title: Plasma cytokine profile in tropical endomyocardial fibrosis: predominance of TNF-a, IL-4 and IL-10.
abstract: BACKGROUND
  The participation of immune/inflammatory mechanisms in the pathogenesis of tropical endomyocardial fibrosis (EMF) has been suggested by the finding of early blood and myocardial eosinophilia. However, the inflammatory activation status of late-stage EMF patients is still unknown.
  
  
  RESULTS
  We evaluated pro- and anti-inflammatory cytokine levels in plasma samples from late stage EMF patients. Cytokine levels of Tumor Necrosis Factor (TNF)-α, Interferon (IFN)-γ, Interleukin (IL)-2, IL-4, IL-6, and IL-10 were assayed in plasma samples from 27 EMF patients and compared with those of healthy control subjects. All EMF patients displayed detectable plasma levels of at least one of the cytokines tested. We found that TNF-α, IL-6, IL-4, and IL-10 were each detected in at least 74% of tested sera, and plasma levels of IL-10, IL-4, and TNF-α were significantly higher than those of controls. Plasma levels of such cytokines positively correlated with each other.
  
  
  CONCLUSIONS
  The mixed pro- and anti-inflammatory/Th2circulating cytokine profile in EMF is consistent with the presence of a persistent inflammatory stimulus. On the other hand, the detection of increased levels of TNF-α may be secondary to the cardiovascular involvement observed in these patients, whereas IL-4 and IL-10 may have been upregulated as a homeostatic mechanism to buffer both production and deleterious cardiovascular effects of pro-inflammatory cytokines. Further studies might establish whether these findings play a role in disease pathogenesis.
authors.affiliation: Laboratory of Immunology, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil; Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Aline S
authors.initials: AS
authors.lastname: Bossa
authors.affiliation: Cardiomyopathy Unit, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Vera M C
authors.initials: VM
authors.lastname: Salemi
authors.affiliation: Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Ribeiro
authors.affiliation: Division of Immunology, Department of Microbiology, Immunology and Parasitology-Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Daniela S
authors.initials: DS
authors.lastname: Rosa
authors.affiliation: Laboratory of Immunology, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil; Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ludmila Rodrigues Pinto
authors.initials: LR
authors.lastname: Ferreira
authors.affiliation: Cardiomyopathy Unit, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Suzete C
authors.initials: SC
authors.lastname: Ferreira
authors.affiliation: Pró-Sangue Foundation, São Paulo, Brazil; Institute for Investigation in Immunology (iii), INCT, São Paulo, Brazil.
authors.forename: Anna Shoko
authors.initials: AS
authors.lastname: Nishiya
authors.affiliation: Cardiomyopathy Unit, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.affiliation: Laboratory of Immunology, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil; Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Kalil
authors.affiliation: Laboratory of Immunology, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil; Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Edecio
authors.initials: E
authors.lastname: Cunha-Neto
mesh_terms: D000328:Adult; D004719:Endomyocardial Fibrosis / Q000097:blood*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood*; D007376:Interleukin-2 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D055815:Young Adult
chemical_list: D007376:Interleukin-2; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4; D007371:Interferon-gamma