Lipolytic Effects of B-Type Natriuretic Peptide1–32 in Adipose Tissue of Heart Failure Patients Compared With Healthy Controls

Sep 28, 2011
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Authors:
Polak J, Kotrc M, Wedellova Z, et al.
Citation:
J Am Coll Cardiol 2011;58:1119-1125.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the role of B-type natriuretic peptide (BNP) in lipolysis regulation in heart failure (HF) patients?

Methods:

Ten nondiabetic HF patients (New York Heart Association functional class III, 50% nonischemic etiology) and 13 healthy subjects (control subjects) of similar age, sex, and body composition underwent a microdialysis study of subcutaneous abdominal adipose tissue. Four microdialysis probes were simultaneously perfused with 0.1 µM BNP1–32, 10 µM BNP1–32, 10 µM norepinephrine, or Ringer’s solution. Outgoing dialysate glycerol concentration (DGC) was measured as an index of lipolysis. Differential responses to BNP1–32, norepinephrine, or Ringer’s solution perfusion between groups were evaluated using a t test.

Results:

Spontaneous lipolysis was higher in HF patients compared with control subjects (DGC: 189 ± 37 µmol/L vs. 152 ± 35 µmol/L, p < 0.01). Response to norepinephrine was similar (p = 0.35) in HF patients and control subjects (DGC increase of 1.7 ± 0.2-fold vs. 1.7 ± 0.4-fold). BNP1–32 10 µM markedly increased lipolysis in both HF patients and control subjects (DGC increase of 2.8 ± 0.5-fold vs. 3.2 ± 0.3-fold), whereas the response to 0.1 µM BNP1–32 was more pronounced in HF patients (p = 0.02). In HF patients, spontaneous lipolysis positively correlated with insulin resistance, and the response to BNP1–32 negatively correlated with adiposity.

Conclusions:

The authors concluded that BNP1–32 exerts strong lipolytic effects in humans.

Perspective:

This study suggests that the induction of lipolysis by BNP1–32 is increased in HF patients compared with control subjects, which suggests that BNP might play an important role in excessive free fatty acid mobilization and related metabolic abnormalities including cardiac cachexia. Future studies using systemic BNP1–32 infusion at more physiological concentrations are indicated to delineate a true cause-and-effect relationship, and describe other endocrine and metabolic changes induced by BNP (e.g., changes in adipokine levels and substrate use). Additionally, studies comparing patients with different HF severity across a range of adiposity and insulin resistance may provide further insight into the role of BNP in lipolysis.

Keywords: Natriuretic Peptides, Body Composition, Biomarkers, Heart Failure, Adiposity, Norepinephrine, Isotonic Solutions, Lipolysis, Microdialysis, Subcutaneous Fat


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