title: Circulating levels of interleukin 18 reflect etiologies of heart failure: Th1/Th2 cytokine imbalance exaggerates the pathophysiology of advanced heart failure.
abstract: BACKGROUND
  Proinflammatory cytokines such as tumor necrosis factor alpha play an important role in the pathophysiology of CHF. However, the mechanisms of immune activation in CHF remain unknown. Interleukin (IL)-18, a newly discovered cytokine with pleiotropic activities, is known to induce proinflammatory cytokines, chemokines, nitric oxide, and prostaglandins.
  
  
  RESULTS
  We studied 86 patients with New York Heart Association functional class II-IV heart failure. Mean age was 62 years, 20 were women, and mean left ventricular ejection fraction was 34.8%. Circulating levels of IL-18 and IL-10, high-sensitivity testing for C-reactive protein, and brain natriuretic peptide levels were determined. Serum IL-18 concentrations were significantly higher in patients with NYHA class IV than in patients with classes II and III (P <.001). The serum level of IL-18 and the ratio of IL-18 to IL-10 were greater in patients with ischemic cardiomyopathy than in those with dilated cardiomyopathy.
  
  
  CONCLUSIONS
  Th1/Th2 cytokine imbalance exists in patients with advanced CHF according to various etiologies of CHF. The findings suggest an important role for IL-18 in the pathophysiology of CHF and provide a direction for more specific immunomodulating therapy.
authors.affiliation: Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Yamaoka-Tojo
authors.forename: Taiki
authors.initials: T
authors.lastname: Tojo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.forename: Yoji
authors.initials: Y
authors.lastname: Machida
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Osada
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D016207:Cytokines / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D020382:Interleukin-18 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018417:Th1 Cells; D018418:Th2 Cells
chemical_list: D016207:Cytokines; D020382:Interleukin-18; D016753:Interleukin-10