[Cytokines in heart failure]

Cytokines are produced in the heart and at the periphery in response to stimuli such as ischemia, left ventricular (LV) overload and endotoxemia. Acting on specific receptors located at the cell membrane, they promote cardiac dysfunction by producing LV enlargement, reducing LV systolic function and inducing apoptosis. These effects stem directly from the cytokines' actions or are dependent on the increased synthesis of nitric oxide and sphingosine. The cytokines are able to increase their own synthesis, by a positive feedback mechanism, thus perpetuating their actions and leading to the progression of heart failure (HF). Despite the available evidence linking cytokines to the pathogenesis of HF and its progression, anti-cytokine therapy has not yet been shown to be effective in patients with HF. In this paper, the molecular mechanisms involved in cytokine synthesis and actions are reviewed.