title: Increased toll-like receptor 4 in the myocardium of patients requiring left ventricular assist devices.
abstract: BACKGROUND
  Cytokine activation in the myocardium of deteriorating patients with heart failure who undergo left ventricular assist-device (LVAD) implantation has been documented, but the underlying mechanisms remain poorly understood. We hypothesized the innate immune system is activated with expression of Toll-like receptor 4 (TLR4), leading to cytokine activation in these patients.
  
  
  METHODS
  We used quantitative real-time reverse-transcriptase polymerase chain reaction to measure TLR4, interleukin-1 (IL-1) receptor, IL-1 beta, IL-6, and tumor necrosis factor alpha (TNF-alpha) mRNA expression in myocardial samples from 36 patients. We compared 18 patients who underwent LVAD implantation with 18 patients with less severe heart failure who underwent elective heart transplantation.
  
  
  RESULTS
  Toll-like receptor 4 expression was 1.69-fold greater (p < 0.05) and IL-1 receptor expression was 3.64-fold greater (p < 0.0001) in the deteriorating patients who required LVADs. Myocardial TNF-alpha (1.71-fold, p < 0.05), IL-6 (2.57-fold, p < 0.005), and IL-1 beta (9.78-fold, p < 0.001) also were increased in the LVAD candidates. Toll-like receptor 4 expression correlated strongly with IL-1 receptor expression (r= 0.75, p < 0.0001) and with IL-1 beta expression in individual patients (r = 0.7, p < 0.0001). Interleukin-1 receptor expression also correlated with IL-1 beta expression (r = 0.78, p < 0.0001) within patients. We found no correlation between TLR4 and either TNF-alpha or IL-6 expression.
  
  
  CONCLUSIONS
  Patients who required LVAD support showed evidence of innate immune system activation, indicated by an increase in the key effector molecule TLR4 associated with a specific pattern of cytokine expression in the myocardium.
authors.affiliation: Heart Science Centre, Royal Brompton and Harefield Hospital, Harefield, Middlesex, United Kingdom.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Birks
authors.forename: Leanne E
authors.initials: LE
authors.lastname: Felkin
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
authors.forename: Paul J R
authors.initials: PJ
authors.lastname: Barton
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000328:Adult; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000276:immunology* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D007375:Interleukin-1 / Q000276:immunology; D015850:Interleukin-6 / Q000276:immunology; D008297:Male; D008562:Membrane Glycoproteins / Q000276:immunology*; D009206:Myocardium / Q000276:immunology*; D012333:RNA, Messenger / Q000235:genetics; D011956:Receptors, Cell Surface / Q000276:immunology*; D017472:Receptors, Interleukin-1 / Q000276:immunology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D051197:Toll-Like Receptor 4; D051193:Toll-Like Receptors; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
chemical_list: D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D008562:Membrane Glycoproteins; D012333:RNA, Messenger; D011956:Receptors, Cell Surface; D017472:Receptors, Interleukin-1; C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D051193:Toll-Like Receptors; D014409:Tumor Necrosis Factor-alpha