Takotsubo Syndrome (TTS), often called “broken heart syndrome,” is a fascinating and complex condition in cardiology. In a recent review published in Frontiers in Immunology, researchers explored the immunological mechanisms underlying this stress-induced cardiomyopathy, highlighting the role of inflammation and the immune response in disease progression.
Figure 1: The cardiac inflammatory response in high dose isoproterenol-injected mice. The accompanying changes in the left ventricular ejection fraction (LVEF) as a measure of cardiac function are shown below. Potential points of therapeutic intervention are indicated, i.e., depletion of macrophages or T cells, or the enhancement of programmed death-1 (PD-1)/PD-ligand 1 (PD-L1) signaling in macrophages and T cells. CCR, receptor for CCL2/MCP1 and CCL7/MCP3; LYVE1, tissue-resident macrophage marker.
TTS occurs when a sudden surge of catecholamines, typically triggered by physical or emotional stress, causes the heart’s left ventricle to weaken, leading to transient dysfunction. Although the heart usually recovers within days or weeks, the study shows that the inflammatory response plays a significant role in both the acute phase of the disease and its long-term consequences.
Patients with TTS often present elevated levels of inflammatory markers such as C-reactive protein (CRP) and cytokines at the onset of symptoms. This inflammatory response is thought to contribute to the persistence of symptoms in some patients, even after the acute phase has resolved. Animal studies have demonstrated that innate immune cells like macrophages and neutrophils infiltrate the heart tissue during the acute phase, exacerbating myocardial damage.
Interestingly, the review suggests that inflammation may not only be a consequence but could also be a cause of TTS, as certain inflammatory conditions have been shown to trigger TTS episodes. By targeting inflammation with therapies such as anti-inflammatory drugs, researchers believe it may be possible to improve outcomes for patients with TTS, particularly those at risk for recurrence or long-term complications.
The study concludes that further research is needed to better understand the immunological pathways involved in TTS and to develop treatments that address both the physical and immune components of the disease.
Journal Article: Lim, Kenji Rowel, et al. “The Immunology of Takotsubo Syndrome.” Frontiers in Immunology, vol. 14, 6 Oct. 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC10588665/, https://doi.org/10.3389/fimmu.2023.1254011.
Summary by Faith Oluwamakinde
