Immunomodulating therapy: new treatment modality in congestive heart failure.
Accumulating evidence indicates that inflammatory cytokines play a pathogenic role in congestive heart failure (CHF) by influencing heart contractility, inducing hypertrophy, and promoting apoptosis or fibrosis, contributing to the continuous myocardial remodeling process. Traditional cardiovascular drugs seem to have little influence on the overall cytokine network, and immunomodulatory therapy has emerged as a possible new treatment modality in CHF. Several animal studies have suggested that modulation of inflammatory cytokines may improve cardiac performance. The authors have recently demonstrated that intravenous immunoglobulin enhances the left ventricular ejection fraction in CHF patients, and that this is significantly correlated with anti-inflammatory effects of such therapy. While intravenous immunoglobulin is not necessarily the drug of choice, this study suggests a potential role for immunomodulatory therapy in CHF in addition to optimal cardiovascular treatment regimens. Further research will more precisely identify the most important actors in the immunopathogenesis of CHF and contribute to the development of more specific immunomodulating agents for this disorder.