Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition.

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Title: Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition.
Author(s): Panahi, M
Papanikolaou, A
Torabi, A
Zhang, JG
Khan, H
Vazir, A
Hasham, MG
Cleland, J
Rosenthal, N
Harding, S
Sattler, S
Item Type: Journal Article
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.
Publication Date: 14-Jul-2018
Date of Acceptance: 11-Jun-2018
URI: http://hdl.handle.net/10044/1/61274
DOI: https://dx.doi.org/10.1093/cvr/cvy145
ISSN: 1755-3245
Publisher: Oxford University Press (OUP)
Journal / Book Title: Cardiovascular Research
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: PG/16/93/32345
Keywords: 1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published online
Online Publication Date: 2018-07-14
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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