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European Heart Journal 1999 20(20):1503-1513; doi:10.1053/euhj.1999.1580
Copyright © 1999 by the European Society of Cardiology.
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Induction of functional inducible nitric oxide synthase in monocytes of patients with congestive heart failure. Link with tumour necrosis factor-{alpha}

L. Cominia, T. Bachettia, L. Agnolettia, G. Gaiaa, S. Curellob, B. Milanesic, M. Volterranid, G. Parrinelloe, C. Ceconib, A. Giordanod, A. Cortif and R. Ferrarig,f1

a Cardiovascular Pathophysiology Research Centre, Heart Failure Unit, ‘Salvatore Maugeri’ Foundation for Care and Research, Gussago, Brescia, Italy
d Division of Cardiology, Heart Failure Unit, ‘Salvatore Maugeri’ Foundation for Care and Research, Gussago, Brescia, Italy
b University of Brescia, Spedali Civili, Brescia, Italy
c Clinical Chemistry Laboratory, Haematology Service, Spedali Civili, Brescia, Italy
e Statistics Department, University of Brescia, Brescia, Italy
f DIBIT, San Raffaele Scientific Institute, Milan, Italy
g University of Ferrara, Ferrara, Italy

revised February 22, 1999; accepted February 24, 1999

Abstract

Aims We studied the induction of monocytic inducible nitric oxide synthase expression and the tumour necrosis factor-{alpha} system in patients with congestive heart failure.

Methods and Results Forty-three congestive heart failure patients and 15 healthy subjects were studied. Antigenic tumour necrosis factor-{alpha} and its soluble receptors, measured by ELISA, were increased in chronic heart failure and the increase was related to the clinical severity of the syndrome (tumour necrosis factor-{alpha} from 8·2±5·2 in NYHA class II to 18·2±7·2 in class III and 26·9±13·2pg.ml–1in class IV, P<0·0001 classes III and IV vs class II; soluble tumour necrosis factor receptor I from 1·0±0·2 in class II to 2·3±1·1 in class III and 5·5±3·2ng.ml–1in class IV, P<0·0001 classes III and IV vs class II; soluble tumour necrosis factor receptor II from 2·7±0·7 in class II to 4·9±1·9 in class III and 8·4±5·0ng.ml–1in class IV, P<0·002 classes III and IV vs class II). Monocytic inducible nitric oxide synthase assessed by Western blot, was expressed only in congestive heart failure patients (13 out of 43). The association among monocytic inducible nitric oxide synthase expression, tumour necrosis factor-{alpha} system activation, neurohormones and other clinical parameters was studied. The univariate logistic regression showed that inducible nitric oxide synthase expression was strictly associated with NYHA class (P<0·05), antigenic tumour necrosis factor-{alpha} (P<0·01) and its soluble receptors (P<0·05). The multivariate analysis showed that antigenic tumour necrosis factor-{alpha} was the only predictor for monocytic inducible nitric oxide synthase expression (P<0·05, RR=2·75, CI 1·34–5·43).

Conclusions Inducible nitric oxide synthase is expressed in circulating monocytes of patients with severe congestive heart failure. This phenomenon is linked to the activation of the tumour necrosis factor-{alpha} system.

Key Words: Congestive heart failure, neurohormones, inducible nitric oxide synthase, tumour necrosis factor-{alpha}, monocytes

f1 Correspondence : Prof. Roberto Ferrari, Ospedale S. Anna, Sezione di Malattie dell'Apparato Respiratorio, Nuove Cliniche IIIopiano, Corso Giovecca 203, 44100 Ferrara, Italy.


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