Recombinant Feline NT-proBNP

N-terminal pro B-type natriuretic peptide (NTproBNP): The proton protein produced by myocardial cells under overload was used to diagnose and predict cardiovascular conditions including heart failure and acute coronary syndromes. NT-proBNP was extensively clinically tested for diagnosing and predicting heart failure. Its precursor, B-type natriuretic peptide (BNP), is released by myocardial cells (perhaps ventricle myocytes) in the event of elevated blood pressure or heart failure.Two kinds of BNP exist: myocardial cells generate proto-BNP (preproBNP) and the proto-BNP turns into mature BNP with an inoperative N-terminus — NT-proBNP. Although NT-proBNP plays no role in physiological natriuresis or diuresis, it is a precursor molecule to the peptide BNP. Since NT-proBNP has a longer half-life, it is a safer biomarker in blood, and a natural indirect indicator of cardiac load. That ejection of BNP and NT-proBNP is dependent on several physiological and pathological factors, but chief among them are ventricular pressure overload, dilation, ischemia, and myocardial injury. Increasing pressure on the ventricular wall activates pressure sensors in myocardial cells that release BNP genes and generate NT-proBNP. NT-proBNP thus rises in the clinic, especially in hypertension and heart failure, and so can be seen as a sign of cardiac overload.

Figure 1. Synthesis of ProBNP from the BNP (NPPB) Gene. (Source: McKie P, Burnett J, 2016)

NT-proBNP is linked to numerous cardiovascular diseases. The highly effective HF biomarker, NT-proBNP is now widely clinically utilized to diagnose, predict and monitor HF patients. NT-proBNP tracks left ventricular function, remodeling, and HF in both acute and chronic HF patients. NT-proBNP levels were observed to be elevated in heart failure in a large number of clinical trials (Framingham Heart Study, CORONA trial), and were highly correlated with mortality and hospitalisation. The NT-proBNP score also predicts LVEDP and PCWP in HF patients, and is predictive of HF progression and mortality. Most guidelines use NT-proBNP to define HF. The European Society of Cardiology Guidelines for the Management of Heart Failure (2016) prescribes 450 pg/mL (50 years), 900 pg/mL (50-75 years), and 1800 pg/mL (>75 years) as HF diagnoses. NT-proBNP works clinically against ACS. During acute ACS (and AMI in particular), elevated levels of NT-proBNP correlate with myocardial infarction, remodeling and atrophication of the walls of the ventricular cavity. In ACS patients, researchers have identified a strong correlation between NT-proBNP levels and the rate of heart events, death, and hospitalization. In particular, higher levels of NT-proBNP may allow clinicians to more efficiently spot high-risk patients and intervene in time to treat them individually.

Even with the success of NT-proBNP in HF diagnosis and therapy, the clinical use of the drug remains controversial. To begin with, the reference value of NT-proBNP depends a great deal on age, gender, renal function, and obesity, and can be hard to understand in different patient groups. Additionally, while NT-proBNP can be used to detect cardiac function, it is not the biomarker of heart failure; other conditions (pulmonary embolism, renal insufficiency) can result in elevated levels of NT-proBNP. This technology might one day deliver better, more sensitive NT-proBNP detection. Moreover, NT-proBNP in combination with other biomarkers (atrial natriuretic peptide, troponin) could enhance the diagnosis and treatment of HF. Our other aspirations are to explain the applications of NT-proBNP in HF medicine, especially in personalized and precision medicine, through further clinical trials. In summary, NT-proBNP is an invaluable heart failure biomarker to diagnose HF, track treatment, and predict the outcome. Monitoring NT-proBNP trends allows physicians to measure heart function more precisely, alter treatment regimens and optimize patient outcomes. While the NT-proBNP's present uses are limited, future technological and scientific development will broaden its heart failure management utility, and make it even more crucial to cardiovascular care.

Feline NT-proBNP Protein
Recombinant NT-proBNP