Multiple cytokine biomarkers in heart failure.

Raised levels of circulating proinflammatory cytokines are associated with disease progression and adverse outcomes in chronic heart failure patients. Inflammatory markers may be predictive of congestive heart failure and myocardial infarction, allowing enhanced risk stratification. The profile of cytokine blood levels differs in accordance with the initiating cause and type of heart failure. Therefore, subclassification of heart failure patients based on cytokine measurements could potentially identify subgroups of patients, permitting tailored or personalized therapy. During inflammatory states, cytokine production is often regulated by activation of other cytokines, resulting in a perpetuating, complex cytokine cascade. Thus, single-assay measurement of cytokines provides limited information, and to obtain a more comprehensive picture of immune activation, multiple cytokines need to be analyzed simultaneously. With the technological development in multiplex protein analyses, multiplexing cytokines has become simple, fast and reproducible. Luminex technology represents one platform for simultaneous measurements of several cytokines, and has gained increasing interest among researchers in recent years. However, the measurement of multiple cytokines as part of a multimarker prognostic or diagnostic biomarker approach remains to be implemented in current clinical practice, as current knowledge of the underlying biology of cytokine release in heart disease is still too limited and a bioinformatic tool for interpretation of cytokine profiles is needed. Nevertheless, multiplex protein analyses are likely to constitute an important part of experimental and clinical research on heart failure and cytokines, paving the way for more accurate heart failure treatment.