Curr Treat Options Cardio Med (2018) 20: 26
Heart Failure (W Tang, Section Editor)
Immune Modulation in Heart
Failure: the Promise of Novel
Paulino Alvarez, MD
Alexandros Briasoulis, MD PhD
Department of Medicine, Division of Cardiovascular Diseases, Section of Heart
Failure and Transplant, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242,
Published online: 15 March 2018
* Springer Science+Business Media, LLC, part of Springer Nature 2018
This article is part of the Topical Collection on Heart Failure
Keywords Heart failure
Purpose of review Immune system activation plays a central role in heart failure progres-
sion. Large-scale immune modulatory clinical trials targeting tumor necrosis factor-α and
broad spectrum immune modulation have been negative. The objective of this review is to
highlight past, present, and what is in the horizon for the immunomodulation in heart
failure with a focus of biologics.
Recent findings Strategies targeting interleukin-1 pathway are currently undergoing
clinical evaluation and data from pilot studies are promising. The potential of cell
therapy for immune modulation is increasingly recognized in clinical trials.
Strategies targeting anti-cardiac antibodies such as immunoadsorption and intra-
venous immunoglobulin have been used in clinical practice with positive out-
comes but large pragmatic clinical trials are lacking. The use of an aptamer to
block anti-cardiac antibodies is undergoing phase 1 clinical evaluation. Promising
targets include inflammasomes, toll-like receptors, chemokines, natural killer
cells, and macrophages.
Summary Large-scale immune modulatory clinical trials have been negative. Nev-
ertheless, the experience gained from them along with increasing understanding
of molecular mechanisms of immune pathophysiology in heart failure is leading to
rapid recognition of new therapeutic targets and approaches.