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Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure

Support measures currently represent the mainstay of treatment for fulminant myocarditis, while effective and safe anti-inflammatory therapies remain an unmet clinical need. However, clinical and experimental evidence indicates that inhibition of the pro-inflammatory cytokine interleukin 1 (IL-1) is...

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Autores principales: Cavalli, Giulio, Foppoli, Marco, Cabrini, Luca, Dinarello, Charles A., Tresoldi, Moreno, Dagna, Lorenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298961/
https://www.ncbi.nlm.nih.gov/pubmed/28232838
http://dx.doi.org/10.3389/fimmu.2017.00131
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author Cavalli, Giulio
Foppoli, Marco
Cabrini, Luca
Dinarello, Charles A.
Tresoldi, Moreno
Dagna, Lorenzo
author_facet Cavalli, Giulio
Foppoli, Marco
Cabrini, Luca
Dinarello, Charles A.
Tresoldi, Moreno
Dagna, Lorenzo
author_sort Cavalli, Giulio
collection PubMed
description Support measures currently represent the mainstay of treatment for fulminant myocarditis, while effective and safe anti-inflammatory therapies remain an unmet clinical need. However, clinical and experimental evidence indicates that inhibition of the pro-inflammatory cytokine interleukin 1 (IL-1) is effective against both myocardial inflammation and contractile dysfunction. We thus evaluated treatment with the IL-1 receptor antagonist anakinra in a case of heart failure secondary to fulminant myocarditis. A 65-year-old man with T cell lymphoma developed fulminant myocarditis presenting with severe biventricular failure and cardiogenic shock requiring admittance to the intensive care unit and mechanical circulatory and respiratory support. Specifically, acute heart failure and cardiogenic shock were initially treated with non-invasive ventilation and mechanical circulatory support with an intra-aortic balloon pump. Nevertheless, cardiac function deteriorated further, and there were no signs of improvement. Treatment with anakinra, the recombinant form of the naturally occurring IL-1 receptor antagonist, was started at a standard subcutaneous dose of 100 mg/day. We observed a dramatic clinical improvement within 24 h of initiating anakinra. Prompt, progressive amelioration of cardiac function allowed weaning from mechanical circulatory and respiratory support within 72 h of anakinra administration. Recent studies point at inhibition of IL-1 activity as an attractive treatment option for both myocardial inflammation and contractile dysfunction. Furthermore, IL-1 receptor blockade with anakinra is characterized by an extremely rapid onset of action and remarkable safety and may thus be suitable for the treatment of patients critically ill with myocarditis.
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spelling pubmed-52989612017-02-23 Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure Cavalli, Giulio Foppoli, Marco Cabrini, Luca Dinarello, Charles A. Tresoldi, Moreno Dagna, Lorenzo Front Immunol Immunology Support measures currently represent the mainstay of treatment for fulminant myocarditis, while effective and safe anti-inflammatory therapies remain an unmet clinical need. However, clinical and experimental evidence indicates that inhibition of the pro-inflammatory cytokine interleukin 1 (IL-1) is effective against both myocardial inflammation and contractile dysfunction. We thus evaluated treatment with the IL-1 receptor antagonist anakinra in a case of heart failure secondary to fulminant myocarditis. A 65-year-old man with T cell lymphoma developed fulminant myocarditis presenting with severe biventricular failure and cardiogenic shock requiring admittance to the intensive care unit and mechanical circulatory and respiratory support. Specifically, acute heart failure and cardiogenic shock were initially treated with non-invasive ventilation and mechanical circulatory support with an intra-aortic balloon pump. Nevertheless, cardiac function deteriorated further, and there were no signs of improvement. Treatment with anakinra, the recombinant form of the naturally occurring IL-1 receptor antagonist, was started at a standard subcutaneous dose of 100 mg/day. We observed a dramatic clinical improvement within 24 h of initiating anakinra. Prompt, progressive amelioration of cardiac function allowed weaning from mechanical circulatory and respiratory support within 72 h of anakinra administration. Recent studies point at inhibition of IL-1 activity as an attractive treatment option for both myocardial inflammation and contractile dysfunction. Furthermore, IL-1 receptor blockade with anakinra is characterized by an extremely rapid onset of action and remarkable safety and may thus be suitable for the treatment of patients critically ill with myocarditis. Frontiers Media S.A. 2017-02-09 /pmc/articles/PMC5298961/ /pubmed/28232838 http://dx.doi.org/10.3389/fimmu.2017.00131 Text en Copyright © 2017 Cavalli, Foppoli, Cabrini, Dinarello, Tresoldi and Dagna. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Cavalli, Giulio
Foppoli, Marco
Cabrini, Luca
Dinarello, Charles A.
Tresoldi, Moreno
Dagna, Lorenzo
Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title_full Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title_fullStr Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title_full_unstemmed Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title_short Interleukin-1 Receptor Blockade Rescues Myocarditis-Associated End-Stage Heart Failure
title_sort interleukin-1 receptor blockade rescues myocarditis-associated end-stage heart failure
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298961/
https://www.ncbi.nlm.nih.gov/pubmed/28232838
http://dx.doi.org/10.3389/fimmu.2017.00131
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