Letter to the Editor Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1000 words (typed double-spaced) in length and may be subject to editing or abridgment.
Using Serum Transforming Growth Factor- To Predict Myocardial Fibrosis To the Editor: We read with interest the timely review by Souders et al1 on the role of cardiac fibroblasts in the development of physiological and pathological cardiac conditions. Fibrosis has been linked to heart failure and arrhythmia and may explain the reasons for which contractile dysfunction has been the best predictor of ventricular arrhythmia and sudden cardiac death. Therefore, risk stratification for myocardial fibrosis may be an accurate method of predicting the emergence and course of both heart failure and arrhythmia. In our review of the literature, we found that transforming growth factor (TGF)- has been shown to have a central role in stimulating fibroblasts and promoting their differentiation into myofibroblasts, which is a key step in the development of increased myocardial fibrosis in both infarcted and noninfarcted regions of the heart.2 Souders et al1 have cited a few studies that question the proliferating effect of TGF- on cardiac fibroblasts. However, none of that cited research is an in vivo study, and as a matter of fact 2 of 4 of the studies3,4 cited by Souders et al support the proliferating effect of TGF- on fibroblasts. One may suggest that this controversy on the exact role of TGF- on fibroblasts in vivo, and some other potentially beneficial effect that TGF- may have,5 will make it a fairly difficult therapeutic target for near future. However, to our knowledge, all studies agree on the association of an increased level of TGF- with an increase in myocardial fibrosis. We therefore suggest that the serum level of TGF- after myocardial infarction can be used as a risk stratification tool for predicting the development of myocardial fibrosis resulting in heart failure and ventricular arrhythmia. If this hypothesis is proven to be
correct, it will greatly and positively affect the prevention and treatment of sudden cardiac death and heart failure.
Sources of Funding Supported by NIH R01 HL085558, R01 HL073753, P01 HL058000 (to S.C.D.).
Disclosures None. Ali A. Sovari Samuel C. Dudley Section of Cardiology University of Illinois Chicago E-mail
[email protected] E-mail
[email protected] 1. Souders CA, Bowers SL, Baudino TA. Cardiac fibroblast: the renaissance cell. Circ Res. 2009;105:1164 –1176. 2. Sovari AA, Morita N, Weiss JN, Karagueuzian HS. Serum transforming growth factor-beta1 as a risk stratifier of sudden cardiac death. Med Hypotheses. 2008;71:262–265. 3. Squires CE, Escobar GP, Payne JF, Leonardi RA, Goshorn DK, Sheats NJ, Mains IM, Mingoia JT, Flack EC, Lindsey ML. Altered fibroblast function following myocardial infarction. J Mol Cell Cardiol. 2005;39:699 –707. 4. Sigel AV, Centrella M, Eghbali-Webb M. Regulation of proliferative response of cardiac fibroblasts by transforming growth factor-beta 1. J Mol Cell Cardiol. 1996;28:1921–1929. 5. Pepper MS. Transforming growth factor-beta: vasculogenesis, angiogenesis, and vessel wall integrity. Cytokine Growth Factor Rev. 1997;8: 21– 43.
(Circ Res. 2010;106:e3.) © 2010 American Heart Association, Inc. Circulation Research is available at http://circres.ahajournals.org
DOI: 10.1161/CIRCRESAHA.109.215921
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Using Serum Transforming Growth Factor-β To Predict Myocardial Fibrosis Ali A. Sovari and Samuel C. Dudley Circ Res. 2010;106:e3 doi: 10.1161/CIRCRESAHA.109.215921 Circulation Research is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2010 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7330. Online ISSN: 1524-4571
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