Journal Article

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Bison, Elisa, Basso, Cristina, Menghi, Caterina, Peloso Cattini, Maria, De Gaspari, Monica, Thiene, Gaetano, Caforio, Alida, Giordani, Andrea, Iliceto, Sabino, Vicenzetto, Cristina, Marcolongo, Renzo, Pontara, Elena, Baritussio, Anna, Rizzo, Stefania

2024

Overview

The role of the immune system in myocarditis onset and progression involves a range of complex cellular and molecular pathways. Both innate and adaptive immunity contribute to myocarditis pathogenesis, regardless of its infectious or non-infectious nature and across different histological and clinical subtypes. The heterogeneity of myocarditis etiologies and molecular effectors is one of the determinants of its clinical variability, manifesting as a spectrum of disease phenotype and progression. This spectrum ranges from a fulminant presentation with spontaneous recovery to a slowly progressing, refractory heart failure with ventricular dysfunction, to arrhythmic storm and sudden cardiac death. In this review, we first examine the updated definition and classification of myocarditis at clinical, biomolecular and histopathological levels. We then discuss recent insights on the role of specific immune cell populations in myocarditis pathogenesis, with particular emphasis on established or potential therapeutic applications. Besides the well-known immunosuppressive agents, whose efficacy has been already demonstrated in human clinical trials, we discuss the immunomodulatory effects of other drugs commonly used in clinical practice for myocarditis management. The immunological complexity of myocarditis, while presenting a challenge to simplistic understanding, also represents an opportunity for the development of different therapeutic approaches with promising results.

• Publisher: MDPI AG,MDPI
• Subject: Adaptive immunity / Adenoviruses / Antigens / autoimmune disease / Biopsy / Cardiac arrhythmia / Cardiomyopathy / Cardiovascular disease / Classification / Clinical trials / Congestive heart failure / Coronary artery disease / Cytomegalovirus / Development and progression / drug repurposing / Epstein-Barr virus / Etiology / Health aspects / Heart / Heart diseases / Heart failure / Immune system / Immunomodulation / Immunosuppressive agents / immunosuppressive therapy / Infections / Inflammation / Inflammatory diseases / Ipilimumab / Ischemia / Myocarditis / Pathogenesis / Pathology / Patients / Phenotypes / Review / Severe acute respiratory syndrome coronavirus 2 / Spontaneous recovery / systemic immune-mediated disease / Therapeutic applications / Viral infections