Hutchins Elizabeth, Yang Eric H, Stein-Merlob Ashley F
Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Curr Cardiol Rep. 2024 Dec;26(12):1329-1340. doi: 10.1007/s11886-024-02131-5. Epub 2024 Oct 8.
In this review we describe the role of inflammation in chemotherapy-induced cardiotoxicity with a particular focus on anthracycline-induced cardiomyopathy (AIC). First, we discuss inflammation associated with anthracyclines at a cellular level. Next, we discuss the clinical implications of these inflammatory mechanisms for early detection and cardioprotective strategies in patients undergoing anthracycline treatment.
Key inflammatory pathways identified in AIC include cytokine release, upregulation of the innate immune system via toll-like receptors, and activation of the inflammasome. Emerging evidence suggests a role for inflammatory biomarkers in detecting subclinical AIC. Advanced imaging techniques, such as cardiac PET with novel tracers targeting inflammation, may enhance early detection. Both traditional cardioprotective strategies and novel anti-inflammatory therapies show potential in preventing and treating AIC. Understanding the inflammatory mechanisms involved in AIC provides new opportunities for early detection and targeted cardioprotective strategies in patients undergoing anthracycline treatment and informs our understanding of other forms of chemotherapy-induced cardiotoxicity.
在本综述中，我们描述炎症在化疗诱导的心脏毒性中的作用，特别关注蒽环类药物诱导的心肌病（AIC）。首先，我们在细胞水平上讨论与蒽环类药物相关的炎症。接下来，我们讨论这些炎症机制对接受蒽环类药物治疗的患者早期检测和心脏保护策略的临床意义。
在AIC中确定的关键炎症途径包括细胞因子释放、通过Toll样受体上调先天免疫系统以及炎性小体的激活。新出现的证据表明炎症生物标志物在检测亚临床AIC中发挥作用。先进的成像技术，如使用靶向炎症的新型示踪剂的心脏PET，可能会加强早期检测。传统的心脏保护策略和新型抗炎疗法在预防和治疗AIC方面都显示出潜力。了解AIC中涉及的炎症机制为接受蒽环类药物治疗的患者的早期检测和靶向心脏保护策略提供了新机会，并增进了我们对其他形式化疗诱导的心脏毒性的理解。
