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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

420
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Heart Failure Drugs: Inotropic Agents01:26

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Related Experiment Video

Updated: Jun 23, 2025

Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood
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Stringent monitoring can decrease mortality of immune checkpoint inhibitor induced cardiotoxicity.

Ying Wang1, Carolin Ertl1,2, Christina Schmitt1

  • 1Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.

Frontiers in Cardiovascular Medicine
|June 25, 2024
PubMed
Summary
This summary is machine-generated.

Immune checkpoint inhibitor (ICI)-induced myocarditis is a serious adverse event. Intensified patient management and monitoring significantly reduced mortality rates in a recent study.

Keywords:
cardiovascular toxicitycheckpoint inhibitorimmunotherapymelanomamyocarditis

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Area of Science:

  • Immunology
  • Cardiology
  • Oncology

Background:

  • Immune checkpoint inhibitors (ICIs) can cause myocarditis, a rare but potentially fatal immune-related adverse event (irAE).
  • Current mortality rates for ICI-induced myocarditis range from 40%-46%, with cases often being asymptomatic, necessitating improved monitoring and therapeutic strategies.
  • This study aimed to elucidate the pathogenesis of ICI-induced myocarditis and evaluate outcomes in cancer centers employing intensified patient management protocols.

Purpose of the Study:

  • To investigate the pathogenesis of immune checkpoint inhibitor (ICI)-induced myocarditis.
  • To assess the outcomes of patients with cardiac irAEs under intensified management in cancer centers.
  • To identify potential predictive biomarkers for ICI-induced myocarditis.

Main Methods:

  • Analysis of patient data from the SERIO registry, including demographics, ICI details, irAE treatment, and outcomes.
  • Cardiac biopsies from irMyocarditis patients were analyzed using Nanostring, compared to healthy controls.
  • Longitudinal immunophenotyping of peripheral blood mononuclear cells (PBMCs) was performed using flow cytometry.

Main Results:

  • A total of 51 patients with 53 cardiac irAEs were analyzed; 11.3% were fatal.
  • Centers with established troponin monitoring and prompt treatment demonstrated significantly lower mortality rates.
  • Differential regulation of cytokine-mediated signaling pathways was observed in myocardial biopsies; ICI-driven changes in CD4+ Treg cells and effector memory T cells were noted in PBMCs.
  • LAG3 and PD-L1 expression showed potential as predictive indicators for irMyocarditis.

Conclusions:

  • Intensified patient management, including monitoring and prompt treatment, substantially lowers mortality rates for ICI-induced myocarditis.
  • Novel local and systemic immunological patterns associated with ICI-induced cardiotoxicity have been identified.
  • Further research into predictive biomarkers like LAG3 and PD-L1 expression is warranted.