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Giordani AS, Candelora A, Fiacca M, Cheng C, Barberio B, Baritussio A, Marcolongo R, Iliceto S, Carturan E, De Gaspari M, Rizzo S, Basso C, Tarantini G, Savarino EV, Alp C. Myocarditis and inflammatory bowel diseases: A single-center experience and a systematic literature review. Int J Cardiol 2023; 376:165-171. [PMID: 36738845 DOI: 10.1016/j.ijcard.2023.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocarditis and inflammatory bowel diseases (IBD) are rare conditions, but may coexist. Myocarditis in IBD may be infective, immune-mediated, or due to mesalamine toxicity. A gap of knowledge exists on the clinical features of patients that present myocarditis in association with IBD, especially for endomyocardial biopsy-proven cases. Our aims are: 1) to describe the clinical characteristics of patients with an associated diagnosis of myocarditis and IBD in a single-center hospital, 2) to perform a systematic review of the literature of analogous cases. METHODS We retrospectively analyzed data of patients followed up at the outpatient Cardio-immunology and Gastroenterology Clinic of Padua University Hospital, to identify those with an associated diagnosis of myocarditis and IBD. In addition, a systematic review of the literature was conducted. We performed a qualitative analysis of the overall study population. RESULTS The study included 104 patients (21 from our single center cohort, 83 from the literature review). Myocarditis in IBD more frequently affects young (median age 31 years) males (72%), predominantly with infarct-like presentation (58%), within an acute phase of the IBD (67%) and with an overall benign clinical course (87%). Nevertheless, a not negligible quote of patients may present giant cell myocarditis, deserve immunosuppression and have a chronic, or even fatal course. Histological evidence of mesalamine hypersensitivity is scarce and its incidence may be overestimated. CONCLUSIONS Our study shows that myocarditis in association with IBD, if correctly managed, may have a spontaneous benign course, but predictors of worse prognosis must be promptly recognized.
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Affiliation(s)
- A S Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - A Candelora
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - M Fiacca
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - C Cheng
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - B Barberio
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - A Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - R Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - S Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - E Carturan
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - M De Gaspari
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - S Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - C Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - G Tarantini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - E V Savarino
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - Caforio Alp
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy.
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Damoiseaux J. The IL-2 - IL-2 receptor pathway in health and disease: The role of the soluble IL-2 receptor. Clin Immunol 2020; 218:108515. [PMID: 32619646 DOI: 10.1016/j.clim.2020.108515] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023]
Abstract
The interleukin (IL)-2 - IL-2 receptor (IL-2R) pathway is important in immunity, but is also involved in maintenance of self-tolerance. This paradox is further complicated by shedding of the IL-2Rα chain, revealing soluble (s)IL-2R. Binding of IL-2 to sIL-2R may either reduce or enhance responses depending on the target cell being involved in immunity or self-tolerance. Since sIL-2R levels are increasingly measured in clinical practice, it is detrimental for clinical interpretation to understand the possible functional impact of IL-2R shedding. In this review the role of the IL-2 - IL-2R pathway is explored and the conflicting results on the function of sIL-2R are summarized. Finally, the added value of measuring sIL-2R in different types of diseases is being elaborated upon in terms of diagnosis, follow-up, and prognosis. Adequate interpretation of results is hampered by the apparent gap in our knowledge about the functional role of sIL-2R in immunity and tolerance.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands.
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Bartekova M, Radosinska J, Jelemensky M, Dhalla NS. Role of cytokines and inflammation in heart function during health and disease. Heart Fail Rev 2019; 23:733-758. [PMID: 29862462 DOI: 10.1007/s10741-018-9716-x] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
By virtue of their actions on NF-κB, an inflammatory nuclear transcription factor, various cytokines have been documented to play important regulatory roles in determining cardiac function under both physiological and pathophysiological conditions. Several cytokines including TNF-α, TGF-β, and different interleukins such as IL-1 IL-4, IL-6, IL-8, and IL-18 are involved in the development of various inflammatory cardiac pathologies, namely ischemic heart disease, myocardial infarction, heart failure, and cardiomyopathies. In ischemia-related pathologies, most of the cytokines are released into the circulation and serve as biological markers of inflammation. Furthermore, there is an evidence of their direct role in the pathogenesis of ischemic injury, suggesting cytokines as potential targets for the development of some anti-ischemic therapies. On the other hand, certain cytokines such as IL-2, IL-4, IL-6, IL-8, and IL-10 are involved in the post-ischemic tissue repair and thus are considered to exert beneficial effects on cardiac function. Conflicting reports regarding the role of some cytokines in inducing cardiac dysfunction in heart failure and different types of cardiomyopathies seem to be due to differences in the nature, duration, and degree of heart disease as well as the concentrations of some cytokines in the circulation. In spite of extensive research work in this field of investigation, no satisfactory anti-cytokine therapy for improving cardiac function in any type of heart disease is available in the literature.
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Affiliation(s)
- Monika Bartekova
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic.,Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Jana Radosinska
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic.,Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Marek Jelemensky
- Institute for Heart Research, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Naranjan S Dhalla
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Center, 351 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada. .,Department of Physiology and Pathophysiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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Wojciechowska C, Wodniecki J, Wojnicz R, Romuk E, Jacheć W, Tomasik A, Skrzep-Poloczek B, Spinczyk B, Nowalany-Kozielska E. Neopterin and beta-2 microglobulin relations to immunity and inflammatory status in nonischemic dilated cardiomyopathy patients. Mediators Inflamm 2014; 2014:585067. [PMID: 25214716 PMCID: PMC4151370 DOI: 10.1155/2014/585067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/29/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the relationships among serum neopterin (NPT), β2-microglobulin (β2-M) levels, clinical status, and endomyocardial biopsy results of dilated cardiomyopathy patients (DCM). METHODS Serum NPT and β-2 M were determined in 172 nonischaemic DCM patients who underwent right ventricular endomyocardial biopsy and 30 healthy subjects (ELISA test). The cryostat biopsy specimens were assessed using histology, immunohistology, and immunochemistry methods (HLA ABC, HLA DR expression, CD3 + lymphocytes, and macrophages counts). RESULTS The strong increase of HLA ABC or HLA DR expression was detected in 27.2% patients-group A-being low in 72.8% patients-group B. Neopterin level was increased in patients in group A compared to healthy controls 8.11 (4.50-12.57) versus 4.99 (2.66-8.28) nmol/L (P < 0.05). β-2 microglobulin level was higher in DCM groups A (2.60 (1.71-3.58)) and B (2.52 (1.51-3.72)) than in the control group 1.75 (1.28-1.96) mg/L, P < 0.001. Neopterin correlated positively with the number of macrophages in biopsy specimens (P < 0.05) acute phase proteins: C-reactive proteins (P < 0.05); fibrinogen (P < 0.01); and NYHA functional class (P < 0.05) and negatively with left ventricular ejection fraction (P < 0.05). CONCLUSIONS Neopterin but not β-2 microglobulin concentration reflected immune response in biopsy specimens. Neopterin correlated with acute phase proteins and stage of heart failure and may indicate a general immune and inflammatory activation in heart failure.
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Affiliation(s)
- Celina Wojciechowska
- Second Department of Cardiology, School of Medicine with the Division of Dentistry, Medical University of Silesia,
Ulica M.C. Skłodowskiej 10, 41-800 Zabrze, Poland
| | - Jan Wodniecki
- Second Department of Cardiology, School of Medicine with the Division of Dentistry, Medical University of Silesia,
Ulica M.C. Skłodowskiej 10, 41-800 Zabrze, Poland
| | - Romuald Wojnicz
- Department of Histology and Embryology, School of Medicine with the Division of Dentistry, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Ewa Romuk
- Department of Biochemistry, School of Medicine with the Division of Dentistry, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Wojciech Jacheć
- Second Department of Cardiology, School of Medicine with the Division of Dentistry, Medical University of Silesia,
Ulica M.C. Skłodowskiej 10, 41-800 Zabrze, Poland
| | - Andrzej Tomasik
- Second Department of Cardiology, School of Medicine with the Division of Dentistry, Medical University of Silesia,
Ulica M.C. Skłodowskiej 10, 41-800 Zabrze, Poland
| | - Bronisława Skrzep-Poloczek
- Department of Biochemistry, School of Medicine with the Division of Dentistry, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Beata Spinczyk
- Department of Histology and Embryology, School of Medicine with the Division of Dentistry, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Ewa Nowalany-Kozielska
- Second Department of Cardiology, School of Medicine with the Division of Dentistry, Medical University of Silesia,
Ulica M.C. Skłodowskiej 10, 41-800 Zabrze, Poland
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5
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Rubaj A, Rucinski P, Kutarski A, Dabrowska-Kugacka A, Oleszczak K, Zimon B, Trojnar M, Zapolski T, Drozd J, Tarkowski A, Wysokinski A. Cardiac hemodynamics and proinflammatory cytokines during biatrial and right atrial appendage pacing in patients with interatrial block. J Interv Card Electrophysiol 2013; 37:147-54. [PMID: 23625090 PMCID: PMC3698432 DOI: 10.1007/s10840-013-9792-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 02/12/2013] [Indexed: 11/10/2022]
Abstract
Purpose Interatrial block (IAB) frequently coexists with sinus node disease and is considered a risk factor of left atrial dysfunction, atrial arrhythmias, and heart failure development. Conventional right atrial appendage (RAA) pacing impairs intra- and interatrial conductions and consequently prolongs P wave duration. Biatrial (BiA) pacing helps correct IAB, but its advantageous influence remains controversial. The aim of the study was to compare the effects of BiA and RAA pacing on cardiac hemodynamics and serum concentrations of inflammatory markers and neuropeptides. Methods Twenty-eight patients with IAB and preserved atrio-ventricular conduction treated with BiA pacing were studied. Standard invasive hemodynamic measurements were performed during BiA and RAA pacings. Furthermore, the influence of 1 week of BiA and RAA pacing on neuropeptides: atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and markers of inflammation: high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and neopterin was examined. Results BiA pacing resulted in significant increase of cardiac output (CO) and reduction of pulmonary capillary wedge pressure. We demonstrated significantly lower concentrations of ANP, hs-CRP, IL-6, and neopterin after 1 week of BiA in comparison to RAA pacing. BNP levels remained unchanged. Conclusions BiA pacing in comparison to RAA pacing improves hemodynamic performance in patients with IAB and preserved atrio-ventricular conduction. BiA pacing is associated with reduction of ANP and markers of inflammation (hs-CRP, IL-6, and neopterin).
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Affiliation(s)
- Andrzej Rubaj
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str, Lublin, Poland
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Caruso R, De Chiara B, Campolo J, Verde A, Musca F, Belli O, Parolini M, Cozzi L, Moreo A, Frigerio M, Parodi O. Neopterin levels are independently associated with cardiac remodeling in patients with chronic heart failure. Clin Biochem 2013; 46:94-8. [DOI: 10.1016/j.clinbiochem.2012.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 01/29/2023]
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7
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Differences in virus prevalence and load in the hearts of patients with idiopathic dilated cardiomyopathy with and without immune-mediated inflammatory diseases. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1182-7. [PMID: 22695157 DOI: 10.1128/cvi.00281-12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infections with cardiotrophic viruses and immune-mediated responses against the heart have been suggested to play a dominant role in the pathogenesis of idiopathic dilated cardiomyopathy (DCM). Furthermore, immune-mediated inflammatory diseases (IMIDs) may result in DCM. It has not previously been assessed whether DCM patients with and without an IMID have different prevalences and quantities of cardiotrophic viruses in the heart. Therefore, we compared the profiles of cardiotrophic viruses in heart tissue of DCM patients with and without an IMID. Serum and myocardial tissue samples were obtained from 159 consecutive patients with DCM and 20 controls. Patients were subdivided into three groups, the first two based on the presence (n = 34) or absence (n = 125) of an IMID and the third being a control group. The parvovirus B19 virus genome was detected in equal quantities in the non-IMID DCM patients (100/125) and the control group (15/20) but in lower quantities in the IMID patients (21/34, P = 0.02). Both the non-IMID and IMID DCM patients demonstrated increased myocardial inflammation compared to controls: 12.5 ± 1.8 and 14.0 ± 3.2 CD45-positive inflammatory cells, respectively, versus 5.1 ± 0.7 for the controls (P < 0.05 for both). Importantly, significantly higher parvovirus B19 copy numbers could be amplified in non-IMID than in IMID patients (561 ± 97 versus 191 ± 92 copies/μg DNA, P < 0.001) and control subjects (103 ± 47 copies/μg DNA, P < 0.001). The present study shows decreased parvovirus B19 prevalence and copy numbers in hearts of DCM patients with an IMID compared to those without an IMID. These findings may suggest that DCM patients with an IMID have a different pathophysiologic mechanism from that which is present in the virus-induced form of DCM.
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8
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Li X, Luo R, Jiang R, Chen R, Hua W. Human leukocyte antigen-DQ beta 1 chain (DQB1) gene polymorphisms are associated with dilated cardiomyopathy: a systematic review and meta-analysis. Heart Lung 2012; 41:360-7. [PMID: 22386792 DOI: 10.1016/j.hrtlng.2012.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 01/06/2012] [Accepted: 01/28/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies reported an association between the human leukocyte antigen (HLA)-DQ antigen beta 1 chain (DQB1) alleles and dilated cardiomyopathy (DCM). However, the results of those studies have been inconsistent. To clarify the association between HLA-DQB1 and DCM, we performed a systematic review and meta-analysis of case-control studies. METHODS Searches were performed using the PubMed database, the Excerpta Medica Database (EMBASE), the Cochrane Central Register of Controlled Trials database, the Science Citation Index database, the China Biology Medicine disc, the China National Knowledge Information database, the Wanfang database, and the Chinese Scientific and Technological Journal Database (VIP database). The search terms included "dilated cardiomyopathy" and "DQB1." Ten case-controlled studies were included in the systematic review to assess the association between DCM and the HLA-DQB1*0201, *0302, *0504, *0301, and *0602 alleles. RESULTS In total, 8 studies were included in the meta-analysis of the HLA-DQB1 *0201 allele. The pooled odds risk (OR) for this allele was .47, with a 95% confidence interval (CI) of .28 to .77 (P < .01). With respect to the HLA-DQB1 *0504 allele, only 3 studies were included in our meta-analysis. The pooled OR was .36 (95% CI, .15 to .84; P < .05). Nine, 8, and 7 studies of the HLA-DQB1 *0301, *0302, and *0602 alleles, respectively, were included in our meta-analysis. No statistically significant difference was evident in the frequency of these 3 alleles between the DCM and normal control groups. CONCLUSION The HLA-DQB1 *0201 and *0504 alleles may be protective against DCM.
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Affiliation(s)
- Xiaoping Li
- Department of Clinical Electrophysiology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Deng J, Luo R, Li X. HLA-DRB1 gene polymorphism is associated with idiopathic dilated cardiomyopathy: a meta-analysis. J Cardiovasc Med (Hagerstown) 2011; 12:648-52. [PMID: 21709571 DOI: 10.2459/jcm.0b013e328349424b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Some studies have reported that the HLA-DRB1 allele was associated with idiopathic dilated cardiomyopathy. However, there have been inconsistent results among different studies. To clarify the association of HLA-DRB1 and idiopathic dilated cardiomyopathy, a meta-analysis of case-control studies was performed. METHODS PubMed database, Science Citation Index database, The Cochrane Central Register of Controlled Trials database, China National Knowledge Information database, Chinese Biomedical Literature database, Wanfang database, and VIP database in China were searched. Search terms included dilated cardiomyopathy and DRB1. Five case-control studies were included in the present meta-analysis to assess the association between HLA-DRB1*1401, HLA-DRB1*0901, HLA-DRB1*0301, and idiopathic dilated cardiomyopathy. RESULTS A total of four studies were included in our meta-analysis for HLA-DRB1*1401 and HLA-DRB1*0901. The pooled odds ratio (OR) was 2.6 [95% confidence interval (CI) 1.11-6.11, P<0.05] and 0.70 (95% CI 0.48-1.00, P=0.05), respectively. For the HLA-DRB1*0301 allele, just three studies were included in our meta-analysis. The pooled OR was 0.49 (95% CI 0.27-0.91, P<0.05). The present meta-analysis indicated that the frequency of HLA-DRB1*1401 was higher in idiopathic dilated cardiomyopathy patients than in healthy people, whereas HLA-DRB1*0901 and HLA-DRB1*0301 were higher in healthy people than in idiopathic dilated cardiomyopathy patients. CONCLUSION The HLA-DRB1*1401 allele might be a risk factor for idiopathic dilated cardiomyopathy and HLA-DRB1*0901 and HLA-DRB1*0301 might protect humans from idiopathic dilated cardiomyopathy.
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Affiliation(s)
- Jinlong Deng
- Department of Cardiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China
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Hennig F, Stepanenko AV, Lehmkuhl HB, Kukucka M, Dandel M, Krabatsch T, Hetzer R, Potapov EV. Neurohumoral and inflammatory markers for prediction of right ventricular failure after implantation of a left ventricular assist device. Gen Thorac Cardiovasc Surg 2011; 59:19-24. [DOI: 10.1007/s11748-010-0669-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 07/08/2010] [Indexed: 11/29/2022]
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Hamdy NM. Relationship between pro-anti-inflammatory cytokines, T-cell activation and CA 125 in obese patients with heart failure. Med Sci Monit 2011. [PMCID: PMC3524732 DOI: 10.12659/msm.881453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nadia M. Hamdy
- Department of Biochemistry, Ain Shams University, Faculty of Pharmacy, Cairo, Egypt
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12
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The pathogenesis of heart failure due to dilated cardiomyopathy. Acta Med Litu 2009. [DOI: 10.2478/v10140-009-0012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Evidence for activation of immune system in heart failure: is there a role for anti-inflammatory therapy? Curr Opin Cardiol 2008; 23:254-60. [PMID: 18382215 DOI: 10.1097/hco.0b013e3282fbfbc7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The efficacy of already established heart failure therapeutics limits new developments; however, there are still fertile grounds for growth with a better understanding of often overlooked mechanisms of disease. We will review evidence on inflammation and components of the inflammatory process occurring in patients with chronic heart failure, review different therapeutic techniques such as intravenous immunoglobin, plasmapheresis and immuno-adsorption. RECENT FINDINGS The use of highly specific anti-inflammatory therapeutic strategies in large randomized trials such as anti-TNF-alpha has failed to show clinical benefits; however, by taking a broad spectrum anti-inflammatory approach, strategies as in the ACCLAIM trial have been effective in improving the outcome in a select group of patients. SUMMARY There is substantial evidence of immune modulation promoting the downregulation of inflammatory cytokines thus increasing several important and potentially therapeutic anti-inflammatory cytokines. It will be necessary to design large multicenter trials to overcome the expected improvements of current therapies, which may overshadow results, and to finally elucidate the therapeutic contributions of immune modulation in heart failure.
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Barani J, Mattiasson I, Lindblad B, Gottsäter A. Cardiac function, inflammatory mediators and mortality in critical limb ischemia. Angiology 2006; 57:437-44. [PMID: 17022379 DOI: 10.1177/0003319706290743] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with critical limb ischemia (CLI) have a high frequency of concomitant coronary heart disease and congestive heart failure. The aim of the study was to evaluate cardiac function in relation to inflammatory markers and 1-year mortality rate among patients with CLI. The authors investigated 232 consecutive patients with CLI by means of electrocardiogram (ECG), and measurements of endothelin (ET)-1, tumor necrosis factor alpha (TNF)alpha, interleukin (IL)-6, neopterin, CD40 ligand, and 8-epi-prostaglandin (PG)F2alpha in plasma. Echocardiography (echo) was performed in 88 (38%) patients. One-year mortality rate was assessed after prospective follow-up. One hundred and eighty-six (80%) patients had sinus rhythm (SR), 36 (16%) had atrial fibrillation or flutter (AF), and 10 (4%) pacemaker rhythm. Ischemic ECG changes occurred in 143 (62%) patients. Patients with AF showed higher IL-6 (p = 0.0296) and neopterin (p = 0.0494) concentrations. Patients with ischemic ECG changes showed higher ET-1 (p = 0.0303), 8-epi-PGF2alpha (p = 0.0027), neopterin (p = 0.0004) concentrations and 1-year mortality rate (p = 0.0105). The difference in ET-1 remained in logistic regression (p = 0.0152). Internal diameter of the left ventricle on echo correlated with IL-6 (r = 0.345, p = 0.0017), TNFalpha (r = 0.240, p = 0.0273), and neopterin (r = 0.327, p = 0.0028). Internal diameter of the left atrium correlated with TNFalpha (r = 0.384, p = 0.0092) and neopterin (r = 0.526, p = 0.0004), and ejection fraction (EF) correlated inversely with IL-6 (r = -0.380, p = 0.0015) and neopterin (r = -0.346, p = 0.0038). Patients with EF <40% showed higher (p = 0.0462) 1-year mortality rate than patients with EF >40%. In conclusion, in critical limb ischemia, cardiac rhythm disturbances and ischemic ECG changes were related to inflammatory mediators and predicted 1-year mortality rate. The inflammatory mediators correlated with echocardiographic signs of congestive heart failure.
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Affiliation(s)
- Jamal Barani
- University of Lund, Department of Vascular Diseases, Malmö University Hospital, Malmö, Sweden.
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Caforio ALP, Mahon NG, McKenna WJ. Clinical implications of anti-cardiac immunity in dilated cardiomyopathy. ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2006:169-93. [PMID: 16329663 DOI: 10.1007/3-540-30822-9_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Criteria of organ-specific autoimmunity are fulfilled in a subset of patients with myocarditis/dilated cardiomyopathy (DCM). In particular, circulating heart-reactive autoantibodies are found in such patients and symptom-free relatives. These autoantibodies are directed against multiple antigens, some of which are expressed in the heart (organ-specific), others in heart and some skeletal muscle fibres (partially heart-specific) or in heart and skeletal muscle (muscle-specific). Distinct autoantibodies have different frequency in disease and normal controls. Different techniques detect one or more antibodies, thus they cannot be used interchangeably for screening. It is unknown whether the same patients produce more antibodies or different patient groups develop autoimmunity to distinct antigens. IgG antibodies, shown to be cardiac- and disease-specific for myocarditis/DCM, can be used as autoimmune markers for relatives at risk as well as for identifying patients in whom immunosuppression may be beneficial. Some autoantibodies may also have a functional role, but further work is needed.
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Affiliation(s)
- A L P Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences, Centro V Gallucci, Policlinico University of Padua, Padova, Italy.
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Liu W, Li WM, Sun NL. HLA-DQA1, -DQB1 Polymorphism and Genetic Susceptibility to Idiopathic Dilated Cardiomyopathy in Hans of Northern China. Ann Hum Genet 2005; 69:382-8. [PMID: 15996167 DOI: 10.1111/j.1529-8817.2005.00166.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autoimmune mechanisms are likely to participate in the pathogenesis of at least a subgroup of idiopathic dilated cardiomyopathy (IDC), and components of the major histocompatibility complex (MHC) may serve as markers for the propensity to develop immune-mediated myocardial damage. Human leukocyte antigen (HLA) class II genes, especially HLA-DQ genes, which are highly polymorphic, play an important role in the activation of immune responses and thus control the predisposition to, or protection from, IDC. This study was conducted to investigate the association of HLA-DQA1, -DQB1 allele polymorphisms with an autoantibody against the myocardial mitochondria ADP/ATP carrier, and to explore susceptibility to idiopathic dilated cardiomyopathy (IDC) among the Han ethnic group in northern China and the immunological mechanisms and hereditary susceptibility to IDC. Polymerase chain reaction sequence-specific primer (PCR-SSP) techniques were used to analyze polymorphisms of the second exon of HLA-DQA1 and -DQB1 alleles among 68 unrelated IDC patients, 4 probands of IDC pedigrees, and 100 healthy controls, all of Han nationality and having lived in northern China for a long time. Following echocardiography examination the IDC subjects were stratified according to ejection fraction (EF) values. Those with EF values higher than 50% were placed in subgroup 1, subgroup 2 included the patients with an EF value of 15-35%, and subgroup 3 consisted of those whose EF values were less than 15%. An autoantibody against the myocardial mitochondria ADP/ATP carrier was examined using immunoblot analysis. The frequencies of HLA-DQA1*0501 and HLA-DQB1*0303 were 0.3889 and 0.1806 in the IDC group, significantly higher than those of the healthy controls (0.0900 and 0.0364 respectively, both P < 0.05). The OR was 5.20 (95% CI: 3.60-8.50) and 4.85 (95% CI: 2.56-9.39) respectively. Further analysis of the three subgroups showed a higher frequency of HLA-DQA1*0501 among patients whose EF was less than 15% than those whose EF values were > or =15%. Conversely, the frequencies of HLA-DQA1*0201 and -DQB1*0502, *0504 were significantly lower in the IDC group (0.0139, 0.0139 and 0.0417 respectively) than in the control group (0.2000, 0.0727 and 0.1091 respectively) (P < 0.05). The frequency of the HLA-DQA1*0501 allele was significantly higher in IDC patients whose autoantibody is positive in contrast with those whose autoantibody is negative (18.57% vs. 5.86%, P < 0.05); the relative risk (RR) was 4.32. The other frequencies of HLA-DQA1 and -DQB1 alleles showed no significant difference in the antibody positive and negative groups of IDC patients. The alleles of HLA-DQA1*0501 and HLA-DQB1*0303 were closely associated with poor EF values in the IDC group, and may be involved in susceptibility to the disease. The DQA1*0201 and DQB1*0502, *0504 alleles may confer protection to IDC among individuals of northern Chinese Han nationality. The SER(57) residue in the second exon of DQB1*0502 and *0504 may confer resistance to IDC, and defects or substitution of this amino acid residue at position 57 of the DQbeta chain may be associated with IDC susceptibility. HLA-DQ allele polymorphisms may serve as genetic markers for IDC and be involved in the regulation of the immune specific response to auto or exterior anti-myocardium antibodies.
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Affiliation(s)
- Wei Liu
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
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Abstract
BACKGROUND Heart failure (HF) is a devastating disease with increasing prevalence in elderly populations. One-half of all patients die within 5 years of diagnosis. The annual cost of treating patients with HF in the US is more than $20 billion, which is estimated to be greater than that of myocardial infarction and all cancers combined. Given the complex pathophysiology and varied manifestations of HF, interest has intensified in developing biological markers to predict susceptibility and aid in the early diagnosis and management of this disease. METHODS We searched Medline via Ovid for studies published during the period 1966-2003 regarding various biomarkers suggested for HF. Our review focused on developing strategies for discovering and using new biomarkers, particularly those potentially linked to pathophysiologic mechanisms. We also point out strategic advantages, limitations, and methods available for measuring each of the currently proposed markers. RESULTS Biomarkers reviewed include those released from the heart during normal homeostasis (natriuretic peptides), those produced elsewhere that act on the heart (endogenous cardiotonic steroids and other hormones), and those released in response to tissue damage (inflammatory cytokines). The concept of using a combination of multiple markers based on diagnosis, prognosis, and acute vs chronic disease is also discussed. In view of recent advances in our understanding of molecular biochemical derangements observed during cardiac failure, we consider the concept of myocardial remodeling and the heart as part of an endocrine system as strategies. CONCLUSION Strategically, biomarkers linked to mechanisms involved in the etiology of HF, such as dysregulation of ion transport, seem best suited for serving as early biological markers to predict and diagnose disease, select therapy, or assess progression.
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Affiliation(s)
- Saeed A Jortani
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY 40292, USA
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Caforio ALP, Mahon NJ, Tona F, McKenna WJ. Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance. Eur J Heart Fail 2002; 4:411-7. [PMID: 12167378 DOI: 10.1016/s1388-9842(02)00010-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a relevant cause of heart failure and a common indication for heart transplantation. It may be idiopathic, familial/genetic, viral, autoimmune or immune-mediated associated with a viral infection. Myocarditis is an inflammatory disease of the myocardium; it may be idiopathic, infectious or autoimmune and may heal or lead to DCM. Thus, in a patient subset, myocarditis and DCM are thought to represent the acute and chronic stages of an organ-specific autoimmune disease of the myocardium. In keeping with this hypothesis, autoimmune features in patients with myocarditis/DCM include: familial aggregation; a weak association with HLA-DR4; abnormal expression of HLA class II on cardiac endothelium on endomyocardial biopsy; and detection of organ- and disease-specific cardiac autoantibodies of the IgG class in the sera of affected patients and symptom-free relatives. The cardiac autoantibodies detected by immunofluorescence are directed against multiple antigens. Two of these, first identified using immunoblotting and confirmed by ELISA, are the atrial-specific alpha- and the ventricular and skeletal muscle beta-heavy chain isoform. The alpha-myosin isoform fulfils the expected criteria for organ-specific autoimmunity, in that immunization with cardiac, but not skeletal myosin reproduces, in susceptible mouse strains, the human disease phenotype of myocarditis/DCM; in addition, alpha-myosin is entirely cardiac-specific. Additional antigenic targets of heart-reactive autoantibodies include unknown sarcolemmal proteins, mitochondrial enzymes, beta-adrenergic and muscarinic receptors. For some of these antibodies, there is in vitro evidence for a functional role. The organ-specific cardiac autoantibodies detected by immunofluorescence in symptom-free relatives were associated with echocardiographic features suggestive of early disease. Mid-term follow-up suggests that these antibodies are predictive markers of progression to DCM among symptom-free relatives with or without abnormal echocardiographic findings.
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Affiliation(s)
- Alida L P Caforio
- Division of Cardiology, Department of Clinical and Experimental Medicine, University of Padua, Policlinico Universitario, Centro 'V. Gallucci', via N. Giustiniani, 2, Italy.
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Karakuzu A, Aktaş A, Akçay F. Serum E-selectin and beta 2-microglobulin levels in Behçet's disease. J Int Med Res 2002; 30:85-8. [PMID: 11921504 DOI: 10.1177/147323000203000113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Behçet's disease is a systemic vasculitis of unknown aetiology. Endothelial cell injury plays an important role in the pathogenesis and immunopathology of systemic vasculitises, but an immunopathogenic basis is also probable in Behçet's disease. E-selectin is an indicator of endothelial injury, and beta 2-microglobulin (beta 2M) is increased in immunological disorders. The serum concentrations of these two markers were determined in 40 patients with active Behçet's disease and 40 healthy controls. E-selectin was determined by enzyme-linked immunosorbent assay and beta 2M was determined by the nephelometric method. The mean (+/- SD) serum concentration of E-selectin was 122.13 +/- 62.32 ng/ml and that of beta 2M was 0.31 +/- 0.05 mg/dl. Both concentrations were statistically significantly increased in patients with Behçet's disease compared with controls. More comprehensive studies are needed to determine whether these parameters are useful indicators of the activity of Behçet's disease.
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Affiliation(s)
- A Karakuzu
- Department of Dermatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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