Secretoneurin is a novel prognostic cardiovascular biomarker associated with cardiomyocyte calcium handling

J Am Coll Cardiol. 2015 Feb 3;65(4):339-351. doi: 10.1016/j.jacc.2014.10.065.


Background: Secretoneurin (SN) levels are increased in patients with heart failure (HF), but whether SN provides prognostic information and influences cardiomyocyte function is unknown.

Objectives: This study sought to evaluate the merit of SN as a cardiovascular biomarker and assess effects of SN on cardiomyocyte Ca(2+) handling.

Methods: We assessed the association between circulating SN levels and mortality in 2 patient cohorts and the functional properties of SN in experimental models.

Results: In 143 patients hospitalized for acute HF, SN levels were closely associated with mortality (n = 66) during follow-up (median 776 days; hazard ratio [lnSN]: 4.63; 95% confidence interval: 1.93 to 11.11; p = 0.001 in multivariate analysis). SN reclassified patients to their correct risk strata on top of other predictors of mortality. In 155 patients with ventricular arrhythmia-induced cardiac arrest, SN levels were also associated with short-term mortality (n = 51; hazard ratio [lnSN]: 3.33; 95% confidence interval: 1.83 to 6.05; p < 0.001 in multivariate analysis). Perfusing hearts with SN yielded markedly increased myocardial levels and SN internalized into cardiomyocytes by endocytosis. Intracellularly, SN reduced Ca(2+)/calmodulin (CaM)-dependent protein kinase II δ (CaMKIIδ) activity via direct SN-CaM and SN-CaMKII binding and attenuated CaMKIIδ-dependent phosphorylation of the ryanodine receptor. SN also reduced sarcoplasmic reticulum Ca(2+) leak, augmented sarcoplasmic reticulum Ca(2+) content, increased the magnitude and kinetics of cardiomyocyte Ca(2+) transients and contractions, and attenuated Ca(2+) sparks and waves in HF cardiomyocytes.

Conclusions: SN provided incremental prognostic information to established risk indices in acute HF and ventricular arrhythmia-induced cardiac arrest.

Keywords: Ca(2+)/calmodulin (CaM)-dependent protein kinase II; biomarker; calcium cycling/excitation-contraction coupling; ventricular arrhythmias.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Animals
  • Biomarkers / blood
  • Calcium / metabolism*
  • Calcium-Calmodulin-Dependent Protein Kinase Type 2 / metabolism
  • Female
  • HEK293 Cells
  • Heart Arrest / blood*
  • Heart Arrest / etiology
  • Heart Failure / blood*
  • Heart Failure / mortality
  • Homeostasis
  • Humans
  • Male
  • Mice
  • Mice, Inbred C57BL
  • Middle Aged
  • Myocytes, Cardiac / metabolism*
  • Neuropeptides / blood*
  • Phosphorylation
  • Rats
  • Rats, Wistar
  • Secretogranin II / blood*
  • Ventricular Dysfunction / complications


  • Biomarkers
  • Neuropeptides
  • Secretogranin II
  • secretoneurin
  • Calcium-Calmodulin-Dependent Protein Kinase Type 2
  • Calcium