Tumour necrosis factor α (TNF-α) plays a pivotal role in inflammation by potentiating
the inflammatory reaction. Recent studies and clinical experience have shown remarkable
effects, on inflammatory markers and symptoms, of drugs that block the biologic activity
of TNF-α in patients with rheumatoid arthritis (RA). Without being a traditional inflammatory
disease, left ventricular dysfunction has recently been characterised by increased
expression of TNF-α in the myocardium [
[1]
]. As a result, inhibition of TNF-α has been suggested to be beneficial for patients
with heart failure. However, several recent studies of TNF-α blockade in heart failure
have shown a lack of improvement of symptoms and an increased risk for death [
2
,
3
]. The lack of effect and the possible risk of TNF-α blockade in heart failure is not
well understood. The following case reported suggests that TNF-α blockade might aggravate
coronary heart disease (CHD) which is the underlying cause of heart failure in many
patients.- Chung E.S.
- Packer M.
- Lo K.H.
- Fasanmade A.A.
- Willerson J.T.
Anti-TNF therapy against congestive heart failure investigators. Randomized, double-blind,
placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor
necrosis factor-alpha, in patients with moderate-to-severe heart failure: results
of the anti-TNF therapy against congestive heart failure (ATTACH) trial.
Circulation. 2003; 107: 3133-3140
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References
- Inflammatory mediators and the failing heart. Past, present and the foreseeable future.Circ. Res. 2002; 91: 988-998
- Clinical trials update: RENEWAL (RENAISSANCE and RECOVER) and ATTACH.Eur. J. Heart Fail. 2002; 4: 559-561
- Anti-TNF therapy against congestive heart failure investigators. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF therapy against congestive heart failure (ATTACH) trial.Circulation. 2003; 107: 3133-3140
- Left ventricular remodeling in transgenic mice with cardiac restricted overexpression of tumor necrosis factor.Circulation. 2001; 104: 826-831
Article Info
Publication History
Received:
December 2,
2003
Identification
Copyright
© 2004 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
