Inflammatory markers and cytokines in peripartum cardiomyopathy: a delicate balance

Acute peripartum cardiomyopathy, a unique form of heart failure with onset in the last phase of pregnancy or shortly postpartum, has demonstrated evidence of an inflammatory process characterized by cytokine imbalance. Cytokines serve as inducers of repair mechanisms and promoters of both inflammatory and anti-inflammatory immune responses. Elevated plasma C-reactive protein, a marker of an inflammatory process, is co-expressed in the heart with the pro-inflammatory cytokine, TNF-alpha. Both pro-inflammatory and anti-inflammatory cytokines are involved in an intricate balance in response to injury to the heart. This article discusses potential and identified imbalances in levels of cytokines in peripartum cardiomyopathy that have led to clinical trials aimed at the modulation of select number of cytokines, some of which have been shown to have significant clinical benefit. Continuing investigation in this area is important since restoration of critical cytokine balance may be an area that holds promise for therapy. At the same time, one must be cautious in the timing of any intervention that alters cytokine balance.