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Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis
SIMPLE SUMMARY: Myocarditis is an infrequent but highly hazardous complication of the cancer therapy of immune checkpoint inhibitors (ICIs). The study of the pathophysiology of this disease is an active field of research and a clearer comprehension of the mechanisms is crucial to provide an accurate...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9497311/ https://www.ncbi.nlm.nih.gov/pubmed/36139654 http://dx.doi.org/10.3390/cancers14184494 |
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author | Jiménez-Alejandre, Rosa Ruiz-Fernández, Ignacio Martín, Pilar |
author_facet | Jiménez-Alejandre, Rosa Ruiz-Fernández, Ignacio Martín, Pilar |
author_sort | Jiménez-Alejandre, Rosa |
collection | PubMed |
description | SIMPLE SUMMARY: Myocarditis is an infrequent but highly hazardous complication of the cancer therapy of immune checkpoint inhibitors (ICIs). The study of the pathophysiology of this disease is an active field of research and a clearer comprehension of the mechanisms is crucial to provide an accurate diagnosis, appropriate therapy, and to prevent cardiac adverse toxicities occurring during ICI treatment that compromise the continuation of the cancer treatment. This review provides an update of the currently approved ICIs and their relationship with myocarditis induction through boosting the immune system. It also discusses preclinical models of ICI-associated myocarditis and their contribution to the state of the art and presents recent advances in the pathogenesis of the disease. ABSTRACT: Immune checkpoint inhibitors (ICIs) have recently emerged as strong therapies for a broad spectrum of cancers being the first-line treatment for many of them, even improving the prognosis of malignancies that were considered untreatable. This therapy is based on the administration of monoclonal antibodies targeting inhibitory T-cell receptors, which boost the immune system and prevent immune evasion. However, non-specific T-cell de-repression can result in a wide variety of immune-related adverse events (irAEs), including gastrointestinal, endocrine, and dermatologic, with a smaller proportion of these having the potential for fatal outcomes such as neurotoxicity, pulmonary toxicity, and cardiotoxicity. In recent years, alarm has been raised about cardiotoxicity as it has the highest mortality rate when myocarditis develops. However, due to the difficulty in diagnosing this cardiac condition and the lack of clinical guidelines for the management of cardiovascular disease in patients on therapy with ICIs, early detection of myocarditis has become a challenge in these patients. In this review we outline the mechanisms of tolerance by which this fatal cardiomyopathy may develop in selected cancer patients treated with ICIs, summarize preclinical models of the disease that will allow the development of more accurate strategies for its detection and treatment, and discuss the challenges in the future to decrease the risks of its development with better decision making in susceptible patients. |
format | Online Article Text |
id | pubmed-9497311 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-94973112022-09-23 Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis Jiménez-Alejandre, Rosa Ruiz-Fernández, Ignacio Martín, Pilar Cancers (Basel) Review SIMPLE SUMMARY: Myocarditis is an infrequent but highly hazardous complication of the cancer therapy of immune checkpoint inhibitors (ICIs). The study of the pathophysiology of this disease is an active field of research and a clearer comprehension of the mechanisms is crucial to provide an accurate diagnosis, appropriate therapy, and to prevent cardiac adverse toxicities occurring during ICI treatment that compromise the continuation of the cancer treatment. This review provides an update of the currently approved ICIs and their relationship with myocarditis induction through boosting the immune system. It also discusses preclinical models of ICI-associated myocarditis and their contribution to the state of the art and presents recent advances in the pathogenesis of the disease. ABSTRACT: Immune checkpoint inhibitors (ICIs) have recently emerged as strong therapies for a broad spectrum of cancers being the first-line treatment for many of them, even improving the prognosis of malignancies that were considered untreatable. This therapy is based on the administration of monoclonal antibodies targeting inhibitory T-cell receptors, which boost the immune system and prevent immune evasion. However, non-specific T-cell de-repression can result in a wide variety of immune-related adverse events (irAEs), including gastrointestinal, endocrine, and dermatologic, with a smaller proportion of these having the potential for fatal outcomes such as neurotoxicity, pulmonary toxicity, and cardiotoxicity. In recent years, alarm has been raised about cardiotoxicity as it has the highest mortality rate when myocarditis develops. However, due to the difficulty in diagnosing this cardiac condition and the lack of clinical guidelines for the management of cardiovascular disease in patients on therapy with ICIs, early detection of myocarditis has become a challenge in these patients. In this review we outline the mechanisms of tolerance by which this fatal cardiomyopathy may develop in selected cancer patients treated with ICIs, summarize preclinical models of the disease that will allow the development of more accurate strategies for its detection and treatment, and discuss the challenges in the future to decrease the risks of its development with better decision making in susceptible patients. MDPI 2022-09-16 /pmc/articles/PMC9497311/ /pubmed/36139654 http://dx.doi.org/10.3390/cancers14184494 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Jiménez-Alejandre, Rosa Ruiz-Fernández, Ignacio Martín, Pilar Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title | Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title_full | Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title_fullStr | Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title_full_unstemmed | Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title_short | Pathophysiology of Immune Checkpoint Inhibitor-Induced Myocarditis |
title_sort | pathophysiology of immune checkpoint inhibitor-induced myocarditis |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9497311/ https://www.ncbi.nlm.nih.gov/pubmed/36139654 http://dx.doi.org/10.3390/cancers14184494 |
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