Bruggink Annette H, de Jonge Nicolaas, van Oosterhout Matthijs F M, Van Wichen Dick F, de Koning Erica, Lahpor Jaap R, Kemperman Hans, Gmelig-Meyling Frits H J, de Weger Roel A
Department of Pathology, University Medical Center, Utrecht, The Netherlands.
J Heart Lung Transplant. 2006 Feb;25(2):174-80. doi: 10.1016/j.healun.2005.09.007.
Brain natriuretic peptide (BNP) is a cardiac neurohormone synthesized in cardiac ventricles as a result of increased wall stress. Left ventricular assist device (LVAD) support in patients with end-stage heart failure results in reduced wall stress and therefore may change BNP levels in the heart.
BNP plasma levels were measured in 17 patients with end-stage HF before LVAD implantation and at 1 week, 1 month, and 3 months after LVAD support. BNP-messenger RNA (mRNA) expression in cardiac biopsy specimens of 27 patients before and after LVAD support was determined by quantitative polymerase chain reaction. Immunohistochemistry (IHC) and IHC-double staining was used in biopsy specimens from 32 patients before and after LVAD support to localize the BNP protein expression in the heart.
BNP plasma levels significantly decreased from 1,872 +/- 1,098 pg/ml before implantation to 117 +/- 91 pg/ml at 3 months after LVAD implantation. This decrease in plasma levels was accompanied by a significant decrease in mRNA expression (relative quantity) in the heart. IHC and IHC-double staining showed BNP immunoreactivity in the cardiomyocytes, endothelial cells, infiltrating T cells, and macrophages.
The significant decrease in serum BNP concentration after LVAD support coincides with a decrease in BNP mRNA and protein expression in the heart. BNP is produced in the left ventricle not only by cardiomyocytes but also by endothelial cells, T cells, and macrophages. Unloading of the left ventricle by a LVAD results in decreased BNP expression in the heart and plasma and may play an important role in the reverse remodeling process of the heart.
脑钠肽（BNP）是一种在心室中因壁应力增加而合成的心脏神经激素。终末期心力衰竭患者接受左心室辅助装置（LVAD）支持可降低壁应力，因此可能改变心脏中的BNP水平。
对17例终末期心力衰竭患者在LVAD植入前以及LVAD支持后1周、1个月和3个月时测定血浆BNP水平。通过定量聚合酶链反应测定27例患者LVAD支持前后心脏活检标本中BNP信使核糖核酸（mRNA）的表达。对32例患者LVAD支持前后的活检标本进行免疫组织化学（IHC）和IHC双重染色，以定位心脏中BNP蛋白的表达。
血浆BNP水平从植入前的1872±1098 pg/ml显著降至LVAD植入后3个月时的117±91 pg/ml。血浆水平的这种下降伴随着心脏中mRNA表达（相对量）的显著降低。免疫组织化学和免疫组织化学双重染色显示心肌细胞、内皮细胞、浸润性T细胞和巨噬细胞中有BNP免疫反应性。
LVAD支持后血清BNP浓度显著降低与心脏中BNP mRNA和蛋白表达的降低相吻合。BNP不仅由心肌细胞在左心室产生，内皮细胞、T细胞和巨噬细胞也可产生。LVAD减轻左心室负荷导致心脏和血浆中BNP表达降低，这可能在心脏逆向重构过程中起重要作用。
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