Heads and Tails of Natriuretic Peptides: Neuroprotective Role of Brain Natriuretic Peptide

Abstract

BackgroundBesides the relevant role of brain‐type natriuretic peptide (BNP) as biomarker of cardioembolic strokes, new experimental evidences suggest that this peptide may mediate neuroprotective effects. In this study, we have evaluated for the first time the clinical association between BNP (by means of proBNP) and good outcome in ischemic stroke patients, and analyzed the effect of blood BNP increase in an ischemic animal model.Methods and ResultsA retrospective study with 2 different cohorts (262 patients in cohort I and 610 in cohort II) from the same prospective stroke registry was performed. proBNP concentration was analyzed within the first 12 hours from stroke onset. The primary predictor variable was functional outcome evaluated by modified Rankin Scale at 3 months. For the experimental study, BNP pretreatment was tested in an ischemic animal model subjected to a transient occlusion of the cerebral artery, and the infarct volume and sensorimotor deficit were evaluated for 14 days. Cardioembolic strokes presented a positive correlation between proBNP concentration and modified Rankin Scale at 3 months; however, noncardioembolic strokes presented a negative correlation. In the logistic regression analysis, noncardioembolic strokes with concentrations of proBNP ≥340 pg/mL were associated with a good outcome. In line with these clinical findings, the experimental study revealed that those BNP pretreated animals presented a reduction on infarct volumes at 24 hours and functional recovery at days 7 and 14 compared with the control groups.ConclusionsThese clinical and experimental evidences support the potential role of BNP as a protective factor against cerebral ischemia.

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“…In fact, its infusion led to an improvement of cerebral blood flow and of brain injury, with a better functional outcome [ 34 ]. Moreover, infusion of BNP in ischemic animal models showed a significant infarct volume reduction and a better sensorimotor recovery [ 35 ]. The same study reported that patients affected by cardioembolic stroke carrying higher circulating BNP levels presented a better outcome at a 3-month follow-up.…”

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“…In rodent models of traumatic brain injury and intracerebral bleeding, brain natriuretic peptide improves cerebral blood flow and reduces brain inflammation manifested by reduced neurodegeneration and improved functional outcomes. 12 The stimulatory effect of natriuretic peptides on lipolysis would provide the substrate for increased production of ketone bodies, which have been shown to provide a wide range of neuroprotective effects. 13 Natriuretic peptides activate existing depots of brown adipose tissue and promote beiging of white adipose tissue, which, in turn, leads to increased insulin sensitivity.…”