B-Cell Function in Chronic Heart Failure: Antibody Response to Pneumococcal Vaccine ANTHONY DOING, MD,* DANIEL GRIFFIN, MD, † JAY A. JACOBSON, MD, † INA J. AMBER, MD, † EDWARD GILBERT, MD* Salt Lake City, Utah ABSTRACT Background: Several immune system abnormalities have been noted in patients with chronic heart failure (CHF) including autoantibody production and abnormalities in tumor necrosis factor, interleukin 2, interleukin 6, natural killer cells, helper/inducer lymphocytes, lympho- cyte reactivity, and subtherapeutic responses to the influenza vaccination. Patients with CHF have a higher risk of nosocomial infections, mainly pulmonary. Immune function abnormali- ties in patients with CHF raise concern over the ability of patients with symptomatic CHF to mount an effective and protective B-cell response. Methods and Results: B-cell function was assessed by measuring antibody production in response to pneumococcal vaccination. Antibody levels were increased markedly for all serotypes tested (P  .001), and all patients had an increase in the number of serotypes for which they had protective antibody levels from a mean of 7.9 to 10.5 of 12 serotypes tested (P  .001). These responses are consistent with normal responses to vaccination. Conclusions: Despite evidence of multiple immune system abnormalities, patients with CHF seem to have an intact B-cell function and the etiology of CHF does not affect antibody response. The normal response to vaccination confirms the potential utility of the vaccination. Key Words: B cells, heart failure, immune response. Chronic heart failure (CHF) is associated with several changes in immune function. Myocardial autoantibodies have been noted in idiopathic dilated cardiomyopathy and other forms of CHF (1–3). Several studies show impaired lymphocyte reactivity and abnormalities in the number and function of natural killer cells, helper/inducer lymphocytes, and suppressor lympho- cytes in idiopathic and other forms of dilated cardiomy- opathy (3–6). Clinical wasting and increased levels of circulating tumor necrosis factor , interleukin 2, and interleukin 6 have also been noted in patients with CHF (3,7–10). Data indicate that CHF patients have a higher risk of nosocomial infections, particularly pulmonary (11). Additional evidence of impaired immune response is the observation that influenza vaccination of patients with CHF results in a markedly lower percentage of protective responses than in normal controls (12). Response to influenza vaccination requires intact B- and T-cell function, whereas response to pneumococcal vaccination requires only intact B-cell function (13–15). Impairment of B lymphocyte cell function would reduce antibody production and increase the risk of infection, particularly of encapsulated bacteria. Currently it is recommended that patients with CHF receive the pneu- mococcal vaccine. It is not known, however, whether B-cell function is normal in CHF. This concern is From the Divisions of † Infectious Disease and *Cardiology, Univer- sity of Utah School of Medicine, Salt Lake City, UT. Supported by a grant from the Deseret Foundation, Salt Lake City, UT. Manuscript received December 11, 2000; revised manuscript re- ceived June 15, 2001; revised manuscript accepted July 11, 2001. Reprint requests: Edward M. Gilbert, MD, Division of Cardiology, University of Utah Health Sciences Center, 50 N Medical Dr, Salt Lake City, UT 84132. Presented at the Heart Failure Society of America 4th annual meeting, September 2000, Boca Raton, FL. Copyright © 2001 by Churchill Livingstone 1071-9164/01/0704-0007$35.00/0 doi:10.1054/jcaf.2001.27829 Journal of Cardiac Failure Vol. 7 No. 4 2001 318