Increase in Anti-Inflammatory Cytokine Levels in Chronic Heart Failure: A Measure of Treatment Success or Failure?

To the Editor:Gullestad and colleagues report on the effects of intravenous immunoglobulin given to patients with chronic heart failure (CHF).1 They demonstrated that intravenous immunoglobulin treatment is associated with an increase in soluble tumor necrosis factor-α receptors (sTNFRs) 1 and 2, interleukin-1 receptor antagonist (IL-1RA), and interleukin-10 (IL-10). There were no significant changes in inflammatory cytokine levels (tumor necrosis factor-α and IL-1β) after active treatment. The authors conclude that intravenous immunoglobulin therapy leads to a net anti-inflammatory effect in CHF, and they propose that this should be regarded in a favorable light.A degree of caution should be exercised, however, when interpreting the significance of elevated levels of anti-inflammatory cytokines and their receptors in the context of CHF. It is well known, for example, that circulating sTNFR1 and 2 concentrations are raised in this condition, positively correlate with disease severity, and …