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Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.

von Haehling S, Schefold JC, Jankowska E, Doehner W, Springer J, Strohschein K, Genth-Zotz S, Volk HD, Poole-Wilson P, Anker SD - PLoS ONE (2009)

Bottom Line: These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF).These effects were pronounced in patients who were beta-blocker naïve.The underlying mechanism remains to be elucidated.

View Article: PubMed Central - PubMed

Affiliation: Applied Cachexia Research, Dept. of Cardiology, Charité Medical School, Campus Virchow-Clinic, Berlin, Germany. stephan.von.haehling@web.de

ABSTRACT

Background: Overproduction of pro-inflammatory cytokines is a well established factor in the progression of chronic heart failure (CHF). Changes in cellular immunity have not been widely studied, and the impact of standard medication is uncertain. Here we investigate whether a leukocyte redistribution occurs in CHF and whether this effect is influenced by beta-blocker therapy.

Methodology: We prospectively studied 75 patients with systolic CHF (age: 68+/-11 years, left ventricular ejection fraction 32+/-11%, New York Heart Association class 2.5+/-0.7) and 20 age-matched healthy control subjects (age: 63+/-10 years). We measured the response of cells to endotoxin exposure in vitro, analysed subsets of lymphocytes using flow cytometry, and assessed plasma levels of the pro-inflammatory markers interleukin 1, 6, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptors 1 and 2.

Principal findings: While no differences in the number of leukocytes were noted between patients with CHF and healthy controls, we detected relative lymphopenia in patients with CHF (p<0.001 vs. control), mostly driven by reductions in T helper cells and B cells (both p<0.05). The number of neutrophils was increased (p<0.01). These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF). Increased plasma levels of soluble tumor necrosis receptor-1 correlated with the relative number of lymphocyte subsets.

Conclusions: In patients with CHF, we detected a redistribution of leukocyte subsets, i.e. an increase in neutrophils with relative lymphopenia. These effects were pronounced in patients who were beta-blocker naïve. The underlying mechanism remains to be elucidated.

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Related in: MedlinePlus

Distribution of leukocytes (panel A) and their subsets (panels B and C) in healthy control subjects (n = 20) and patients with CHF (n = 75).
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pone-0006411-g002: Distribution of leukocytes (panel A) and their subsets (panels B and C) in healthy control subjects (n = 20) and patients with CHF (n = 75).

Mentions: There were no significant differences in the absolute number of white blood cells between healthy control subjects and patients with CHF (p = 0.39, Figure 2A). No differences in either the absolute or in the relative numbers were noted for monocytes (control: 0.35±0.09×109/L or 4.9±1.1%; CHF: 0.38±0.12×109/L or 5.2±1.6%, both p>0.3), eosinophils (control: 0.23±0.09×109/L or 3.1±1.5%; CHF: 0.26±0.17×109/L or 3.5±2.2%, both p>0.4), or basophils (control: 0.08±0.04×109/L or 0.9±0.5%; CHF: 0.07±0.05×109/L or 0.8±0.4%, both p>0.2). However, both the absolute and the relative number of neutrophils were increased in patients with CHF (control: 4.2±1.2×109/L; CHF: 5.0±1.6×109/L, p = 0.048, Figure 2B). Additionally, the absolute and the relative number of lymphocytes was decreased in these patients (control: 2.1±0.6×109/L; CHF: 1.7±0.7×109/L, p = 0.019, Figure 2C). The distribution of lymphocyte subsets in healthy control subjects and patients with CHF is given (Figure 3).


Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.

von Haehling S, Schefold JC, Jankowska E, Doehner W, Springer J, Strohschein K, Genth-Zotz S, Volk HD, Poole-Wilson P, Anker SD - PLoS ONE (2009)

Distribution of leukocytes (panel A) and their subsets (panels B and C) in healthy control subjects (n = 20) and patients with CHF (n = 75).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2713422&req=5

pone-0006411-g002: Distribution of leukocytes (panel A) and their subsets (panels B and C) in healthy control subjects (n = 20) and patients with CHF (n = 75).
Mentions: There were no significant differences in the absolute number of white blood cells between healthy control subjects and patients with CHF (p = 0.39, Figure 2A). No differences in either the absolute or in the relative numbers were noted for monocytes (control: 0.35±0.09×109/L or 4.9±1.1%; CHF: 0.38±0.12×109/L or 5.2±1.6%, both p>0.3), eosinophils (control: 0.23±0.09×109/L or 3.1±1.5%; CHF: 0.26±0.17×109/L or 3.5±2.2%, both p>0.4), or basophils (control: 0.08±0.04×109/L or 0.9±0.5%; CHF: 0.07±0.05×109/L or 0.8±0.4%, both p>0.2). However, both the absolute and the relative number of neutrophils were increased in patients with CHF (control: 4.2±1.2×109/L; CHF: 5.0±1.6×109/L, p = 0.048, Figure 2B). Additionally, the absolute and the relative number of lymphocytes was decreased in these patients (control: 2.1±0.6×109/L; CHF: 1.7±0.7×109/L, p = 0.019, Figure 2C). The distribution of lymphocyte subsets in healthy control subjects and patients with CHF is given (Figure 3).

Bottom Line: These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF).These effects were pronounced in patients who were beta-blocker naïve.The underlying mechanism remains to be elucidated.

View Article: PubMed Central - PubMed

Affiliation: Applied Cachexia Research, Dept. of Cardiology, Charité Medical School, Campus Virchow-Clinic, Berlin, Germany. stephan.von.haehling@web.de

ABSTRACT

Background: Overproduction of pro-inflammatory cytokines is a well established factor in the progression of chronic heart failure (CHF). Changes in cellular immunity have not been widely studied, and the impact of standard medication is uncertain. Here we investigate whether a leukocyte redistribution occurs in CHF and whether this effect is influenced by beta-blocker therapy.

Methodology: We prospectively studied 75 patients with systolic CHF (age: 68+/-11 years, left ventricular ejection fraction 32+/-11%, New York Heart Association class 2.5+/-0.7) and 20 age-matched healthy control subjects (age: 63+/-10 years). We measured the response of cells to endotoxin exposure in vitro, analysed subsets of lymphocytes using flow cytometry, and assessed plasma levels of the pro-inflammatory markers interleukin 1, 6, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptors 1 and 2.

Principal findings: While no differences in the number of leukocytes were noted between patients with CHF and healthy controls, we detected relative lymphopenia in patients with CHF (p<0.001 vs. control), mostly driven by reductions in T helper cells and B cells (both p<0.05). The number of neutrophils was increased (p<0.01). These effects were pronounced in patients who were beta-blocker naïve (32% of all patients with CHF). Increased plasma levels of soluble tumor necrosis receptor-1 correlated with the relative number of lymphocyte subsets.

Conclusions: In patients with CHF, we detected a redistribution of leukocyte subsets, i.e. an increase in neutrophils with relative lymphopenia. These effects were pronounced in patients who were beta-blocker naïve. The underlying mechanism remains to be elucidated.

Show MeSH
Related in: MedlinePlus