Abstract
Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies.
Highlights
Ischaemic heart disease is estimated to account for 9 million deaths per year and is the leading cause of global mortality.[1]
Post-myocardial infarction (MI), the severe tissue damage caused by an acute infarct is a potent trigger to activate the immune system, which orchestrates the various steps of the post-MI healing process, starting immediately with the removal of cellular debris and restoration of tissue integrity
We aim to provide a comprehensive overview of clinical trials on pharmacological interventions targeting the immune system to prevent MI or improve post-MI prognosis, from broad immunosuppressive therapy to more refined approaches targeting specific pathways and factors including reactive oxygen species (ROS), complement, mast cells, leucocyte infiltration, inflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF), and IL-6, and the inhibition of adaptive B and T lymphocytes (Figure 1)
Summary
Ischaemic heart disease is estimated to account for 9 million deaths per year and is the leading cause of global mortality.[1]. We aim to provide a comprehensive overview of clinical trials on pharmacological interventions targeting the immune system to prevent MI or improve post-MI prognosis, from broad immunosuppressive therapy to more refined approaches targeting specific pathways and factors including reactive oxygen species (ROS), complement, mast cells, leucocyte infiltration, inflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF), and IL-6, and the inhibition of adaptive B and T lymphocytes (Figure 1). Most of these therapeutics are repurposed anti-inflammatory and immunosuppressive agents that have been in long-standing clinical use to prevent transplant rejection or treat autoimmunity
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