The Role of Inflammatory Mediators in the Failing Heart (Developments in Cardiovascular Medicine)


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Although clinicians have recognized the importance of inflammatory mediators in the pathogenesis of heart disease for well over 200 years, it has taken nearly as many years for clinicians and scientists to focus on the basic biological mechanisms by which inflammatory mediators contribute to the pathogenesis of cardiac disease states. Over the past decade there has been increasing interest in the potential role that inflammatory mediators, play in a variety of cardiac disease states, including chronic heart failure.The Role of Inflammatory Mediators in the Failing Heart provides a state-of-the-art review on inflammatory mediators and the failing heart. This book will serve both as a useful introduction to the field, as well as an update for those interested in the role of inflammatory mediators and the failing heart.
The Role of Inflammatory Mediators in the Failing Heart (Developments in Cardiovascular Medicine) Review
Chronic heart failure is much more than mere pump failure; recent years have seen growing research into its musculoskeletal, renal, neuroendocrine and immune implications. When, over ten years ago, Levine and associates demonstrated that the inflammatory tumour necrosis factor-� (TNF�) is elevated in heart failure patients, they triggered an avalanche of research. It became clear that not only neurohormonal mediators, such as the renin angiotensin system and the adrenergic system, are overactivated in this disease; the immune system merits attention. "The role of inflammatory mediators in the failing heart" edited by Douglas Mann, gives an excellent insight into this. Several chapters summarise the current knowledge of the role of the immune system in this disease. Douglas Mann, however, admits in his introduciton "it is probably not possible to cover all aspects of this rapidly changing field in a single text".The first three chapters deal with the most important cytokines in heart failure, namely TNF�, interleukin (IL) 1 and IL6. Douglas Mann himself covers the section on TNF�, which he diffidently calls "Recent insights into the role of tumour necrosis factor in the failing heart", although it represents more or less the entire current knowledge on TNF physiology and pathophysiology in heart failure. Other acclaimed experts describe IL-1 and IL-6, and provide us with insights into less investigated phenomena, such as the induction of cardiac apoptosis and the role in arrhythmogenesis. The interactions of these substances with each other, with neurohormonal systems, and with nitric oxide (NO) and nitric oxide synthase are far from clear. Walter J. Paulus, a specialist in NO research, gives a concise overview of the role of NO in myocardial function and its altered significance in the failing heart. Indeed, NO appears to be a mixed blessing in this setting.Anita Deswall and Diykem Bozkurt contributed a very stimulating chapter on "The roles of anticytokine therapy in the failing heart". They discuss different approaches to reducing TNF� in the circulation and the failing heart. Drugs such as prednisone thalidomide, and pentoxifyline have shown promising results. Small studies investigating the role of direct TNF antagonism using a TNF� receptor fusion protein called etanercept have also been promising. However, the outcome of a large-scale clinical trial to investigate this drug in a large heart failure population has shown detrimental effects.This book gives an up-to-date overview of current knowledge and we cannot recommend it strongly enough. In future editions, chapters on the role of physiological dampeners of the immune response as well as on the role of leukocytes and immune organs in heart failure, along with summaries of the recently finished and ongoing trials, would be of additional value.Stephan von Haehling and Stefan D. Anker, Department of Clinical Cardiology, National Heart & Lung Institute, London, UKCardiology News, Volume 7 Number 2, December/January 2004 p 17 Help other customers find the most helpful reviews� Was this review helpful to you?�Yes No Report abuse | PermalinkComment�Comment
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