Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition
| Autor: | Angelos Papanikolaou, Susanne Sattler, Mona Panahi, Muneer G. Hasham, Nadia Rosenthal, Ji-Gang Zhang, Azam Torabi, Ali Vazir, John G.F. Cleland, Habib Khan, Sian E. Harding |
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| Přispěvatelé: | British Heart Foundation |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Cardiac & Cardiovascular Systems MONOCLONAL-ANTIBODY Physiology medicine.medical_treatment Anti-Inflammatory Agents Myocardial Infarction 030204 cardiovascular system & hematology Bioinformatics RANDOMIZED DOUBLE-BLIND 0302 clinical medicine Risk Factors Medicine 1102 Cardiorespiratory Medicine and Haematology TUMOR-NECROSIS-FACTOR Clinical Trials as Topic biology C-REACTIVE PROTEIN VENTRICULAR-FUNCTION Cytokine Treatment Outcome CORONARY ANGIOPLASTY Immunotherapy medicine.symptom Inflammation Mediators Cardiology and Cardiovascular Medicine Life Sciences & Biomedicine Immunosuppressive Agents Signal Transduction ACUTE MYOCARDIAL-INFARCTION Reviews Inflammation Proinflammatory cytokine Immunomodulation 03 medical and health sciences Immune system Physiology (medical) INTRAVENOUS IMMUNOGLOBULIN Humans Heart Failure Science & Technology business.industry C-reactive protein HOSPITAL CARDIAC-ARREST N-ACETYLCYSTEINE Blockade Clinical trial IL-1 inhibition Editor's Choice 030104 developmental biology Cardiovascular System & Hematology biology.protein Cardiovascular System & Cardiology Systematic review business Interleukin-1 |
| Zdroj: | Cardiovascular Research |
| ISSN: | 1755-3245 0008-6363 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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