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Selective intestinal decontamination in advanced chronic heart failure: a pilot trial
Viviane M Conraads1, Philippe G Jorens, Luc S De Clerck
1Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. Viviane.Conraads@uza.be
European Journal of Heart Failure
|June 9, 2004
Summary
Selective decontamination of the digestive tract (SDD) reduced endotoxin levels in patients with chronic heart failure (CHF). This led to decreased monocyte activation and improved endothelial function, suggesting an anti-inflammatory effect of SDD.
Area of Science:
- Cardiovascular Medicine
- Immunology
- Gastroenterology
Background:
- Endotoxin from intestinal aerobic Gram-negative bacilli (AGNB) may activate monocytes in chronic heart failure (CHF).
- Selective decontamination of the digestive tract (SDD) aims to reduce endotoxin exposure.
Purpose of the Study:
- To investigate the effects of SDD on monocyte activation and endothelial function in severe CHF patients.
- To assess changes in intracellular monocyte cytokine production, CD14 expression, and flow-mediated dilation (FMD).
Main Methods:
- A pilot trial administered SDD (polymyxin B, tobramycin) for 8 weeks to 10 CHF patients (NYHA class III-IV).
- Measurements included monocyte CD14 expression, intracellular cytokine production (IL-1beta, IL-6, TNF-alpha), endotoxin, and FMD at various time points.
- AGNB in feces and fecal endotoxin levels were also assessed.
Main Results:
- SDD eradicated intestinal AGNB and decreased fecal endotoxin concentrations significantly.
- Monocyte CD14 expression and intracellular cytokine production (IL-1beta, IL-6, TNF-alpha) declined significantly with SDD treatment.
- Flow-mediated dilation (FMD) significantly improved after 4 weeks of SDD, returning to baseline post-treatment.
Conclusions:
- Reducing the intestinal endotoxin pool via SDD decreases monocyte CD14 expression and intracellular cytokine production in severe CHF.
- The observed improvement in peripheral endothelial function may indicate an anti-inflammatory effect of SDD in CHF patients.