The Role of the Immunogenetic Background in the Development and Recurrence of Acute Idiopathic Pericarditis

Abstract

Objectives: We assessed the role of the immunogenetic background in the development and recurrence of acute idiopathic pericarditis (AIP). Methods: Fifty-five patients with a first episode of AIP were followed for 23.8 ± 6.3 months and recurrences were recorded. The control group consisted of 246 healthy individuals. In all subjects, genomic human leukocyte antigen (HLA) typing was performed. Moreover, circulating lymphocyte subpopulations were studied in 44 randomly selected patients and in 20 controls. Results: An increased frequency of HLA-A*02, -Cw*07 and -DQB1*0202 alleles, and a decreased frequency of the -DQB1*0302 allele was detected in patients with AIP. The recurrence rate was 40% and time to recurrence was 202.8 ± 164.1 days. In patients with idiopathic recurrent pericarditis (RP), increased frequencies of HLA-A*02, -Cw*07 and -DQB1*0202 alleles were found. Notably, no patient with RP exhibited HLA-DRB1*04 and -DQB1*0302 alleles. Patients with RP exhibited lower CD4+/CD45RA+ naïve T cells (p = 0.03) than controls, and higher CD8+DR+ activated T cells (p = 0.01) than patients without recurrence and controls. Conclusions: HLA alleles may confer either susceptibility or resistance to AIP and RP. Circulating T-cell subpopulations may also predict RP. A combination of the above parameters might help to better define patients prone to recurrence.

Autoimmunity and autoinflammation as the yin and yang of idiopathic recurrent acute pericarditis

“…In a cohort of 55 patients with a first episode of idiopathic acute pericarditis, followed for a mean period of almost 2 years, genomic human leukocyte antigen (HLA) typing was performed and circulating lymphocyte subpopulations were studied, finding a recurrence rate of 40% and an increased frequency of HLA-A*02, -Cw*07 and -DQB1*0202 alleles in patients with a recurrent disease. Notably, no patient with IRAP exhibited HLA-DRB1*04 and -DQB1*0302 alleles [106]. Thereby, HLA alleles may confer either susceptibility or resistance to IRAP, though further studies are needed to define the possible contribution of the major HLA complex and other candidate genes to the recurrence of pericarditis.…”

Acute pericarditis

“…Patients receiving these drugs should also receive a proton-pump inhibitor for gastric protection. 23 Aspirin is the preferred NSAID in patients with symptomatic pericarditis occurring during the early post-myocardial infarction period, and in combination with colchicine for the majority of other patients in need of concomitant antiplatelet therapy.…”

Colchicine and beyond: New options for the treatment of pericarditis

“…It has been hypothesized that many patients with recurrent pericarditis without an obvious cause suffer from an immune-mediated disorder [12,13], either from its onset or incited by an initial viral infection. In addition to the fact that immunomodulatory treatment is usually effective, the existence of an immune response underlying recurrent pericarditis is supported by the presence of elevated levels of autoantibodies in patients compared with control subjects as well as an association with specific leukocyte antigens [14][15][16]. A systematic study of immune system responses in these patients would be most welcome as an aid to the design of new and novel treatments.…”