Evidence for activation of immune system in heart failure: is there a role for anti-inflammatory therapy?
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Celis
René
R
Department of Cardiology, The Methodist DeBakey Heart Center at the Methodist Hospital, Houston, Texas 77030, USA.
Torre-Martinez
Guillermo
G
Torre-Amione
Guillermo
G
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000502:physiology; D010956:Plasmapheresis
D000893:Anti-Inflammatory Agents; D007136:Immunoglobulins; D007155:Immunologic Factors; D018836:Inflammation Mediators