Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Luca, Giacomo De; Campochiaro, Corrado; Sartorelli, Silvia; Peretto, Giovanni; Dagna, Lorenzo

doi:10.1016/j.ejim.2020.04.050

Cited by 31 publications

(24 citation statements)

References 120 publications

(186 reference statements)

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“…Both the patient and his parents were actively involved in the discussion about the risk‐to‐benefit ratio, and time was needed before they accepted the indication to IST. Treatment regimen was derived from adult patients with autoimmune myocarditis 2,7 and adapted to pediatric doses as in other immune‐mediated diseases of childhood 8,9 . Overall, IST was safe and well tolerated.…”

Section: Discussionmentioning

confidence: 99%

Immunosuppressive therapy in childhood‐onset arrhythmogenic inflammatory cardiomyopathy

Peretto

Barzaghi

Cicalese

et al. 2021

Pacing Clinical Electrophis

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We present, to our knowledge, the first case of immunosuppressive therapy (IST) application in a 12‐year‐old child with arrhythmogenic inflammatory cardiomyopathy resulting from the overlap between autoimmune myocarditis and primary arrhythmogenic cardiomyopathy. Indication to off‐lable IST was compelling, because of recurrent drug‐refractory ventricular arrhythmias (VAs). We show that IST was feasible, safe, and effective on multiple clinical endpoints, including symptoms, VA recurrences, and T‐troponin release. Remarkably, all diagnostic and therapeutic strategies were worked out by a dedicated multidisciplinary team, including specialized pediatric immunologists.

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Section: Discussionmentioning

confidence: 99%

Immunosuppressive therapy in childhood‐onset arrhythmogenic inflammatory cardiomyopathy

Peretto

Barzaghi

Cicalese

et al. 2021

Pacing Clinical Electrophis

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“…Previous recommendations suggest immunosuppressive therapy be considered only whenever the virus load is negative in myocarditis. 136 Evidence indicates the administration of glucocorticoids can significantly improve the prognosis of patients with EMB proven lymphocytic myocarditis, in either virus-positive or virus-negative individuals. 137 Hence, there remains a debate about the effectiveness of glucocorticoids in FM.…”

Section: Figmentioning

confidence: 99%

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Hang

Chen

Seubert

et al. 2020

Sig Transduct Target Ther

103

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Fulminant myocarditis (FM) is characterized by a rapid progressive decline in cardiac function and a high mortality rate. Since the first report of FM patients in the 1980s, several clinical trials and research studies have been published increasing our knowledge regarding FM. Currently, the diagnosis of FM depends on various techniques including electrocardiography, echocardiography, endomyocardial biopsy, and cardiac magnetic resonance. The development of mechanical circulation support (MCS) devices and progress in our understanding of the pathophysiological mechanisms underlying FM, treatment regimens have evolved from simple symptomatic treatment to a life support-based comprehensive treatment approach. The core mechanism underlying the development of FM is the occurrence of an inflammatory cytokine storm. This review provides a comprehensive account of the current understanding of FM pathophysiology and knowledge regarding its etiology, pathophysiology, treatments, and outcomes.

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“…Improvement began soon after anakinra administration with improvement of the arrhythmic outburst, decrease of cardiac biomarkers, and normalized echocardiography and CMR imaging-including those that measured LVEF (105). Anakinra treatment was also beneficial in patients with fulminant myocarditis (106)(107)(108). Taken together, these observations suggest that IL-1 inhibition could curb heart inflammation while also ameliorating myocardial contractility.…”

Section: Therapeutic Applicability Of Il-1 Inhibition and Future Persmentioning

confidence: 84%

Interleukin-1 and Systemic Sclerosis: Getting to the Heart of Cardiac Involvement

et al. 2021

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Systemic sclerosis (SSc) is rare, severe connective tissue disease characterized by endothelial and vascular damage, immune activation, and resulting in inflammation and fibrosis of skin and internal organs, including the heart. SSc is associated with high morbidity and mortality. Cardiac involvement is frequent in SSc patients, even though often asymptomatic at early stages, and represents one of the major causes of SSc-related mortality. Heart involvement has a variable clinical presentation, and its pathogenesis is not completely understood. Myocardial fibrosis is traditionally considered the immunopathologic hallmark of heart involvement in SSc. This unique histological feature is paralleled by distinctive clinical and prognostic features. The so-called “vascular hypothesis” represents the most credited hypothesis to explain myocardial fibrosis. More recently, the prominent role of an inflammatory myocardial process has been identified as a cardinal event in the evolution to fibrosis, thus also delineating an “inflammation-driven pathway to fibrosis”. The pro-inflammatory cytokine interleukin (IL)-1 has an apical and cardinal role in the myocardial inflammatory cascade and in cardiac dysfunction. The primary aim of this perspective article is: to present the emerging evidence on the role of IL-1 and inflammasome in both SSc and heart inflammation, to review the complex interplay between cellular metabolism and inflammasome activation, and to discuss the rationale for targeted inhibition of IL-1 for the treatment of SSc-heart involvement, providing preliminary experimental and clinical data to support this hypothesis.

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Therapeutic strategies for virus-negative myocarditis: a comprehensive review

Cited by 31 publications

References 120 publications

Immunosuppressive therapy in childhood‐onset arrhythmogenic inflammatory cardiomyopathy

Immunosuppressive therapy in childhood‐onset arrhythmogenic inflammatory cardiomyopathy

Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes

Interleukin-1 and Systemic Sclerosis: Getting to the Heart of Cardiac Involvement

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