The autoinflammatory side of recurrent pericarditis: Enlightening the pathogenesis for a more rational treatment |
| |
| Authors: | Giuseppe Lopalco Donato Rigante Luca Cantarini Massimo Imazio Antonio Lopalco Giacomo Emmi Vincenzo Venerito Marco Fornaro Bruno Frediani Mariangela Nivuori Antonio Brucato Florenzo Iannone |
| |
| Affiliation: | 1. Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Piazza G. Cesare 11, Bari 70124, Italy;2. Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy;3. Università Cattolica Sacro Cuore, Rome, Italy;4. Research Centre of Systemic Autoinflammatory Diseases, Behçet''s Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Centre, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy;5. Cardiovascular and Thoracic Department, University Cardiology, Turin, Italy;6. AOU Città della Salute e della Scienza of Turin, University of Turin, Turin, Italy;7. Department of Pharmacy - Drug Sciences, University of Bari, Bari, Italy;8. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;9. Department of Medicine, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco and Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy;1. Cardiology Unit, Azienda Ospedaliero-Universitaria of Ferrara, Via Aldo Moro 8, Cona, Province of Ferrara, Italy;2. Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy;3. Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy;4. Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Province of Ferrara, Italy;1. Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;2. Serviço de Medicina III, Hospital Pulido Valente, CHLN, Lisboa, Portugal;3. Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal;4. Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal;5. Centro Cardiovascular da Universidade de Lisboa - CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal;6. Serviço de Cardiologia, Hospital Universitário de Santa Maria – CHULN, Portugal;1. Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium;2. Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium;1. Department of Medicine, Duke University Medical Center (DUMC), Box 3182, Durham, NC 27710, United States;2. Division of Cardiology, Duke University Medicial Center, Durham, NC 27710, United States;3. Duke Clinical Research Institute, 300 West Morgan Street, Durham, NC 27701, United States;4. Division of Pharmacology, Duke University Medical Center, Durham, NC 27710, United States |
| |
| Abstract: | Recurrent pericarditis (RP) is a troublesome and debilitating complication of acute pericarditis. Although the etiopathogenesis of this condition remains unknown, an intricate overlap of autoimmune and autoinflammatory pathways has been hypothesized to explain its beginning and recurrence over time. The majority of cases are defined as “idiopathic”, reflecting our awkwardness to unravel the intimate mechanisms of RP. Given the possible occurrence of anti-nuclear, anti-heart and anti-intercalated disk antibodies as well as the association with peculiar human leukocyte antigen haplotypes, an autoimmune contribution has been claimed to specify the nature of RP. However, the most innovative pathogenic scenario of RP has been conferred to the innate immune system, mainly involving neutrophils and macrophages that produce a large amount of interleukin (IL)-1 via inflammasome activation. The clinical resemblance of RP with autoinflammatory diseases that may be marked by symptomatic serositis, high fevers and strikingly increased inflammatory parameters further suggests a similar inflammasome-mediated pathogenesis. Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of therapy in RP, whereas colchicine is recommended on top of standard anti-inflammatory therapy, due to its role in inhibiting the IL-1 converting enzyme (caspase 1) within the inflammasome as well as the release of additional pro-inflammatory mediators and reactive oxygen species. With regard to treatment of RP refractory to NSAIDs and colchicine, blockade of IL-1 is the most relevant advance achieved in the last decade: the outstanding effect of the short-acting IL-1 receptor antagonist anakinra has been first recognized in the pediatric population, giving a proof of its practical feasibility. Over a more recent time, a growing experience with anakinra deriving from both large and small studies has further confirmed that RP might be regarded as an IL-1-mediated disease. This review aims to provide a contemporary insight into the mechanisms leading to RP as well as into the most recent literature data showing the beneficial approach originating from IL-1 blockade in this intriguing disorder. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
