Abstract
Cardiac allograft hypertrophy is associated with persistent expression of cardiac tumor necrosis factor (TNF)-alpha. We investigated whether TNFalpha antagonism would impact allograft hypertrophy. EFECT (EFfect of Etanercept on Cardiac Transplantation) was a randomized, controlled, double-blind trial evaluating the effect of etanercept versus placebo treatment immediately posttransplant. The primary end-point was change in left ventricular (LV) mass after 6 months. Secondary endpoints included degree of collagen deposition at 6 months and incidence of adverse events. Forty-nine patients were randomized to either etanercept or placebo. LV mass increased significantly in both arms at 6 months, with a smaller increase in the etanercept group (19% vs. 33%, P=ns). Myocardial collagen content increased in the placebo, but not the etanercept, group (+39.8%, P<0.08 vs. -7.0%, P=NS). Allograft hypertrophy develops posttransplant with a corresponding increase in extracellular matrix. Etanercept appeared to decrease LV hypertrophy by decreasing extracellular matrix deposition.
Publication types
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Randomized Controlled Trial
MeSH terms
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Collagen / metabolism
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Double-Blind Method
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Etanercept
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Extracellular Matrix / metabolism
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Extracellular Matrix / pathology
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Female
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Heart Transplantation / adverse effects*
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Heart Transplantation / immunology
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Heart Transplantation / pathology
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Heart Ventricles / metabolism
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Heart Ventricles / pathology
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Humans
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Hypertrophy, Left Ventricular / etiology*
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Hypertrophy, Left Ventricular / pathology
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Hypertrophy, Left Ventricular / prevention & control*
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Immunoglobulin G / adverse effects
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Immunoglobulin G / therapeutic use*
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / therapeutic use*
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Male
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Middle Aged
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Myocardium / metabolism
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Myocardium / pathology
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Receptors, Tumor Necrosis Factor / metabolism
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Receptors, Tumor Necrosis Factor / therapeutic use*
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Transplantation, Homologous
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Tumor Necrosis Factor-alpha / antagonists & inhibitors*
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Tumor Necrosis Factor-alpha / metabolism
Substances
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Immunoglobulin G
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Immunosuppressive Agents
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Receptors, Tumor Necrosis Factor
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Tumor Necrosis Factor-alpha
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Collagen
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Etanercept