Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review

Barry, Timothy; Gallen, Rory; Freeman, Catherine; Agasthi, Pradyumna; Pedrotty, Dawn M.; Yang, Ming; Jokerst, Clinton; Mookadam, Farouk; Hardaway, Brian; LeMond, Lisa; Arsanjani, Reza; Larsen, Carolyn M.

doi:10.1016/j.amjms.2021.04.018

Cited by 6 publications

(2 citation statements)

References 51 publications

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“…Secondly, irMyocarditis may be less likely to diminish with time or with treatment by immunosuppression. Indeed, numerous cases of irMyocarditis refractory to potent immunosuppression have been reported 62,85,86 . The mechanisms by which activated T cells (and presumably other involved immune cells) escape or withstand the inhibitory effects of immunosuppression remain unknown.…”

Section: Ici Myocarditis Compared To Other Types Of Myocardial Inflam...mentioning

confidence: 99%

“…Indeed, numerous cases of irMyocarditis refractory to potent immunosuppression have been reported. 62,85,86 The mechanisms by which activated T cells (and presumably other involved immune cells) escape or withstand the inhibitory effects of immunosuppression remain unknown. One possibility is that the T cells have been durably reprogrammed by ICI exposure to become resistant to inhibitory signals.…”

Section: Ici Myoc Arditis Compared To Other T Ype S Of Myo C Ard Ial ...mentioning

confidence: 99%

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Mediators and mechanisms of immune checkpoint inhibitor‐associated myocarditis: Insights from mouse and human

Gong

Neilan

Zlotoff

2023

Immunological Reviews

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SummaryThe broad application of immune checkpoint inhibitors (ICIs) has led to significant gains in cancer outcomes. By abrogating inhibitory signals, ICIs promote T cell targeting of cancer cells but can frequently trigger autoimmune manifestations, termed immune‐related adverse events (irAEs), affecting essentially any organ system. Among cardiovascular irAEs, immune‐related myocarditis (irMyocarditis) is the most described and carries the highest morbidity. The currently recommended treatment for irMyocarditis is potent immunosuppression with corticosteroids and other agents, but this has limited evidence basis. The cellular pathophysiology of irMyocarditis remains poorly understood, though mouse models and human data have both implicated effector CD8+ T cells, some of which are specific for the cardiomyocyte protein α‐myosin. While the driving molecular signals and transcriptional programs are not well defined, the involvement of chemokine receptors such as CCR5 and CXCR3 has been proposed. Fundamental questions regarding why only approximately 1% of ICI recipients develop irMyocarditis and why irMyocarditis carries a much worse prognosis than other forms of lymphocytic myocarditis remain unanswered. Further work in both murine systems and with human samples are needed to identify better tools for diagnosis, risk‐stratification, and treatment.

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Section: Ici Myocarditis Compared To Other Types Of Myocardial Inflam...mentioning

confidence: 99%

Section: Ici Myoc Arditis Compared To Other T Ype S Of Myo C Ard Ial ...mentioning

confidence: 99%

Mediators and mechanisms of immune checkpoint inhibitor‐associated myocarditis: Insights from mouse and human

Gong

Neilan

Zlotoff

2023

Immunological Reviews

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Atezolizumab/cabozantinib

2022

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Immune-checkpoint inhibitor-mediated myocarditis: CTLA4, PD1 and LAG3 in the heart

Munir,

Gutierrez,

Qin

et al. 2024

Nat Rev Cancer

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Successful Treatment of Steroid-Refractory Checkpoint Inhibitor Myocarditis with Globulin Derived-Therapy: A Case Report and Literature Review

Cited by 6 publications

References 51 publications

Mediators and mechanisms of immune checkpoint inhibitor‐associated myocarditis: Insights from mouse and human

Mediators and mechanisms of immune checkpoint inhibitor‐associated myocarditis: Insights from mouse and human

Atezolizumab/cabozantinib

Immune-checkpoint inhibitor-mediated myocarditis: CTLA4, PD1 and LAG3 in the heart

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