Abstract
BackgroundNatriuretic peptides have been proposed as biomarkers of cardiovascular disease, especially heart failure. Brain natriuretic peptide (BNP) has also been shown to be upregulated at the transcriptional and translational levels by pro-inflammatory cytokines in cardiac myocytes. Although we often measure plasma BNP levels in cancer patients, it remains unknown whether cancer-related inflammation affects the plasma BNP levels. We investigated the relationship between the BNP and human cancers.MethodsWe retrospectively studied 2,923 patients in whom the plasma BNP levels and serum C-reactive protein (CRP) were measured and echocardiography was performed. Patients with clinically evident heart failure (NYHA II or higher), heart disease requiring medical treatment or surgery, renal dysfunction, and inflammatory disease were excluded. There were 234 patients in the final analysis. Blood sampling was performed before surgery and chemotherapy. In addition, we evaluated the relationship between the inflammation and plasma BNP levels in mouse models of colon cancer.ResultsOf the 234 patients, 80 were diagnosed with cancer. Both the plasma BNP and serum CRP levels were significantly higher in cancer patients than those without. There were no significant differences in the echocardiographic parameters. There was a significant positive correlation between the plasma BNP and serum CRP levels in cancer patients (r = 0.360, P<0.01) but not in those without. In cancer patients, only the CRP correlated with the BNP independent of the age, creatinine level, hypertension, and body mass index. In addition, in nude mice with subcutaneous colon cancer, the plasma BNP level was elevated compared with that in non-cancer mice, and there was a significant relationship between the plasma BNP and serum levels of the inflammatory markers.ConclusionsIn cancer patients, as well as colon cancer model mice, the plasma BNP levels were elevated, possibly due to cancer-related inflammation. The effect of cancer on the BNP levels should be considered when using BNP as an indicator of heart failure in cancer patients.
Highlights
The family of natriuretic peptides plays an important role in the regulation of cardiovascular homeostasis and extracellular fluid volume
Of the 234 patients, 80 were diagnosed with cancer. Both the plasma Brain natriuretic peptide (BNP) and serum Creactive protein (CRP) levels were significantly higher in cancer patients than those without
There were no significant differences in the echocardiographic parameters
Summary
The family of natriuretic peptides plays an important role in the regulation of cardiovascular homeostasis and extracellular fluid volume. Several lines of evidence suggest that BNP is superior to the other cardiac biomarkers including ANP for the prognostication and risk stratification in patients with heart failure [4,5,6]. Endogenous ANP has been shown to be expressed in the nucleus and cytoplasm of the human pancreatic adenocarcinomas [10]. Natriuretic peptides have been proposed as biomarkers of cardiovascular disease, especially heart failure. Brain natriuretic peptide (BNP) has been shown to be upregulated at the transcriptional and translational levels by pro-inflammatory cytokines in cardiac myocytes.
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