title: Cardiorenal syndrome type 1: a defective regulation of monocyte apoptosis induced by proinflammatory and proapoptotic factors.
abstract: In this study, we examined the possible immune-mediated mechanisms in cardiorenal syndrome (CRS) type 1 pathogenesis. We enrolled 40 patients with acute heart failure (AHF), 11 patients with CRS type 1 and 15 controls. Plasma from the different groups was incubated with monocytes; subsequently, cell apoptosis was evaluated by DNA fragmentation, caspase activity and cytofluorometric assay. Cytokine quantification in plasma and supernatant was performed by ELISA. Monocytes treated with CRS type 1 plasma showed significantly higher apoptosis compared with those treated with AHF and the controls (p < 0.05). Caspase-3 (CRS type 1: 2.20 ng/ml, IQR 2.06-2.33; AHF: 1.48 ng/ml, IQR 1.31-1.56; controls: 0.71 ng/ml, IQR 0.67-0.81) and caspase-8 levels (CRS type 1: 1.49 ng/ml, IQR 1.42-1.57; AHF: 0.94 ng/ml, IQR 0.84-0.98; controls: 0.56 ng/ml, IQR 0.51-0.58) in cells incubated with plasma from these patients demonstrated a significantly higher concentration. We observed a strong upregulation of plasma IL-6 and IL-18 in CRS type 1 compared with AHF and the controls (p < 0.05). Interestingly, we observed a similar concentration of TNF-α in CRS type 1 and AHF. In CRS type 1 patients, IL-6 (52.13 ng/ml, IQR 47.29-66.83) and IL-18 levels (197.75 ng/ml, IQR 120.80-265.49) in supernatant were significantly higher than in AHF patients (IL-6: 28.79 ng/ml, IQR 19.90-36.10; IL-18: 21.98 ng/ml, IQR 15.98-29.85) and controls (IL-6: 5.02 ng/ml, IQR 4.56-6.44; IL-18: 7.91 ng/ml, IQR 5.57-10.62). These findings suggest the presence of a defective regulation of monocyte apoptosis in CRS type 1 patients and the involvement of an immune-mediated mechanism in the pathophysiology of this syndrome.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy ; Department of Information Engineering, University of Padua, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pastori
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy.
authors.forename: Grazia Maria
authors.initials: GM
authors.lastname: Virzì
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy ; Laboratory of Experimental Hepatology, Department of Medicine, University of Padua, Italy ; Department of Medicine DIMED, University of Padua Medical School, Padua, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brocca
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: de Cal
authors.affiliation: IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy ; Department of Nephrology and Dialysis, San Giovanni Di Dio Hospital, Agrigento, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Clementi
authors.affiliation: Internal Medicine, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Vescovo
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Vicenza, Italy ; IRRIV-International Renal Resarch Institute Vicenza, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
keywords: Acute heart failure; Apoptosis; Cardiorenal syndrome; Immune-mediated mechanism; Inflammation; Monocytes