免疫检查点抑制剂相关心肌炎的见解。

Insight of immune checkpoint inhibitor related myocarditis.

作者信息

Pi Jin-Kui, Chen Xiao-Ting, Zhang Yan-Jing, Chen Xue-Mei, Wang Yin-Chan, Xu Jia-Yi, Zhou Jin-Han, Yu Shuai-Shuai, Wu Si-Si

机构信息

Core Facilities, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.

Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.

出版信息

Int Immunopharmacol. 2024 Dec 25;143(Pt 3):113559. doi: 10.1016/j.intimp.2024.113559. Epub 2024 Nov 12.

Abstract

As the understanding of immune-related mechanisms in the development and progression of cancer advances, immunotherapies, notably Immune Checkpoint Inhibitors (ICIs), have become integral in comprehensive cancer treatment strategies. ICIs reactivate T-cell cytotoxicity against tumors by blocking immune suppressive signals on T cells, such as Programmed Death-1 (PD-1) and Cytotoxic T-lymphocyte Antigen-4 (CTLA-4). Despite their beneficial effects, ICIs are associated with immune-related adverse events (irAEs), manifesting as autoimmune side effects across various organ systems. A particularly alarming irAE is life-threatening myocarditis. This rare but severe side effect of ICIs leads to significant long-term cardiac complications, including arrhythmias and heart failure, and has been observed to have a mortality rate of up to 50% in affected patients. This greatly limits the clinical application of ICI-based immunotherapy. In this review, we provide a comprehensive summary of the current knowledge regarding the diagnosis and management of ICI-related myocarditis. We also discuss the utility of preclinical mouse models in understanding and addressing this critical challenge.

摘要

随着对癌症发生发展过程中免疫相关机制的认识不断深入,免疫疗法,尤其是免疫检查点抑制剂(ICIs),已成为综合癌症治疗策略中不可或缺的一部分。ICIs通过阻断T细胞上的免疫抑制信号,如程序性死亡受体1(PD-1)和细胞毒性T淋巴细胞相关抗原4(CTLA-4),重新激活T细胞对肿瘤的细胞毒性。尽管ICIs具有有益作用,但它们与免疫相关不良事件(irAEs)有关,表现为累及各个器官系统的自身免疫副作用。一种特别令人担忧的irAE是危及生命的心肌炎。这种ICIs罕见但严重的副作用会导致严重的长期心脏并发症,包括心律失常和心力衰竭,并且据观察,受影响患者的死亡率高达50%。这极大地限制了基于ICI的免疫疗法的临床应用。在这篇综述中,我们全面总结了目前关于ICI相关心肌炎诊断和管理的知识。我们还讨论了临床前小鼠模型在理解和应对这一关键挑战方面的作用。

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