Authors’ Reply
To the Editor:
We thank Dr. Mihai Capilna and colleagues for their valuable comments on our recent study titled “Expression of Programmed Cell Death‐1 and Its Ligand B7 Homolog 1 in Peripheral Blood Lymphocytes From Patients With Peripartum Cardiomyopathy.”1 We have taken these comments into serious consideration and would like to give our response.
First, which one of cellular or humoral immunity is responsible in a higher extent for the development of PPCM?. Immunity is regulated by CD4+ T cells that can be divided into type 1 T helper (Th1) and type 2 T helper (Th2) cells based on their prevalent profile of cytokine production.2 Th1 cells, which secrete interferon (IFN)‐γ, augment T cell proliferation to drive cellular immunity. Likewise, Th2 cells, which secrete interleukin (IL)‐4, activate B cells to facilitate humoral immunity.3 Th1 and Th2 cell immunity alterations, with a shift toward humoral immunity dominance linked to Th2 cells, contribute to a successful normal pregnancy.4 This is the notion that pregnancy is a Th2 phenomenon.5 Second, whether the changes in cytokine pattern can work in the onset or progression of PPCM that leads to alteration of the immunologic status? The pathogenesis of PPCM remains uncertain. Therefore, it is difficult to decide that cytokines may trigger the onset or progression of PPCM. However, investigations demonstrated evidence of an inflammatory process characterized by the cytokine imbalance, include IFN‐γ and IL‐4,6 may contribute to the pathophysiology of cardiac failure in PPCM.7 Sliwa K, et al. reported the CRP level was significantly higher in PPCM compared to healthy women. Nevertheless, in the study of the small number of Haitian PPCM patients, there was no statistically significant difference in CRP plasma levels in survivors versus deceased patients.8 Therefore, the issue is further supported by a study on the level of serum CRP in patients with PPCM.
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest.
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