Basic Science and Experimental Studies
Decreased Immune Responses to Influenza Vaccination in Patients With Heart Failure

https://doi.org/10.1016/j.cardfail.2008.11.009Get rights and content

Abstract

Background

Heart failure (HF) patients are at risk for influenza despite widespread vaccination. Both humoral (antibody) and cytotoxic T-lymphocyte (CTL) responses are important for protection. We explored antibody- and CTL-mediated responses to the influenza vaccine in HF patients compared with healthy controls.

Methods and Results

We studied 29 HF patients (9 ischemic, 20 nonischemic) stable on HF therapies and 17 healthy controls. Participants had phlebotomy before and after influenza vaccination. Antibody production was measured in serum by hemagglutination inhibition assay and CTL responses (via interferon [IFN]-γ and interleukin [IL]-10 production) were measured in isolated peripheral blood mononuclear cells with enzyme-linked immunosorbent assay. CTL responses demonstrated increased IL-10 production in HF patients after vaccination (P = .002), but similar IFN-γ responses to healthy controls. All participants demonstrated antibody seroprotection; groups had similar rates of seroconversion (P = NS). Antibody-mediated response to the newest vaccine antigen, H3N2, was reduced in HF (P = .009).

Conclusions

Patients with HF had higher vaccine induced IL-10 concentrations, suggesting a different CTL phenotype for vaccine responses. HF patients did not mount as vigorous of an antibody immune response to the newest vaccine viral strain compared with healthy individuals. These data suggest that immunologic memory may be important for vaccine protection in HF patients.

Section snippets

Participants

We studied patients with HF and healthy controls. Eligible HF participants had systolic or diastolic dysfunction documented by echocardiogram in previous 6 months, with American College of Cardiology/American Heart Association Stage C, New York Heart Association Functional Class I, II, or III HF. All patients with HF were on stable medical therapy for at least 30 days, including target or maximally tolerated doses of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and

Patients

Thirty-two HF patients (8 females, 24 males) and 19 healthy controls (8 females, 11 males) were enrolled, with a mean age of 58 ± 13 years (median 57 years, range 26–81 years) for HF participants, and 47 ± 10 for healthy controls (median 51 years, range 29–65). HF participants were older than healthy control participants (P = .004 for comparison between groups). Among the HF group, mean ejection fraction was 39% ± 11% (median 35%, range 15% to 55%), and patients were New York Heart Association

Discussion

In this study, we compared humoral and CTL immune responses to influenza vaccination in patients with HF compared with healthy individuals. Our results were 3-fold.

First, participants with HF exhibited higher IL-10 production in response to influenza vaccination compared with healthy controls. Additionally, HF participants had a lower IFN-γ:IL-10 ratio compared with healthy controls, indicating a Th2 dominant phenotype. There were no differences in IFNγ production between groups. CTL responses

Acknowledgments

The authors gratefully acknowledge Drs. Walter Kao, David Murray, Peter Rahko, and Elaine Winkel for allowing their patients to participate in this study.

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  • Cited by (0)

    Dr. Vardeny was supported by NIH (NCRR) 8K12RRO23268 and the American College of Clinical Pharmacy. Dr. Sweitzer was supported by NIH K23AG01022.

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