Selective intestinal decontamination in advanced chronic heart failure: A pilot trial

Viviane M. Conraads, Philippe G. Jorens, Luc S. De Clerck, Hendrik K. Van Saene, Margaretha M. Ieven, Johan M. Bosmans, Annemie Schuerwegh, Chris H. Bridts, Floris Wuyts, Wim J. Stevens, Stefan D. Anker, Mathias Rauchhaus, Christiaan J. Vrints

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: Endotoxin, derived from intestinal aerobic Gram-negative bacilli (AGNB), could be an important monocyte activator in chronic heart failure (CHF). The effect of selective decontamination of the digestive tract (SDD) on intracellular monocyte cytokine production, monocyte CD14 expression, circulating endotoxin and cytokines, and flow-mediated dilation (FMD) was studied in patients with severe CHF. Methods and results: Ten patients with CHF (NYHA class III-IV) were enrolled in a non-placebo controlled pilot trial involving the administration of SDD (polymyxin B, tobramycin) for 8 weeks. One patient was later excluded due to cardiac transplantation. Before treatment, after 4 and 8 weeks therapy, and 6 weeks post-treatment, monocyte CD14 expression, intracellular monocyte production of interleukin-1β [IL-1β], interleukin-6 [IL-6], tumour necrosis factor (TNF)-α with and without lipopolysaccharide (LPS) stimulation were measured. Concentrations of endotoxin and cytokines (IL-1β, IL-6, TNF-α) were also determined. AGNB in faeces, intestinal endotoxin and FMD were assessed at baseline, after 4 weeks of treatment and 6 weeks post-treatment. SDD eradicated intestinal AGNB (P

Original languageEnglish
Pages (from-to)483-491
Number of pages9
JournalEuropean Journal of Heart Failure
Volume6
Issue number4
DOIs
Publication statusPublished - Jun 2004

Keywords

  • Chronic heart failure
  • Endothelial dysfunction
  • Endotoxin
  • Inflammation
  • Selective digestive decontamination

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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