Skip to main content
Top
Published in: Journal of Translational Medicine 1/2014

Open Access 01-12-2014 | Research

Circulating N-terminal brain natriuretic peptide and cardiac function in response to acute systemic hypoxia in healthy humans

Authors: Ilkka Heinonen, Matti Luotolahti, Olli Vuolteenaho, Mikko Nikinmaa, Antti Saraste, Jaakko Hartiala, Juha Koskenvuo, Juhani Knuuti, Olli Arjamaa

Published in: Journal of Translational Medicine | Issue 1/2014

Login to get access

Abstract

Background

As it remains unclear whether hypoxia of cardiomyocytes could trigger the release of brain natriuretic peptide (BNP) in humans, we investigated whether breathing normobaric hypoxic gas mixture increases the circulating NT-proBNP in healthy male subjects.

Methods

Ten healthy young men (age 29 ± 5 yrs, BMI 24.7 ± 2.8 kg/m2) breathed normobaric hypoxic gas mixture (11% O2/89% N2) for one hour. Venous blood samples were obtained immediately before, during, and 2 and 24 hours after hypoxic exposure. Cardiac function and flow velocity profile in the middle left anterior descending coronary artery (LAD) were measured by Doppler echocardiography.

Results

Arterial oxygen saturation decreased steadily from baseline value of 99 ± 1% after the initiation hypoxia challenge and reached steady-state level of 73 ± 6% within 20–30 minutes. Cardiac output increased from 6.0 ± 1.2 to 8.1 ± 1.6 L/min and ejection fraction from 67 ± 4% to 75 ± 6% (both p < 0.001). Peak diastolic flow velocity in the LAD increased from 0.16 ± 0.04 to 0.28 ± 0.07 m/s, while its diameter remained unchanged. In the whole study group, NT-proBNP was similar to baseline (60 ± 32 pmol/ml) at all time points. However, at 24 h, concentration of NT-proBNP was higher (34 ± 18%) in five subjects and lower (17 ± 17%), p = 0.002 between the groups) in five subjects than at baseline.

Conclusion

In conclusion, there is no consistent increase in circulating NT-proBNP in response to breathing severely hypoxic normobaric gas mixture in healthy humans, a possible reason being that the oxygen flux to cardiac myocytes does not decrease because of increased coronary blood flow. However, the divergent individual responses as well as responses in different cardiac diseases warrant further investigations.
Appendix
Available only for authorised users
Literature
1.
go back to reference Moro C, Lafontan M: Natriuretic peptides and cGMP signaling control of energy homeostasis. Am J Physiol Heart Circ Physiol. 2013, 304: H358-H368. 10.1152/ajpheart.00704.2012.CrossRefPubMed Moro C, Lafontan M: Natriuretic peptides and cGMP signaling control of energy homeostasis. Am J Physiol Heart Circ Physiol. 2013, 304: H358-H368. 10.1152/ajpheart.00704.2012.CrossRefPubMed
2.
go back to reference Nikinmaa M: “What is hypoxia?”. Acta Physiol (Oxf). 2013, doi:10.1111/apha.12146 Nikinmaa M: “What is hypoxia?”. Acta Physiol (Oxf). 2013, doi:10.1111/apha.12146
3.
go back to reference Arjamaa O, Nikinmaa M: Hypoxia regulates the natriuretic peptide system. Int J Physiol Pathophysiol Pharmacol. 2011, 3: 191-201.PubMedCentralPubMed Arjamaa O, Nikinmaa M: Hypoxia regulates the natriuretic peptide system. Int J Physiol Pathophysiol Pharmacol. 2011, 3: 191-201.PubMedCentralPubMed
4.
go back to reference Arjamaa O, Nikinmaa M: Natriuretic peptides in hormonal regulation of hypoxia responses. Am J Physiol Regul Integr Comp Physiol. 2009, 296: R257-R264.CrossRefPubMed Arjamaa O, Nikinmaa M: Natriuretic peptides in hormonal regulation of hypoxia responses. Am J Physiol Regul Integr Comp Physiol. 2009, 296: R257-R264.CrossRefPubMed
5.
go back to reference Casals G, Ros J, Sionis A, Davidson MM, Morales-Ruiz M, Jimenez W: Hypoxia induces B-type natriuretic peptide release in cell lines derived from human cardiomyocytes. Am J Physiol Heart Circ Physiol. 2009, 297: H550-H555. 10.1152/ajpheart.00250.2009.CrossRefPubMed Casals G, Ros J, Sionis A, Davidson MM, Morales-Ruiz M, Jimenez W: Hypoxia induces B-type natriuretic peptide release in cell lines derived from human cardiomyocytes. Am J Physiol Heart Circ Physiol. 2009, 297: H550-H555. 10.1152/ajpheart.00250.2009.CrossRefPubMed
6.
go back to reference Mollmann H, Nef HM, Kostin S, Dragu A, Maack C, Weber M, Troidl C, Rolf A, Elsasser A, Bohm M, Brantner R, Hamm CW, Holubarsch CJ: Ischemia triggers BNP expression in the human myocardium independent from mechanical stress. Int J Cardiol. 2010, 143: 289-297. 10.1016/j.ijcard.2009.03.012.CrossRefPubMed Mollmann H, Nef HM, Kostin S, Dragu A, Maack C, Weber M, Troidl C, Rolf A, Elsasser A, Bohm M, Brantner R, Hamm CW, Holubarsch CJ: Ischemia triggers BNP expression in the human myocardium independent from mechanical stress. Int J Cardiol. 2010, 143: 289-297. 10.1016/j.ijcard.2009.03.012.CrossRefPubMed
7.
go back to reference Luo Y, Jiang C, Belanger AJ, Akita GY, Wadsworth SC, Gregory RJ, Vincent KA: A constitutively active hypoxia-inducible factor-1alpha/VP16 hybrid factor activates expression of the human B-type natriuretic peptide gene. Mol Pharmacol. 2006, 69: 1953-1962. 10.1124/mol.105.017905.CrossRefPubMed Luo Y, Jiang C, Belanger AJ, Akita GY, Wadsworth SC, Gregory RJ, Vincent KA: A constitutively active hypoxia-inducible factor-1alpha/VP16 hybrid factor activates expression of the human B-type natriuretic peptide gene. Mol Pharmacol. 2006, 69: 1953-1962. 10.1124/mol.105.017905.CrossRefPubMed
8.
go back to reference Due-Andersen R, Pedersen-Bjergaard U, Hoi-Hansen T, Olsen NV, Kistorp C, Faber J, Boomsma F, Thorsteinsson B: NT-pro-BNP during hypoglycemia and hypoxemia in normal subjects: impact of renin-angiotensin system activity. J Appl Physiol. 2008, 104: 1080-1085. 10.1152/japplphysiol.01082.2007.CrossRefPubMed Due-Andersen R, Pedersen-Bjergaard U, Hoi-Hansen T, Olsen NV, Kistorp C, Faber J, Boomsma F, Thorsteinsson B: NT-pro-BNP during hypoglycemia and hypoxemia in normal subjects: impact of renin-angiotensin system activity. J Appl Physiol. 2008, 104: 1080-1085. 10.1152/japplphysiol.01082.2007.CrossRefPubMed
9.
go back to reference Karadag R, Sen A, Yildirim N, Basmak H, Golemez H, Cakir E, Akin A: The relation between intraocular pressure change and plasma natriuretic peptide under simulated hypobaric conditions. Indian J Ophthalmol. 2010, 58: 195-198. 10.4103/0301-4738.62642.PubMedCentralCrossRefPubMed Karadag R, Sen A, Yildirim N, Basmak H, Golemez H, Cakir E, Akin A: The relation between intraocular pressure change and plasma natriuretic peptide under simulated hypobaric conditions. Indian J Ophthalmol. 2010, 58: 195-198. 10.4103/0301-4738.62642.PubMedCentralCrossRefPubMed
10.
go back to reference Woods D, Hooper T, Mellor A, Hodkinson P, Wakeford R, Peaston B, Ball S, Green N: Brain natriuretic peptide and acute hypobaric hypoxia in humans. J Physiol Sci. 2011, 61: 217-220. 10.1007/s12576-011-0141-3.CrossRefPubMed Woods D, Hooper T, Mellor A, Hodkinson P, Wakeford R, Peaston B, Ball S, Green N: Brain natriuretic peptide and acute hypobaric hypoxia in humans. J Physiol Sci. 2011, 61: 217-220. 10.1007/s12576-011-0141-3.CrossRefPubMed
11.
go back to reference Levin ER, Gardner DG, Samson WK: Natriuretic peptides. N Engl J Med. 1998, 339: 321-328. 10.1056/NEJM199807303390507.CrossRefPubMed Levin ER, Gardner DG, Samson WK: Natriuretic peptides. N Engl J Med. 1998, 339: 321-328. 10.1056/NEJM199807303390507.CrossRefPubMed
12.
go back to reference Ala-Kopsala M, Magga J, Peuhkurinen K, Leipala J, Ruskoaho H, Leppaluoto J, Vuolteenaho O: Molecular heterogeneity has a major impact on the measurement of circulating N-terminal fragments of A- and B-type natriuretic peptides. Clin Chem. 2004, 50: 1576-1588. 10.1373/clinchem.2004.032490.CrossRefPubMed Ala-Kopsala M, Magga J, Peuhkurinen K, Leipala J, Ruskoaho H, Leppaluoto J, Vuolteenaho O: Molecular heterogeneity has a major impact on the measurement of circulating N-terminal fragments of A- and B-type natriuretic peptides. Clin Chem. 2004, 50: 1576-1588. 10.1373/clinchem.2004.032490.CrossRefPubMed
13.
go back to reference Ala-Kopsala M, Moilanen AM, Rysa J, Ruskoaho H, Vuolteenaho O: Characterization of molecular forms of N-terminal B-type natriuretic peptide in vitro. Clin Chem. 2010, 56: 1822-1829. 10.1373/clinchem.2010.148775.CrossRefPubMed Ala-Kopsala M, Moilanen AM, Rysa J, Ruskoaho H, Vuolteenaho O: Characterization of molecular forms of N-terminal B-type natriuretic peptide in vitro. Clin Chem. 2010, 56: 1822-1829. 10.1373/clinchem.2010.148775.CrossRefPubMed
14.
go back to reference Kiviniemi TO, Saraste M, Koskenvuo JW, Airaksinen KE, Toikka JO, Saraste A, Parkka JP, Hartiala JJ: Coronary artery diameter can be assessed reliably with transthoracic echocardiography. Am J Physiol Heart Circ Physiol. 2004, 286: H1515-H1520.CrossRefPubMed Kiviniemi TO, Saraste M, Koskenvuo JW, Airaksinen KE, Toikka JO, Saraste A, Parkka JP, Hartiala JJ: Coronary artery diameter can be assessed reliably with transthoracic echocardiography. Am J Physiol Heart Circ Physiol. 2004, 286: H1515-H1520.CrossRefPubMed
15.
go back to reference Kiviniemi TO, Toikka JO, Koskenvuo JW, Saraste A, Saraste M, Parkka JP, Raitakari OT, Hartiala JJ: Vasodilation of epicardial coronary artery can be measured with transthoracic echocardiography. Ultrasound Med Biol. 2007, 33: 362-370. 10.1016/j.ultrasmedbio.2006.08.012.CrossRefPubMed Kiviniemi TO, Toikka JO, Koskenvuo JW, Saraste A, Saraste M, Parkka JP, Raitakari OT, Hartiala JJ: Vasodilation of epicardial coronary artery can be measured with transthoracic echocardiography. Ultrasound Med Biol. 2007, 33: 362-370. 10.1016/j.ultrasmedbio.2006.08.012.CrossRefPubMed
16.
go back to reference Naeije R: Physiological adaptation of the cardiovascular system to high altitude. Prog Cardiovasc Dis. 2010, 52: 456-466. 10.1016/j.pcad.2010.03.004.CrossRefPubMed Naeije R: Physiological adaptation of the cardiovascular system to high altitude. Prog Cardiovasc Dis. 2010, 52: 456-466. 10.1016/j.pcad.2010.03.004.CrossRefPubMed
17.
go back to reference Hultgren HN, Grover RF: Circulatory adaptation to high altitude. Annu Rev Med. 1968, 19: 119-152. 10.1146/annurev.me.19.020168.001003.CrossRefPubMed Hultgren HN, Grover RF: Circulatory adaptation to high altitude. Annu Rev Med. 1968, 19: 119-152. 10.1146/annurev.me.19.020168.001003.CrossRefPubMed
18.
go back to reference Bartsch P, Gibbs JS: Effect of altitude on the heart and the lungs. Circulation. 2007, 116: 2191-2202. 10.1161/CIRCULATIONAHA.106.650796.CrossRefPubMed Bartsch P, Gibbs JS: Effect of altitude on the heart and the lungs. Circulation. 2007, 116: 2191-2202. 10.1161/CIRCULATIONAHA.106.650796.CrossRefPubMed
19.
go back to reference Dedobbeleer C, Hadefi A, Naeije R, Unger P: Left ventricular adaptation to acute hypoxia: a speckle-tracking echocardiography study. J Am Soc Echocardiogr. 2013, 26 (7): 736-745. 10.1016/j.echo.2013.04.012.CrossRefPubMed Dedobbeleer C, Hadefi A, Naeije R, Unger P: Left ventricular adaptation to acute hypoxia: a speckle-tracking echocardiography study. J Am Soc Echocardiogr. 2013, 26 (7): 736-745. 10.1016/j.echo.2013.04.012.CrossRefPubMed
20.
go back to reference Namdar M, Koepfli P, Grathwohl R, Siegrist PT, Klainguti M, Schepis T, Delaloye R, Wyss CA, Fleischmann SP, Gaemperli O, Kaufmann PA: Caffeine decreases exercise-induced myocardial flow reserve. J Am Coll Cardiol. 2006, 47: 405-410. 10.1016/j.jacc.2005.08.064.CrossRefPubMed Namdar M, Koepfli P, Grathwohl R, Siegrist PT, Klainguti M, Schepis T, Delaloye R, Wyss CA, Fleischmann SP, Gaemperli O, Kaufmann PA: Caffeine decreases exercise-induced myocardial flow reserve. J Am Coll Cardiol. 2006, 47: 405-410. 10.1016/j.jacc.2005.08.064.CrossRefPubMed
21.
go back to reference Tenhunen O, Szokodi I, Ruskoaho H: Posttranscriptional activation of BNP gene expression in response to increased left ventricular wall stress: role of calcineurin and PKC. Regul Pept. 2005, 128: 187-196. 10.1016/j.regpep.2004.12.024.CrossRefPubMed Tenhunen O, Szokodi I, Ruskoaho H: Posttranscriptional activation of BNP gene expression in response to increased left ventricular wall stress: role of calcineurin and PKC. Regul Pept. 2005, 128: 187-196. 10.1016/j.regpep.2004.12.024.CrossRefPubMed
22.
go back to reference Maeder MT, Mariani JA, Kaye DM: Hemodynamic determinants of myocardial B-type natriuretic peptide release: relative contributions of systolic and diastolic wall stress. Hypertension. 2010, 56: 682-689.CrossRefPubMed Maeder MT, Mariani JA, Kaye DM: Hemodynamic determinants of myocardial B-type natriuretic peptide release: relative contributions of systolic and diastolic wall stress. Hypertension. 2010, 56: 682-689.CrossRefPubMed
23.
go back to reference Wiese S, Breyer T, Dragu A, Wakili R, Burkard T, Schmidt-Schweda S, Fuchtbauer EM, Dohrmann U, Beyersdorf F, Radicke D, Holubarsch CJ: Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin II and diastolic fiber length. Circulation. 2000, 102: 3074-3079. 10.1161/01.CIR.102.25.3074.CrossRefPubMed Wiese S, Breyer T, Dragu A, Wakili R, Burkard T, Schmidt-Schweda S, Fuchtbauer EM, Dohrmann U, Beyersdorf F, Radicke D, Holubarsch CJ: Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin II and diastolic fiber length. Circulation. 2000, 102: 3074-3079. 10.1161/01.CIR.102.25.3074.CrossRefPubMed
24.
go back to reference Woods D, Hooper T, Hodkinson P, Ball S, Wakeford R, Peaston B, Bairsto C, Green N, Mellor A: Effects of altitude exposure on brain natriuretic peptide in humans. Eur J Appl Physiol. 2011, 111: 2687-2693. 10.1007/s00421-011-1881-8.CrossRefPubMed Woods D, Hooper T, Hodkinson P, Ball S, Wakeford R, Peaston B, Bairsto C, Green N, Mellor A: Effects of altitude exposure on brain natriuretic peptide in humans. Eur J Appl Physiol. 2011, 111: 2687-2693. 10.1007/s00421-011-1881-8.CrossRefPubMed
25.
go back to reference Woods DR, Begley J, Stacey M, Smith C, Boos CJ, Hooper T, Hawkins A, Hodkinson P, Green N, Mellor A: Severe acute mountain sickness, brain natriuretic peptide and NT-proBNP in humans. Acta Physiol (Oxf). 2012, 205: 349-355. 10.1111/j.1748-1716.2012.02407.x.CrossRef Woods DR, Begley J, Stacey M, Smith C, Boos CJ, Hooper T, Hawkins A, Hodkinson P, Green N, Mellor A: Severe acute mountain sickness, brain natriuretic peptide and NT-proBNP in humans. Acta Physiol (Oxf). 2012, 205: 349-355. 10.1111/j.1748-1716.2012.02407.x.CrossRef
26.
go back to reference Ge RL, Mo VY, Januzzi JL, Jin G, Yang Y, Han S, Wood MJ, Levine BD: B-type natriuretic peptide, vascular endothelial growth factor, endothelin-1, and nitric oxide synthase in chronic mountain sickness. Am J Physiol Heart Circ Physiol. 2011, 300: H1427-H1433. 10.1152/ajpheart.00366.2010.CrossRefPubMed Ge RL, Mo VY, Januzzi JL, Jin G, Yang Y, Han S, Wood MJ, Levine BD: B-type natriuretic peptide, vascular endothelial growth factor, endothelin-1, and nitric oxide synthase in chronic mountain sickness. Am J Physiol Heart Circ Physiol. 2011, 300: H1427-H1433. 10.1152/ajpheart.00366.2010.CrossRefPubMed
27.
go back to reference Toshner MR, Thompson AA, Irving JB, Baillie JK, Morton JJ, Peacock AJ: NT-proBNP does not rise on acute ascent to high altitude. High Alt Med Biol. 2008, 9: 307-310. 10.1089/ham.2008.1054.CrossRefPubMed Toshner MR, Thompson AA, Irving JB, Baillie JK, Morton JJ, Peacock AJ: NT-proBNP does not rise on acute ascent to high altitude. High Alt Med Biol. 2008, 9: 307-310. 10.1089/ham.2008.1054.CrossRefPubMed
28.
go back to reference Koch A, Zink S, Singer H: B-type natriuretic peptide in paediatric patients with congenital heart disease. Eur Heart J. 2006, 27: 861-866. 10.1093/eurheartj/ehi773.CrossRefPubMed Koch A, Zink S, Singer H: B-type natriuretic peptide in paediatric patients with congenital heart disease. Eur Heart J. 2006, 27: 861-866. 10.1093/eurheartj/ehi773.CrossRefPubMed
29.
go back to reference Weidemann A, Klanke B, Wagner M, Volk T, Willam C, Wiesener MS, Eckardt KU, Warnecke C: Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J. 2008, 409: 233-242. 10.1042/BJ20070629.CrossRefPubMed Weidemann A, Klanke B, Wagner M, Volk T, Willam C, Wiesener MS, Eckardt KU, Warnecke C: Hypoxia, via stabilization of the hypoxia-inducible factor HIF-1alpha, is a direct and sufficient stimulus for brain-type natriuretic peptide induction. Biochem J. 2008, 409: 233-242. 10.1042/BJ20070629.CrossRefPubMed
30.
go back to reference Goetze JP, Christoffersen C, Perko M, Arendrup H, Rehfeld JF, Kastrup J, Nielsen LB: Increased cardiac BNP expression associated with myocardial ischemia. FASEB J. 2003, 17: 1105-1107.PubMed Goetze JP, Christoffersen C, Perko M, Arendrup H, Rehfeld JF, Kastrup J, Nielsen LB: Increased cardiac BNP expression associated with myocardial ischemia. FASEB J. 2003, 17: 1105-1107.PubMed
Metadata
Title
Circulating N-terminal brain natriuretic peptide and cardiac function in response to acute systemic hypoxia in healthy humans
Authors
Ilkka Heinonen
Matti Luotolahti
Olli Vuolteenaho
Mikko Nikinmaa
Antti Saraste
Jaakko Hartiala
Juha Koskenvuo
Juhani Knuuti
Olli Arjamaa
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2014
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/1479-5876-12-189

Other articles of this Issue 1/2014

Journal of Translational Medicine 1/2014 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.