-transfection of a truncated natriuretic peptide receptor-B (NPR-B) with the full length receptor results in a decrease of 60–80% in wild-type receptor activity. This reduction correlates with a loss of glycosylation of the full length NPR-B. This effect is dose-dependent, and occurs with no change in the glycosylation of the truncated receptor. Co-transfection of the full length NPR-B with other receptors yields similar results. These data suggest that glycosylation may be crucial for NPR-B function. Cross-linking studies further demonstrate that only fully glycosylated NPR-B receptors are able to bind ligand. Our data therefore argue that carbohydrate modification may be critical for NPR-B receptor ligand binding.Abbreviations as amino acids - ANF atrial natriuretic factor - ANOVA analysis of variance - BS³ bis(sulfosuccinimidyl) suberate - BSA bovine serum albumin - CNP C-type natriuretic peptide - DEAE dextran-diethylaminoethyl-dextran - DMEM Dulbecco's modified Eagle medium - DMSO dimethyl sulfoxide - dNTP deoxynucleotide triphosphate - EDTA ethylenediamine tetraacetic acid - IBMX 3-isobutyl-l-methyl-=xanthine - min minutes - N-linked asparagine-linked - NPR natriuretic peptide receptor - nt nucleotide - PCR polymerase chain reaction - RIA radioimmunoassay - RP-HPLC reverse phase-high performance liquid chromatography - RP-HPLC reverse phase-high performance liquid chromatography - SDS sodium dodecyl sulfate - UV ultraviolet Address for offprints:Department of Pharmacology, University of Montreal, 2900 Edouard Montpetit, Montreal, Quebec, H3C3J7, Canada     

Receptor-specific ligands distinguish natriuretic peptide receptors-A and -C in primate tissues

Systemic clearance of atrial natriuretic peptide (ANP) is in part due to neutral endopeptidase (NEP) proteolysis and natriuretic peptide receptor-C (NPR-C) mediated endocytosis. Biological responses to ANP are primarily mediated by the membrane guanylyl cyclase-A/natriuretic peptide receptor-A (NPR-A). Analogs of ANP selective for NPR-A and/or resistant to NEP may have increased activity in those tissues where NPR-C and NEP are coexpressed with NPR-A. The analog of ANP termed vANP; [(R3D, G9T, R11S, M12L, G16R)ANP] is selective for human NPR-A with at least 10,000 fold reduction in affinity for human NPR-C. We report that rat NPR-A is insensitive to 10 nM vANP, demonstrating the limitations of this species in evaluating human therapeutic candidates. As an alternative approach we tested the binding and potency of receptor-selective and NEP-resistant ANP analogs in rhesus monkey tissues. Competition binding studies with a simplified version of vANP, sANP [(G9T, R11S, G16R)rANP], in rhesus monkey kidney and lung membrane preparations shows displacement of ¹²⁵I-ANP from only a fraction of the total ANP receptor population, 30 and 85%, respectively. The remaining ANP binding sites can be occupied with the NPR-C selective ligand cANP(4-23). These data strongly suggest that only two classes of ANP receptor are present in these membrane preparations, NPR-A and NPR-C. The NEP resistant sANP derivative called sANP(TAPR) was 8 fold more potent (ED₅₀ = 0.6 nM) than rANP (ED₅₀ = SnM) in stimulating cGMP production in the lung membrane preparation. Our results demonstrate that the rhesus monkey natriuretic peptide receptors reflect the pharmacology of the human receptors, and that this species may be suitable to determine the role of NPR-C and NEP in peptide clearance and attenuating functional responses.     

Glycosylation of asparagine 24 of the natriuretic peptide receptor-B is crucial for the formation of a competent ligand binding domain

UV cross-linking studies of the natriuretic pepti de receptor- B (NPR-B )using radio labeled C-type natriuretic peptide (CNP) indicate that onlyfully glycosylated receptors are capable of binding ligand. We thereforeused site-directed mutagenesis to determine which potential glycosylationsites are occupied by carbohydrate, and the relevant mutants werecharacterized in order to understand the function of carbohydrate additionat those sites. Our results suggest that five of seven potential N-linkedglycosylation sites are modified. In addition, mutation of asparagine 24results in a loss of ~90% of receptor activity. This mutant isexpressed at levels comparable to the wild-type receptor, and its activityis not significantly different from that of wild-type NPR-B in terms of EC50for CNP. Ligand binding studies on this mutant further show that althoughthere is no change in affinity for ligand, ~90% of receptor bindingis lost. These data suggest that many of the mutant receptors are simply notproperly folded. Our results indicate that glycosylation of asparagine 24 ofNPR-B receptors may be critical for the formation of a competent ligandbinding domain.     

Intracellular trafficking and metabolic turnover ofligand-bound guanylyl cyclase/atrial natriuretic peptide receptor-A into subcellular compartments

Atrial natriuretic peptide (ANP) is the first described member of the natriuretic peptide hormone family. ANP elicits natriuretic, diuretic, vasorelaxant and antiproliferative effects, important factors in the control of blood pressure homeostasis. One of the principal loci involved in the regulatory action of ANP is the guanylyl cyclase-linked ANP-receptor which has been designated as NPRA, also referred to as GC-A, whose ANP-binding efficiency and guanylyl cyclase activity vary remarkably in different target tissues. However, the cellular and molecular basis of these activities and the functional expression and regulation of NPRA are not well understood. The mature form of receptor resides in the plasma membrane and consists of an extracellular ligand-binding domain, a single transmembrane-spanning region, and intracellular protein kinase-like homology and guanylyl cyclase catalytic domains. In this review, emphasis has been placed on the interaction of ANP with NPRA, the ligand-mediated endocytosis, trafficking, and subcellular distribution of ligand-receptor complexes from cell surface to the intracellular compartments. Furthermore, it is implicated that after internalization, the ANP/NPRA complexes dissociate into the subcellular compartments and a population of receptor recycles back to the plasma membrane. This is an interesting area of research in the natriuretic peptide receptor field because there is currently debate over whether ANP/NPRA complexes internalize at all or whether cell utilizes some other mechanisms to release ANP from the bound receptor molecules. Indeed, controversy exist since it has been previously reported by default that among the three natriuretic peptide receptors only NPRC internalizes with bound ligand. Hence, from a thematic standpoint it is clearly evident that there is a current need to review this subject and provide a consensus forum that establishes the cellular trafficking, sequestration and processing of ANP/NPRA complexes in intact cells. Towards this aim the cellular life-cycle of NPRA will be described in the context of ANP-binding, internalization, metabolic processing, and/or inactivation, down-regulation, and degradation of ligand-receptor complexes in model cell systems.     

Subcellular trafficking of guanylyl cyclase/natriuretic peptide receptor-A with concurrent generation of intracellular cGMP

Atrial natriuretic peptide (ANP) activates guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA), which lowers blood pressure and blood volume. The objective of the present study was to visualize internalization and trafficking of enhanced GFP (eGFP)-tagged NPRA (eGFP–NPRA) in human embryonic kidney-293 (HEK-293) cells, using immunofluorescence (IF) and co-immunoprecipitation (co-IP) of eGFP–NPRA. Treatment of cells with ANP initiated rapid internalization and co-localization of the receptor with early endosome antigen-1 (EEA-1), which was highest at 5 min and gradually decreased within 30 min. Similarly, co-localization of the receptor was observed with lysosome-associated membrane protein-1 (LAMP-1); however, after treatment with lysosomotropic agents, intracellular accumulation of the receptor gradually increased within 30 min. Co-IP assays confirmed that the localization of internalized receptors occurred with subcellular organelles during the endocytosis of NPRA. Rab 11, which was used as a recycling endosome (Re) marker, indicated that ∼20% of receptors recycled back to the plasma membrane. ANP-treated cells showed a marked increase in the IF of cGMP, whereas receptor was still trafficking into the intracellular compartments. Thus, after ligand binding, NPRA is rapidly internalized and trafficked from the cell surface into endosomes, Res and lysosomes, with concurrent generation of intracellular cGMP.     

Biochemistry and physiology of the natriuretic peptide receptor guanylyl cyclases

Guanylyl cyclases (GC) exist as soluble and particulate, membrane-associated enzymes which catalyse the conversion of GTP to cGMP, an intracellular signalling molecule. Several membrane forms of the enzyme have been identified up to now. Some of them serve as receptors for the natriuretic peptides, a family of peptides which includes atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP), three peptides known to play important roles in renal and cardiovascular physiology. These are transmembrane proteins composed of a single transmembrane domain, a variable extracellular natriuretic peptide-binding domain, and a more conserved intracellular kinase homology domain (KHD) and catalytic domain. GC-A, the receptor for ANP and BNP, also named natriuretic peptide receptor-A or -1 (NPR-A or NPR-1), has been studied widely. Its mode of activation by peptide ligands and mechanisms of regulation serve as prototypes for understanding the function of other particulate GC. Activation of this enzyme by its ligand is a complex process requiring oligomerization, ligand binding, KHD phosphorylation and ATP binding. Gene knockout and genetic segregation studies have provided strong evidence for the importance of GC-A in the regulation of blood pressure and heart and renal functions. GC-B is the main receptor for CNP, the latter having a more paracrine role at the vascular and venous levels. The structure and regulation of GC-B is similar to that of GC-A. This chapter reviews the structure and roles of GC-A and GC-B in blood pressure regulation and cardiac and renal pathophysiology.     

Expression of C-type natriuretic peptide and of its receptor NPR-B in normal and failing heart

C-type natriuretic peptide (CNP) was recently found in the myocardium, but possible insights into differences between atrium and ventricle production are so far lacking. Our aim was to evaluate, in an experimental model of pacing-induced heart failure (HF), plasma and tissue levels of CNP and mRNA expression of the peptide and of its specific receptor, NPR-B. Cardiac tissue was collected from male adult minipigs without (control, n=5) and with pacing-induced HF (n=5). Blood samples were collected at baseline and after pacing (10 min, 1, 2, 3 weeks). CNP in plasma and in cardiac extracts was determined by a radioimmunoassay, while the expression of mRNA by real time PCR. Compared to control, plasma CNP was increased after 1 week of pacing stress (36.9+/-10.4 pg/ml vs.16.7+/-1.1, p=0.013, mean+/-S.E.M.). As to myocardial extract, at baseline, CNP was found in all cardiac chambers and its content was 10-fold higher in atria than in ventricles (RA: 13.7+/-1.9 pg/mg protein; LA: 8.7+/-3.8; RV: 1.07+/-0.33; LV: 0.93+/-0.17). At 3 weeks of pacing, myocardial levels of CNP in left ventricle were higher than in controls (15.8+/-9.9 pg/mg protein vs. 0.9+/-0.17, p=0.01). CNP gene expression was observed in controls and at 3 weeks of pacing. NPR-B gene expression was found in all cardiac regions analyzed, and a down-regulation was observed in ventricles after HF. The co-localization of the CNP system and NPR-B suggests a possible role of CNP in HF and may prompt novel therapeutical strategies.