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(Circulation. 1999;100:1983-1991.)
© 1999 American Heart Association, Inc.


Clinical Investigation and Reports

Serum From Patients With Severe Heart Failure Downregulates eNOS and Is Proapoptotic

Role of Tumor Necrosis Factor-{alpha}

Laura Agnoletti, MSc; Salvatore Curello, MD; Tiziana Bachetti, MSc; Fabio Malacarne, MSc; Giuseppina Gaia, MSc; Laura Comini, MSc, PhD; Maurizio Volterrani, MSc, PhD; Paolo Bonetti, MD; Giovanni Parrinello, PhD; Moris Cadei; Pier Giovanni Grigolato, MD; Roberto Ferrari, MD, PhD

From the Salvatore Maugeri Foundation, Institute for Care and Research, Cardiovascular Pathophysiology Research Centre (L.A., T.B., G.G., L.C.), and the Departments of Cardiology (S.C., P.B.), Statistics (G.P.), and Pathologic Anatomy (M.C., P.G.G.), University of Brescia; the Immunology Department, Spedali Civili, Brescia (F.M.); the Cardiology Department, Gussago, Brescia (M.V.); and the Department of Cardiology, University of Ferrara (R.F.), Italy.

Correspondence to Prof Roberto Ferrari, Cardiovascular Pathophysiology Research Center, Salvatore Maugeri Foundation, Via Pinidolo, 23, 25064 Gussago, Brescia, Italy. E-mail ferrari{at}master.cci.unibs.it

Background—Cytokine activation and endothelial dysfunction are typical phenomena of congestive heart failure (CHF). We tested the hypothesis that incubating human umbilical vein endothelial cells with serum from patients with CHF will downregulate endothelial constitutive nitric oxide synthase (eNOS) and induce apoptosis.

Methods and Results—We studied 21 patients with severe CHF. Levels of tumor necrosis factor-{alpha} (TNF-{alpha}) and several neuroendocrine parameters were assessed. eNOS was measured by Western Blot analysis and apoptosis by optical microscopy and flow cytometry. We observed (1) eNOS downregulation (difference versus healthy subjects at 24 hours [P<0.05] and 48 hours [P<0.001]), (2) nuclear morphological changes typical of apoptosis; and (3) a high apoptotic rate with propidium iodide (increasing from 2.1±0.4% to 11.3±1.2% at 48 hours; P<0.001 versus healthy subjects) and annexin V. An anti-human TNF-{alpha} antibody did not completely counteract these effects. A strong correlation existed between eNOS downregulation and apoptosis (r=-0.89; P<0.001).

Conclusions—Serum from patients with severe CHF downregulates eNOS expression and increases apoptosis. High levels of TNF-{alpha} likely play a role, but they cannot be the only factor responsible.


Key Words: heart failure • tumor necrosis factor • endothelium • nitric oxide synthase • apoptosis




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