Discovery leads to novel approach for chronic heart failure treatment

Bacterial toxins are found in higher amounts in patients who have experienced a sudden worsening of heart failure, particularly in those who suffer from peripheral oedema (swelling in the legs), according to collaborative work between researchers at the National Heart & Lung Institute (NHLI) at Imperial College School of Medicine, London, and the Charite Medical School, Berlin, Germany. Their results are published in The Lancet on 28 May 1999.

Their findings suggest that bacterial toxins may be an important stimulus of immune activation in patients with chronic congestive heart failure. The research team believe that the bowel wall may become more leaky due to the disease processes in heart failure, leading to the uptake of bacterial toxins that then have detrimental effects. This indicates that it may be useful to treat patients with acute heart failure with antibiotics or drugs that specifically block the action of bacterial toxins.

Lead author Dr Stefan Anker, NHLI, says:

"We suggest that therapeutic actions against the entry of endotoxin from the bowel into the blood stream and against its action when inside the body may have long term beneficial effects for heart failure patients. To achieve this, simple therapies like the use of non-absorbable antibiotics may be useful to decontaminate the bowel. More sophisticated approaches could be via the use of research drugs that are antibodies to bacterial endotoxin. Neither of these approaches have been studied before in heart failure."

This is consistent with research into stomach ulcer and coronary artery disease where bacteria are now known to contribute to the disease development, and antibiotics are now widely used, in the case of stomach ulcer, or under research, in the case of coronary artery disease.

For further information please contact:

Dr Stefan Anker
Cardiac Medicine, NHLI
Tel: 0171-351 8203
Fax: 0171-351 8733

Notes to editors:

1. The paper "Endotoxin and immune activation in chronic heart failure: a prospective cohort study" is published in The Lancet (1999, Vol 353, pp1838-1842). Authors: Niebauer J, Volk H-D, Kemp M, Dominguez M, Schumann RR, Rauchhaus M, Poole-Wilson PA, Coats AJS, Anker SD.

2. Imperial College of Science, Technology and Medicine has the largest income (£309m), the largest research income (£117m) and the largest working estate of any university institution in the UK. The concentration and strength of its research in science, engineering and medicine gives the College a unique and internationally distinctive research presence. Imperial College was rated second overall in the Times Good University Guide (23 April 1999) and in the Financial Times Guide to Britain's top 100 universities (1 April 1999).