BMD598-Case Study About MSIA And BNP : Essay Fountain

Question:

In the case study about MSIA and BNP described in one of this week’s lectures and readings (Niederkofler et al., 2008), there was clear demonstration that the available tests for measuring BNP in the blood measures several species of BNP, including inactive forms. The results from these commercially available, FDA-approved tests can lead to an inaccurate assessment of active BNP levels which could preclude heart failure patients from receiving BNP treatment which could relieve the symptoms of severe heart failure. Basically the BNP test is potentially putting heart failure patients at risk of further suffering and possible death.

Please share your thoughts on why these commercially available tests were approved by the FDA and what you think should be done to avoid this type of problem in the future.
 

 

Answer:

B-type natriuretic peptide, also known as the Brain natriuretic peptide (BNP) is the cardiac hormone which is generated or secreted by the cardiomyocytes within the ventricles of heart (Halfinger et al., 2017). Increased ventricular blood volume or pressure associated with stretching of heart muscles leads to the expression of this hormone, and hence, it is easier to understand heart failure form the diagnosis of overexpression of this hormone in human body (Maalouf & Bailey, 2016). However, through the research conducted by Niederkofler et al. (2008), it was observed that the diagnosis test for expression of BNP within patients with heart disorder did not produce accurate results and there were faults in identification of the amount of cardiac hormone released in the body during heart failure. Despite this fact, the Food and Drug Administration (FDA) has approved this diagnosis test for the identification of BNP through the process of Mass Spectrometry Immunoassay or MSIA.

However, it was determined through researches that BNP is an important and sensitive biomarker which is required in the determination of acute heart failure, besides which it also helps to understand the systolic and diastolic function of the left heart ventricles. Further, it was also observed that BNP works as a complex and universal biological marker for patients affected with heart failure and in neonatal health conditions as well, it helps to identify the rate of morbidity and mortality. Alongside this, BNP significantly narrows the diagnosis process and due to this healthcare professionals are able to understand the difference between dyspnea due to heart failure condition, compared to dyspnea occurring due to other health complications which occurs to elevated BNP level and normal BNP level respectively.  Finally, in patients who are affected with severe heart failure and associated condition, BNP marker helps to understand the efficacy of the treatment process as effective treatment for heart failure associated condition is expected to decrease the level elevated BNP concentration within the patient. Therefore, despite having issues regarding its effectiveness, its accuracy and other concerns, FDA approved this diagnosis process so that identification of heart failure condition could be observed.

From the research of Niederkofler et al. (2008), it was observed that while identification of elevated BNP levels within patients suffering from heart failure, the assessment ends up recognizing two type of BNPs which are inactive pro-BNP and the mature BNP 1-32, whereas the assessment is expected to assess the level of mature BNP 1-32 for the identification of heart failure associated condition within patients. Hence, there should be a strategy using which the identification of inactive pro-BNP could be minimized or eliminated (Maalouf & Bailey, 2016). Therefore, to improve the conditions, protease utilizers should be utilized while collecting blood samples from the patients and it should be treated with antigens marked with active BNP markers so that active antibodies associated to active BNPs could be identified and utilized for the identification of heart failure conditions in patients (Semenov & Katrukha, 2016). Further, MSIA or the Mass Spectrometry Immunoassay and the similar non-FDA approved diagnostic tests should be performed by the healthcare facilities to assure the results obtained from the BNP biomarker tests. 

 

References

Halfinger, B., Hammerer-Lercher, A., Amplatz, B., Sarg, B., Kremser, L., & Lindner, H. H. (2017). Unraveling the Molecular Complexity of O-Glycosylated Endogenous (N-Terminal) pro–B-Type Natriuretic Peptide Forms in Blood Plasma of Patients with Severe Heart Failure. Clinical chemistry, 63(1), 359-368.

Maalouf, R., & Bailey, S. (2016). A review on B-type natriuretic peptide monitoring: assays and biosensors. Heart failure reviews, 21(5), 567-578.

Niederkofler, E. E., Kiernan, U. A., O’Rear, J., Menon, S., Saghir, S., Protter, A. A., … & Schellenberger, U. (2008). Detection of endogenous B-type natriuretic peptide at very low concentrations in patients with heart failure. Circulation: Heart Failure, 1(4), 258-264.

Semenov, A. G., & Katrukha, A. G. (2016). Analytical issues with natriuretic peptides–has this been overly simplified?. EJIFCC, 27(3), 189.

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