Tumour necrosis factor alpha and the cardiovascular system: its role in cardiac allograft rejection and heart disease

Extract

Time for primary review 32 days.

1 Introduction

Tumour necrosis factor alpha (TNFα) is a pleiotropic cytokine that has many proinflammatory actions with negative inotropic effects. It has been implicated in the pathogenesis of many non-infectious disorders, from rheumatoid disease [1], to multiple sclerosis [2]. This cytokine also affects the heart [3] where it is produced by immune cells and the myocardium in some diseases. Raised serum TNFα is seen in patients with cardiomyopathy, myocardial infarction, and chronic heart failure [4], thus implicating TNFα in disease pathogenesis. Raised serum levels of this cytokine have also been identified in transplant patients following episodes of acute cellular rejection. There is a correlation between TNFα expression and rejection grade [5] suggesting that the cytokine is a candidate marker of rejection.

In this review, we consider the basic biology of TNFα in relation to certain cardiac diseases. There are interrelationships between some of the conditions described, but these have been arbitrarily divided into three main groups: allograft rejection, coronary artery disease, and heart failure.