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Zhou YW, Zhu YJ, Wang MN, Xie Y, Chen CY, Zhang T, Xia F, Ding ZY, Liu JY. Immune Checkpoint Inhibitor-Associated Cardiotoxicity: Current Understanding on Its Mechanism, Diagnosis and Management. Front Pharmacol 2019; 10:1350. [PMID: 31849640 PMCID: PMC6897286 DOI: 10.3389/fphar.2019.01350] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/24/2019] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) that target cytotoxic T lymphocyte antigen 4, programmed cell death-1, and PD-ligand 1 have revolutionized cancer treatment, achieving unprecedented efficacy in multiple malignancies. ICIs are increasingly being used in early cancer settings and in combination with various other types of therapies, including targeted therapy, radiotherapy, and chemotherapy. However, despite the excellent therapeutic effect of ICIs, these medications typically result in a broad spectrum of toxicity reactions, termed immune-related adverse events (irAEs). Of all irAEs, cardiotoxicity, uncommon but with high mortality, has not been well recognized. Herein, based on previous published reports and current evidence, we summarize the incidence, diagnosis, clinical manifestations, underlying mechanisms, treatments, and outcomes of ICI-associated cardiotoxicity and discuss possible management strategies. A better understanding of these characteristics is critical to managing patients with ICI-associated cardiotoxicity.
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Affiliation(s)
- Yu-Wen Zhou
- Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ya-Juan Zhu
- Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Man-Ni Wang
- Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu, China
| | - Chao-Yue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Fan Xia
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen-Yu Ding
- Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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9
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Werner RA, Wakabayashi H, Bauer J, Schütz C, Zechmeister C, Hayakawa N, Javadi MS, Lapa C, Jahns R, Ergün S, Jahns V, Higuchi T. Longitudinal 18F-FDG PET imaging in a rat model of autoimmune myocarditis. Eur Heart J Cardiovasc Imaging 2019; 20:467-474. [PMID: 30102319 PMCID: PMC6429237 DOI: 10.1093/ehjci/jey119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/25/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Although mortality rate is very high, diagnosis of acute myocarditis remains challenging with conventional tests. We aimed to elucidate the potential role of longitudinal 2-Deoxy-2-18F-fluoro-D-glucose (18F-FDG) positron emission tomography (PET) inflammation monitoring in a rat model of experimental autoimmune myocarditis. METHODS AND RESULTS Autoimmune myocarditis was induced in Lewis rats by immunizing with porcine cardiac myosin emulsified in complete Freund's adjuvant. Time course of disease was assessed by longitudinal 18F-FDG PET imaging. A correlative analysis between in- and ex vivo18F-FDG signalling and macrophage infiltration using CD68 staining was conducted. Finally, immunohistochemistry analysis of the cell-adhesion markers CD34 and CD44 was performed at different disease stages determined by longitudinal 18F-FDG PET imaging. After immunization, myocarditis rats revealed a temporal increase in 18F-FDG uptake (peaked at week 3), which was followed by a rapid decline thereafter. Localization of CD68 positive cells was well correlated with in vivo18F-FDG PET signalling (R2 = 0.92) as well as with ex vivo18F-FDG autoradiography (R2 = 0.9, P < 0.001, respectively). CD44 positivity was primarily observed at tissue samples obtained at acute phase (i.e. at peak 18F-FDG uptake), while CD34-positive staining areas were predominantly identified in samples harvested at both sub-acute and chronic phases (i.e. at 18F-FDG decrease). CONCLUSION 18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research (IZKF), University of Würzburg, Josef-Schneider-Str. 2, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Jochen Bauer
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Claudia Schütz
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Christina Zechmeister
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Nobuyuki Hayakawa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University Hospital Würzburg, Straubmühlweg 2a, Würzburg, Germany
| | - Süleyman Ergün
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Valerie Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Biomedical Imaging, National Cerebral and Cardiovascular Research Center, 5 Chome-7-1 Fujishirodai, Suita, Osaka Prefecture, Japan
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Haeusler KG, Wollboldt C, Bentheim LZ, Herm J, Jäger S, Kunze C, Eberle HC, Deluigi CC, Bruder O, Malsch C, Heuschmann PU, Endres M, Audebert HJ, Morguet AJ, Jensen C, Fiebach JB. Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin. Stroke 2017; 48:1241-1247. [DOI: 10.1161/strokeaha.116.016227] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up.
Methods—
One-hundred and three patients with magnetic resonance imaging (MRI)–proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke.
Results—
Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53–72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1–4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of κ=0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease.
Conclusions—
Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01917955.
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Affiliation(s)
- Karl Georg Haeusler
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Christian Wollboldt
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Laura zu Bentheim
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Juliane Herm
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Sebastian Jäger
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Claudia Kunze
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Holger-Carsten Eberle
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Claudia Christina Deluigi
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Oliver Bruder
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Carolin Malsch
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Peter U. Heuschmann
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Matthias Endres
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Heinrich J. Audebert
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Andreas J. Morguet
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Christoph Jensen
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
| | - Jochen B. Fiebach
- From the Department of Neurology (K.G.H., C.W., L.z.B., J.H., M.E., H.J.A.) and Center for Stroke Research Berlin (K.G.H., C.K., M.E., H.J.A., J.B.F.), Charité - Universitätsmedizin Berlin, Germany; Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth-Krankenhaus, Essen, Germany (H.-C.E., C.C.D., O.B., C.J.); Department of Cardiology, Alexianer Berlin Krankenhaus Hedwigshöhe, Germany (S.J.); Institute of Clinical Epidemiology and Biometry, University Würzburg and
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