In patients with stable heart failure, soluble TNF-receptor 2 is associated with increased risk for depressive symptoms

Interplay of inflammatory biomarkers in heart disease patients with depressive symptoms: An update

The pathophysiological mechanisms that connect heart disease and depressive disorders have been identified as abnormal endothelial function, dysregulation of the Hypothalamic Pituitary Adrenal (HPA) axis and abnormal platelet activities. Among these mechanisms, both endothelial dysfunction and HPA axis dysregulation are influenced by low grade inflammation and play significant roles in both conditions. Consequently, it is hypothesized that inflammation is an integral part of the formation of atherosclerotic plaques, linking the occurrence of heart diseases to the activation and shedding of intercellular adhesion molecules (ICAMs), especially soluble ICAM-1. This process is accompanied by the local and systemic secretion of various inflammatory markers like interleukin-6, Tumour Necrosis Factor, and C-reactive protein. Therefore, this review primarily focuses on defining the potential role of different inflammatory biomarkers in depression and heart disease and assessing whether mediators could serve as predictive biomarkers for detecting depressive symptoms in patients with heart disease.

Depression Predicts Cardiac Cachexia in Heart Failure Patients

BACKGROUND

Cardiac cachexia (CC) is associated with increased morbidity and mortality in persons with heart failure (HF). Compared to the biological underpinning of CC, little is known about the psychological factors. Thus, the overarching objective of this study was to determine whether depression predicts the onset of cachexia at 6 months in patients with chronic HF.

METHODS

114 participants with a mean age of 56.7 ± 13.0 years, LVEF of 33.13 ± 12.30% and NYHA class III (48.0%) were assessed for depression using the PHQ-9. Body weight was measured at baseline and at 6 months. Patients who had ≥6% non-edematous unintentional weight loss were classified as cachectic. Univariate and logistic multivariate regression were used to examine the relationship between CC and depression, controlling for clinical and demographic variables.

RESULTS

Cachectic patients (11.4%) had significantly higher baseline BMI levels (31.35 ± 5.70 vs. 28.31 ± 4.73; p = .038), lower LVEF (mean = 24.50 ± 9.48 vs. 34.22 ± 12.18, p = .009), and depression scores (mean = 7.17 ± 6.44 vs. 4.27 ± 3.98, p = .049) when compared to their non-cachectic counterparts. In multivariate regression analysis, depression scores (β = 1.193, p = .035) and LVEF (β = .835, p = .031) predicted cachexia after controlling for age, gender, body mass index, VO2 max, and New York Heart Association class and accounted for 49% of the variance in Cardiac cachexia. When depression was dichotomized, depression and LVEF predicted 52.6% of the variance in CC.

CONCLUSION

Depression predicts CC in patients with HF. Additional studies are needed to expand the knowledge of the role of the psychological determinants of this devastating syndrome.

Subgroups of Patients with Distinct Health Utility Profiles after AKI

Key Points

Health utility profiles can be identified at 60 days after AKI. Patient subgroups with distinct health utility profiles have different characteristics at index hospitalization and outcomes at 1 year. These profiles may be useful when considering resources to improve the physical and emotional health of patients after AKI.

Background

A large amount of interindividual variability exists in health-related quality of life outcomes after AKI. This study aimed to determine whether subgroups of early AKI survivors could be identified on the basis of distinct health utility impairment profiles ascertained at 60 days after AKI and whether these subgroups differed in clinical and biomarker characteristics at index hospitalization and outcomes at 1-year follow-up.

Methods

This retrospective analysis used data from the Biologic Markers of Renal Recovery for the Kidney study, an observational subcohort of the Acute Renal Failure Trial Network study. Of 402 patients who survived to 60 days after AKI, 338 completed the Health Utility Index 3 survey, which measures impairments in eight health attributes. Latent class analysis was used to identify subgroups of patients with distinct health utility profiles.

Results

Three subgroups with distinct health utility impairment profiles were identified: Low (28% of participants), Moderate (58%), and High (14%) with a median of one, four, and six impairments across the eight health attributes at 60 days after AKI, respectively. Patient subgroups differed in weight, history of cerebrovascular disease, intensity of dialysis, hospital length of stay, and dialysis dependence. Serum creatinine and blood urea nitrogen at index hospitalization did not differ among the three subgroups. The High impairment subgroup had higher levels of IL-6 and soluble TNF receptor 2 at study day 1. The three subgroups had different 1-year mortality rates: 5% in the Low, 21% in the Moderate, and 52% in the High impairment subgroup.

Conclusion

Patient subgroups with distinct health utility impairment profiles can be identified 60 days after AKI. These subgroups have different characteristics at index hospitalization. A higher level of impairment at 60 days was associated with decreased survival.

Effect of Mobile Internet Technology in Health Management of Heart Failure Patients Guiding Cardiac Rehabilitation

In this paper, we are going to explore the effect of mobile Internet technology in health management for the heart failure patients with cardiac rehabilitation. To implement and evaluate its effects in real environment, a total of 60 heart failure patients were divided, preferably in random fashion, into two groups of 30 cases, i.e., control and observation groups. The former group has received the routine home cardiac rehabilitation after discharge, and the latter group, i.e., observation, has received home cardiac rehabilitation based on mobile medical technical guidance after discharge. The 6 min walking test, Minnesota Cardiac Dysfunction Quality of Life Scale score, cardiac function index, and cardiac rehabilitation training compliance were matched between these groups specifically before and after the intervention. After 12 weeks of intervention, the 6 min walking test, Minnesota Cardiac Dysfunction Quality of Life Scale score, B-type natriuretic peptide of N-terminal, end-diastolic diameter preferably left ventricular, left ventricular ejection fraction, and compliance of training, specifically in the observation group, were better than the control group whereas statistically significant differences were observed, i.e., P < 0.01. Home cardiac rehabilitation guided by mobile Internet technology can improve the function of cardiac, exercise tolerance, life's quality, and compliance of patients with heart failure.

Increased TG/HDL-C in female G allele carriers of rs1061622 at gene of tumour necrosis factor receptor 2 with suicidal ideation

BACKGROUND

Relationships between tumour necrosis factor receptor 2 (TNF-RII), suicidal ideation and levels of serum lipids have not been reported yet. The present study was to explore lipids profiles in Chinese adolescents with different genotypes of TNF-RII rs1061622 and with or without suicidal ideation.

METHODS

Dietary intakes were surveyed by questionnaires. TNF-RII rs1061622 genotypes were examined by polymerase chain reaction restriction-fragment length polymorphism and verified by DNA sequencing. Lipids levels were examined by routine methods.

RESULTS

Higher TC/HDL-C levels were observed in the subjects with suicidal ideation than those without suicidal ideation in the male students, but no significant differences were found in the female counterparts. When both TNF-RII rs1061622 and suicidal ideation were considered, although there was no significant difference of suicidal ideation prevalence between the TT homozygotes and the G allele carriers, the G allele carriers had elevated levels of TG and TG/HDL-C compared with the TT homozygotes only in the female subjects with suicidal ideation. The subjects with suicidal ideation had higher TG/HDL-C levels than those without suicidal ideation only in the female G allele carriers. Both suicidal ideation and TNF-RII rs1061622, together with BMI, gender and fat intakes, were found the predictors of TG/HDL-C levels. Different relationship patterns of lipids levels were discovered between male and female subjects with different genotypes and with or without suicidal ideation.

CONCLUSIONS

Different changes of lipids profiles between the subjects with or without suicidal ideation may result from not only the genders, but also their interactions with TNF-RII rs1061622.

CRP genetic variants are associated with mortality and depressive symptoms in chronic heart failure patients

OBJECTIVE

Heart failure (HF) is a complex medical condition with a multitude of genetic and other factors being involved in the pathogenesis. Emerging evidence points to an involvement of inflammatory mechanisms at least in subgroups of patients. The same is true for depression and depressive symptoms, which have a high prevalence in HF patients and are risk factors for the development and outcomes of cardiovascular disease.

METHODS

In 936 patients of the Interdisciplinary Network Heart Failure (INH) program, CRP and IL-6 protein blood levels were measured and genetic variants (single nucleotide polymorphisms) of the CRP and IL6 gene analyzed regarding their influence on mortality.

RESULTS

Less common recessive genotypes of two single nucleotide polymorphisms in the CRP gene (rs1800947 and rs11265263) were associated with significantly higher mortality risk (p < 0.006), higher CRP levels (p = 0.029, p = 0.006) and increased depressive symptoms in the PHQ-9 (p = 0.005, p = 0.003). Variants in the IL-6 gene were not associated with mortality.

CONCLUSION

Our results hint towards an association of less common CRP genetic variants with increased mortality risk, depressive symptoms and peripheral CRP levels in this population of HF patients thereby suggesting a possible role of the inflammatory system as link between poor prognosis in HF and depressive symptoms.

Reduced Recovery of Depression in Female T Allele Carriers of TNF-RII rs1061622 at Earlier Stage after Wenchuan Earthquake

Objective: The aim of current study was to explore longitudinally the prevalence, severity, potential factors, and predictors of depression among Chinese Han adolescent survivors with different genotypes of tumor necrosis factor receptor-II (TNF-RII) rs1061622 after the 2008 Wenchuan earthquake. Method: TNF-RII rs1061622 variants were examined by polymerase chain reaction–restriction fragment length polymorphism and verified by DNA sequencing. Depression symptoms were assessed by Beck Depression Inventory (BDI) among 439 high school students at 6, 12, and 18 months after the earthquake. Results: No significant differences were observed in depression prevalence and BDI scores between the TT homozygotes and the G allele carriers in both the male and female subjects. However, the female TT homozygotes had a higher depression prevalence than the male TT homozygotes at 6, 12, and 18 months, whereas the female G allele carriers had a higher depression prevalence than the male G allele carriers only at 6 and 12 months after the earthquake. Moreover, BDI scores declined in the male subjects with both genotypes and only in the female G allele carriers at 12 months when compared with those at 6 months. Furthermore, the predictors of depression severity or potential factors of depression prevalence were different between the G allele carriers and the TT homozygotes at different times after the earthquake. Conclusion: It is concluded that the association of TNF-RII rs1061622 with depression is longitudinally different in Chinese Han adolescents after the 2008 Wenchuan earthquake. The T allele may be associated with reduced recovery of depression in female adolescents in the earlier stage of depression rehabilitation.

Are there differences in lipid peroxidation and immune biomarkers between major depression and bipolar disorder: Effects of melancholia, atypical depression, severity of illness, episode number, suicidal ideation and prior suicide attempts

BACKGROUND

There is evidence that major depression (MDD) and bipolar disorder (BD) are accompanied by activated immune & oxidative (I&O) pathways.

METHODS

To compare I&O biomarkers between MDD and BD we assessed serum levels of thiobarbituric acid reactive substances (TBARS; a lipid peroxidation marker), soluble interleukin-2 receptor (sIL-2R), sIL-6R, IL-α, sIL-1R antagonist (sIL-1RA), tumor necrosis factor receptor 60kDa/80kDa (sTNFR60/R80) in 114 MDD and 133 BD patients, and 50 healthy controls. We computed z-unit weighted indices reflecting the 5 cytokine receptor levels (zCytR), cell-mediated immunity (zCMI) and I&O pathways (zCMI+TBARS).

RESULTS

There are no significant differences in biomarkers between MDD and BD. BD/MDD with atypical features is characterized by increased sIL-6R and TBARS, whereas melancholia is associated with higher TBARS and lower sTNFR60 levels. Severity of illness, as measured with the Hamilton Depression Rating Scale, is correlated with increased sIL-6R, sTNFR80, TBARS, zCytR and zCMI+TBARS. The number of episodes the year prior to blood sampling is positively associated with sTNFR80, TBARS, zCMI, zCMI+TBARS, while number of hospitalizations is positively associated with sIL-1RA. Prior suicidal attempts are associated with increased sIL-1RA, IL-1α, zCMI, TBARS and zCMI+TBARS, while TBARS is associated with current suicidal ideation.

CONCLUSIONS

There are no I&O biomarker differences between MDD and BD. Atypical depression is associated with increased IL-6 trans-signaling and lipid peroxidation. Severity of depression, number of episodes and suicidal attempts are associated with activated I&O pathways. Increased TBARS is the single best predictor of BD/MDD, atypical depression, melancholia and current suicidal ideation.

Lipid Peroxidation and Immune Biomarkers Are Associated with Major Depression and Its Phenotypes, Including Treatment-Resistant Depression and Melancholia

To examine immune-inflammatory and oxidative (I&O) biomarkers in major depression (MDD) and its related phenotypes, we recruited 114 well-phenotyped depressed patients and 50 healthy controls and measured serum levels of interleukin (IL)-1α, soluble IL-1 receptor antagonist (sIL-1RA), soluble IL-2 receptor (sIL-2R), soluble IL-6 receptor (sIL-6R), soluble tumor necrosis factor receptor 60 and 80 kDa (sTNF-R1/R2), and thiobarbituric acid reactive substances (TBARS). Obtained results indicate that MDD is characterized by increased sIL-1RA, sTNF-R1, and TBARS concentrations. Melancholic depression is associated with increased sIL-6R but lowered IL-1α levels. A current episode of depression is accompanied by significantly increased sIL-6R compared to the remitted state. Treatment-resistant depression (TRD) is accompanied by increased sIL-6R and TBARS but lowered sTNF-R2 levels compared to non-TRD patients. These immune markers are not significantly correlated with Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Scale (MADRS), number episodes, or age at onset. Our findings show that increased sIL-1RA, sTNF-R1, and TBARS levels may be trait markers of depression, while increased sIL-6R levels may be a state marker of melancholia and an acute phase of depression. MDD is accompanied by increased lipid peroxidation and simultaneous activation of immune pathways, and the compensatory anti-inflammatory reflex system (CIRS). TRD is characterized by highly increased oxidative stress and probably increased TNFα and IL-6 trans-signalling. Novel treatments for major depression should target oxidative stress pathways, while new treatments for TRD should primary target lipid peroxidation and also activated immune-inflammatory pathways.

Central nervous system circuits modified in heart failure: pathophysiology and therapeutic implications

The pathophysiology of heart failure (HF) is characterized by an abnormal activation of neurohumoral systems, including the sympathetic nervous and the renin-angiotensin-aldosterone systems, which have long-term deleterious effects on the disease progression. Perpetuation of this neurohumoral activation is partially dependent of central nervous system (CNS) pathways, mainly involving the paraventricular nucleus of the hypothalamus and some regions of the brainstem. Modifications in these integrative CNS circuits result in the attenuation of sympathoinhibitory and exacerbation of sympathoexcitatory pathways. In addition to the regulation of sympathetic outflow, these central pathways coordinate a complex network of agents with an established pathophysiological relevance in HF such as angiotensin, aldosterone, and proinflammatory cytokines. Central pathways could be potential targets in HF therapy since the current mainstay of HF pharmacotherapy aims primarily at antagonizing the peripheral mechanisms. Thus, in the present review, we describe the role of CNS pathways in HF pathophysiology and as potential novel therapeutic targets.