Chapter

Cytokines and inflammatory markers

Stamatis Adamopoulos, Panagiota Georgiadou and Vassilios Voudris

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0016

Series: Oxford Textbooks

Cytokines and inflammatory markers

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The expression of classic neurohormones, such as angiotensin IIand noradrenaline, plays an important role in disease progressionin chronic heart failure (HF). This so-called neurohormonal activationseems to be involved in the cardiomyopathic process ofadverse left ventricular remodelling and dysfunction, via bothdirect and indirect effects. Therapies blocking the excessiveactivation of the renin–angiotensin system and the adrenergic systemhave become the mainstay of pharmacological treatment ofchronic HF. Another important pathway in chronic HF progression is inflamatoryactivation. Experimental studies have shown that proinflammatory cytokines may induce many aspects of the syndromeof chronic HF, such as left ventricular dysfunction, pulmonaryoedema, and the process of left ventricular remodelling, includingmyocyte hypertrophy, progressive myocyte loss through apoptosis,and endothelial dysfunction. Although the cause of the inflammationis unknown, both infectious (e.g.endotoxins) and non-infectious (e.g. oxidative stress, haemodynamic overload) events couldbe operating, including interaction with the neurohormone system. Inflammatory markers have emerged as potential indicatorsof the evolution of HF, ranging from their use for screening, diagnosis,determining prognosis, and guiding treatment. The emerging association of inflammatory mediators with thepathogenesis and progression of chronic HF has already resulted inthe development of new anti-inflammatory strategies, which might beused as adjunctive therapy in patients with chronic HF. Moreover,there is accumulating evidence that a critical network of interactionsis formed by inflammatory and the classic neurohormonal mediators,and that many of the conventional therapies for HF may, at least partially, modulate the proinflammatory cytokine milieu. However,therapies tested so far have been largely disappointing.

Chapter.  9513 words.  Illustrated.

Subjects: Cardiovascular Medicine

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