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Immunity and inflammation: the neglected key players in congenital heart disease?
Laura M Wienecke1,2,3,4, Sarah Cohen5, Johann Bauersachs6
1Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30621, Hannover, Germany. Laura.Wienecke@med.uni-heidelberg.de.
Insights
Congenital heart disease (CHD) survivors face chronic inflammation and immune system changes, impacting long-term health. Understanding these immune alterations is key for developing new therapies and managing risks, including infections like COVID-19.
Area of Science:
- Cardiology
- Immunology
- Pediatric Health
Background:
- Congenital heart disease (CHD) affects over 90% of childhood survivors into adulthood.
- Adult survivors experience increased morbidity and mortality, often due to heart failure and comorbidities.
- Chronic inflammation and immune activation are implicated in cardiovascular disease progression.
Purpose of the Study:
- To review the role of chronic inflammation, immunity, and immune senescence in congenital heart disease (CHD).
- To explore the long-term immune impact of infant open-heart surgery and thymectomy.
- To discuss the influence of comorbidities, genetics, and infection risk (e.g., SARS-CoV-2) in CHD patients.
Main Methods:
- Literature review focusing on inflammation, immunity, and cardiovascular disorders.
- Analysis of evidence linking immune alterations to CHD progression and outcomes.
- Discussion of potential therapeutic targets and clinical implications.
Main Results:
- Accumulating evidence suggests an inflammatory state and immune alterations in pediatric and adult CHD patients.
- Infant open-heart surgery with thymectomy may have lasting effects on the immune system.
- Altered immunity in CHD may increase vulnerability to infections like COVID-19.
Conclusions:
- Chronic inflammation and immune dysregulation are significant factors in CHD morbidity and mortality.
- Further research into immunomodulatory therapies is warranted for CHD management.
- Understanding immune changes is crucial for improving long-term outcomes and managing pandemic-related risks in CHD survivors.
Abstract:
Although more than 90% of children born with congenital heart disease (CHD) survive into adulthood, patients face significantly higher and premature morbidity and mortality. Heart failure as well as non-cardiac comorbidities represent a striking and life-limiting problem with need for new treatment options. Systemic chronic inflammation and immune activation have been identified as crucial drivers of disease causes and progression in various cardiovascular disorders and are promising therapeutic targets. Accumulating evidence indicates an inflammatory state and immune alterations in children and adults with CHD. In this review, we highlight the implications of chronic inflammation, immunity, and immune senescence in CHD. In this context, we summarize the impact of infant open-heart surgery with subsequent thymectomy on the immune system later in life and discuss the potential role of comorbidities and underlying genetic alterations. How an altered immunity and chronic inflammation in CHD influence patient outcomes facing SARS-CoV-2 infection is unclear, but requires special attention, as CHD could represent a population particularly at risk during the COVID-19 pandemic. Concluding remarks address possible clinical implications of immune changes in CHD and consider future immunomodulatory therapies.
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