REVIEW  MYOCARDIAL AND PERICARDIAL DISEASE 

Minerva Cardiology and Angiology 2022 April;70(2):238-47

DOI: 10.23736/S2724-5683.21.05876-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

The inflammasome as a therapeutic target for myopericardial diseases

Massimo IMAZIO ¹ ✉, Antonio ABBATE ²

¹ Unit of Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy; ² VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA

Myopericardial diseases are relatively common in clinical practice although often neglected due to the limited availability of treatments and evidence to support management strategies. However in the past ten years, growing evidence has improved our knowledge of the pathophysiology of myopericardial diseases and first clinical trials have highlighted the importance of inflammation as therapeutic target developing first steps toward a personalized approach also in this field. The NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) inflammasome is a protein complex that functions as a platform for rapid induction of the inflammatory response to infection or sterile injury through pro-inflammatory cytokines, now recognized as a new important therapeutic target for myopericardial diseases. Colchicine is an old drug that acts as non-specific inhibitor of the inflammasome and could be a useful and inexpensive option in clinical practice and it is currently registered for pericarditis in some European countries (e.g., Italy, Austria). Anti-interleukin-1 (IL-1) agents (anakinra and rilonacept) appear to be a major advance in medical therapy of recurrent pericarditis and could be a therapeutic option also for myocarditis if confirmed in additional studies. In this review, we provide an update on the inflammasome as therapeutic target for myopericardial diseases, a significant advance in medical therapy for these diseases in the last five years.

KEY WORDS: Inflammasomes; Myocarditis; Pericarditis; Colchicine; Rilonacept