Key result
Plasma from patients with cardiorenal syndrome type 1 induced significantly higher monocyte apoptosis (34.95%) compared to plasma from acute heart failure patients (12.50%) and healthy controls (1.39%).
Observational (n=55)
No
Absolute Event Rate: 34.95% vs 12.5%
p-value: p=<0.001
Plasma from patients with cardiorenal syndrome type 1 induces significantly higher monocyte apoptosis and proinflammatory cytokine release compared to acute heart failure alone, suggesting a distinct immune-mediated mechanism in its pathogenesis.
May implicate monocyte apoptosis in CRS type 1; hypothesis-generating for immune-targeted therapies pending validation.
In this study, we examined the possible immune-mediated mechanisms in cardiorenal syndrome (CRS) type 1 pathogenesis. We enrolled 40 patients with acute heart failure (AHF), 11 patients with CRS type 1 and 15 controls. Plasma from the different groups was incubated with monocytes; subsequently, cell apoptosis was evaluated by DNA fragmentation, caspase activity and cytofluorometric assay. Cytokine quantification in plasma and supernatant was performed by ELISA. Monocytes treated with CRS type 1 plasma showed significantly higher apoptosis compared with those treated with AHF and the controls (p < 0.05). Caspase-3 (CRS type 1: 2.20 ng/ml, IQR 2.06-2.33; AHF: 1.48 ng/ml, IQR 1.31-1.56; controls: 0.71 ng/ml, IQR 0.67-0.81) and caspase-8 levels (CRS type 1: 1.49 ng/ml, IQR 1.42-1.57; AHF: 0.94 ng/ml, IQR 0.84-0.98; controls: 0.56 ng/ml, IQR 0.51-0.58) in cells incubated with plasma from these patients demonstrated a significantly higher concentration. We observed a strong upregulation of plasma IL-6 and IL-18 in CRS type 1 compared with AHF and the controls (p < 0.05). Interestingly, we observed a similar concentration of TNF-α in CRS type 1 and AHF. In CRS type 1 patients, IL-6 (52.13 ng/ml, IQR 47.29-66.83) and IL-18 levels (197.75 ng/ml, IQR 120.80-265.49) in supernatant were significantly higher than in AHF patients (IL-6: 28.79 ng/ml, IQR 19.90-36.10; IL-18: 21.98 ng/ml, IQR 15.98-29.85) and controls (IL-6: 5.02 ng/ml, IQR 4.56-6.44; IL-18: 7.91 ng/ml, IQR 5.57-10.62). These findings suggest the presence of a defective regulation of monocyte apoptosis in CRS type 1 patients and the involvement of an immune-mediated mechanism in the pathophysiology of this syndrome.
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Pastori et al. (2015) conducted an observational in Cardiorenal Syndrome Type 1 (n=55). Cardiorenal syndrome type 1 plasma vs. Acute heart failure plasma and healthy control plasma was evaluated on Monocyte apoptosis rate at 24 hours (p=<0.001). Plasma from patients with cardiorenal syndrome type 1 induced significantly higher monocyte apoptosis (34.95%) compared to plasma from acute heart failure patients (12.50%) and healthy controls (1.39%).
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