An elevated level of BNP in plasma is related to the development of good collateral circulation in coronary artery disease.

OBJECTIVE: B-type natriuretic peptide (BNP) was recently demonstrated to be a potential stimulator of angiogenesis and arteriogenesis. The correlation between BNP level and collateral formation in patients with coronary artery disease (CAD) has not been reported. METHODS AND RESULTS: The study included 311 consecutive patients who underwent coronary angiography were divided into three groups according to coronary angiography and collateral formation: normal group (100 patients with normal coronary angiographic findings); poor collateral group (116 patients with at least one coronary stenosis of ≥75% without visible collateral circulation); and good collateral group (95 patients with at least one coronary stenosis of ≥75% with well-developed collateral circulation). Collateral score was analyzed using the Cohen-Rentrop classification. Plasma BNP levels were 45.77 ± 4.66 pg/ml, 116.40 ± 28.15 pg/ml, and 254.20 ± 42.85 pg/ml for patients in normal, poor collateral, and good collateral groups, respectively. Plasma BNP levels in the latter were significantly higher than in the normal group (p < 0.01) and poor collateral group (p < 0.05). There were no significant differences between the good collateral group and poor collateral group when compared with left ventricular ejection fraction (LVEF), left ventricular dimensions at end diastole (LVEDd), age, severity of angiographic disease, and other cardiovascular risk factors. After adjustment in the multiple ordinal logistic regression model, plasma BNP levels showed a strong independent association with collateral Cohen-Rentrop score (χ(2 )= 5.636, OR = 1.002, 95% CI 1.000-1.004, p = 0.018). CONCLUSIONS: An elevated level of BNP in plasma is independently associated with collateral development; patients with good collaterals tend to have a higher BNP level.

Th1 polarization and low-T3 syndrome are correlated with hyperleptinemia in hemodialysis patients.

BACKGROUND: Patients undergoing chronic hemodialysis (HD) have an impaired immune response with a dysregulated Th1/Th2 cytokine network and altered the levels of thyroid hormone (TH) in euthyroid sick syndrome. Leptin, an adipocyte-secreted hormone, is considered to be a proinflammatory adipocytokine, with multiple effects on several tissues acting on the intermediate and energy metabolism. The aims of the present study were to assess the changes in serum levels of leptin and their correlation with Th1/Th2 cytokine and TH production in HD patients. METHODS: Fifty-three uremic patients with hemodialysis were evaluated; 30 healthy volunteers served as controls. Baseline serum concentrations of interleukin-2 (IL-2), sIL-2R, interferon-gamma (IFN-gamma), IL-4 and IL-10 were analyzed using ELISA. Serum levels of leptin, total triiodothyronine (TT3), free triiodothyronine (FT3), total thyroxine (TT4), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were determined by radioimmunoassay (RIA). Other metabolic variables were measured in all patients and control subjects. Multiple correlation analysis was performed among variables. RESULTS: Mean serum leptin concentration was significantly higher in HD patients than that in controls (p<0.01), especially in women (p<0.001). While the fasting serum levels of sIL-2R and Th1-type cytokines including IL-2 and IFN-gamma were significantly higher in HD patients compared with controls, Th2-type cytokine, including IL-4 and IL-10, levels did not differ between patients and controls. The serum TT3 and FT3 levels were lower in patients than controls, but TT4, FT4 and TSH were no different. Serum leptin levels in HD patients were significantly positively correlated with IL-2, IFN-gamma, sIL-2R and TSH; and negatively correlated with IL-4, IL-10, TT3 and FT3. Serum IL-2 levels correlated positively with serum IL-4, sIL-2R, TT3 and FT3. A negative correlation was observed between serum IFN-gamma and IL-4 levels in the patients. CONCLUSIONS: These data suggest that hyperleptinemia in HD patients correlated with cytokine dysregulation with a high level of Th1-type cytokines, and euthyroid sick syndrome with low T3 levels which might be involved in Th1 polarization and low-T3 syndrome in dialysis patients.