Upregulation of A2A adenosine receptor expression by TNF-alpha in PBMC of patients with CHF: A regulatory mechanism of inflammation

Background: Tumor necrosis factor (TNF)-alpha, plays a role in congestive heart failure (CHF). A(2A) adenosine receptor (A(2A)R) activation on immune cells putatively reduces the release of cytokines contributing to CHF progression. The study is aimed at determining the role of the A(2A)R in the modulation of TNF-alpha production, and the ex vivo effect of TNF-alpha on A(2A)R in peripheral blood mononuclear cells (PBMC) from CHF patients. Methods and Results: Plasma levels of TNF-alpha and TNF-alpha production from lipopolysaccharide (LPS)stimulated PBMC were evaluated in 26 CHF patients in comparison to controls. The effects of the A(2A)R agonist CGS-21680 and antagonist ZM-241385 on TNF-alpha production from PBMC were also evaluated. Finally, reverse transcriptase-polymerase chain reaction and Western blot analyses of A(2A)R in PBMC were performed in TNF-alpha-treated and untreated cells. TNF-alpha production from LPS-stimulated PBMC was enhanced in CHF patients with respect to controls. CGS-21680 blunted TNF-alpha production in both groups; ZM-241385 reverted this effect. A(2A)R expression in PBMC was higher in CHF patients than in controls. TNF-alpha addition produced an increase in A(2A)R in PBMC from controls but not in PBMC from CHF patients. Conclusions: PBMC from CHF patients show an upregulation of A(2A)R-mediated inhibition of TNF-alpha, which may represents a mechanism of protection against inappropriate cytokine production.