The Relationship of Pathological Cytokines and Erythropoietin in Patients With Chronic Heart Failure

Abstract

General Background: Chronic heart failure (CHF) is often associated with anemia, significantly impacting patient outcomes. The interplay between erythropoietin (EPO) deficiency and pathological cytokine activation is increasingly recognized in CHF pathogenesis. Specific Background: Elevated levels of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α), contribute to both immunosuppression and impaired erythropoiesis, worsening CHF symptoms. Knowledge Gap: While previous studies have highlighted the cytokine-mediated progression of CHF, the effectiveness of erythropoietin-stimulating agents (ESAs) in mitigating anemia and cytokine aggression remains underexplored. Aims: This study examines the relationship between pathological cytokines and EPO levels in CHF patients with anemia and evaluates the efficacy of methoxypolyethylene glycol-epoetin-β (MEB) in restoring hematological and cardiovascular parameters. Results: A randomized controlled trial involving 94 CHF patients with anemia showed that MEB administration led to a 22.4% hemoglobin increase (p<0.05) and normalization of EPO levels (29.3±4.3 IU/ml; p<0.001). Cytokine levels significantly decreased: IL-1β by 36.6% (p<0.001), IL-6 by 54.3% (p<0.05), and TNF-α by 48.3% (p<0.05). Left ventricular ejection fraction improved by 19.04% (p<0.05), and exercise tolerance increased by 76.6% (p<0.05). Novelty: This study demonstrates that MEB therapy not only corrects anemia but also reduces cytokine aggression, suggesting a dual mechanism of action in CHF management. Implications: These findings support the incorporation of ESAs in CHF treatment protocols, emphasizing their role in anemia correction and inflammation modulation.