Interview with an expert from the Cardioimmunology Unit of the University Hospital Padova, one of the leading world institutions in myocarditis research and management.
Dr. Renzo Marcolongo graduated from Padova University in 1983. He is a specialist in Hematology, Cardiology and Clinical immunology who devoted his professional and academic career to the field of systemic autoimmune, immune-mediated and autoinflammatory diseases and cardioimmunology. Together with Professor Alida Caforio, he is a co-founder of the Cardioimmunology branch of the Cardiology Unit at University Hospital Padova. He has been a member of a European expert panel on Therapeutic Patient Education, and he is a lecturer in this field at many Italian and French institutions. He is the author and co-author of over 90 international publications.
Immune-checkpoint inhibitors (specific antibodies used mostly for treatment in oncology) are of great importance in some cancer patients. However, myocarditis is a very rare complication of their administration. What are your experiences with this clinical entity?
So far, we did not treat any patient with Immune-checkpoint myocarditis. They are probably more rare than expected, at least in Italy.
In Padova Hospital, you have implemented a specific safety protocol for patients with autoimmune myocarditis and immunosuppressive treatment. Could you please share more details about the protocol?
In our experience, a diagnostic workup, namely the Safety Checklist, in biopsy-proven acute myocarditis/dilated cardiomyopathy patients eligible for immunosuppressive therapy should include blood and instrumental tests. In brief, patients were screened for hidden infections (especially tuberculosis, HIV and viral hepatitis B and C) and common malignancies according to age, gender and race (in particular, non-invasive first-line investigations for haematological disorders and breast, cervix, colon and/or prostate cancer were performed when appropriate).
(CAFORIO, Alida Linda Patrizia et al. Long‐term efficacy and safety of tailored immunosuppressive therapy in immune‐mediated biopsy‐proven myocarditis: A propensity‐weighted study. Online. European Journal of Heart Failure. ISSN 1388-9842. https://doi.org/10.1002/ejhf.3220. CAFORIO, Alida L. P. (ed.). Myocarditis. Online. Cham: Springer International Publishing, 2020. ISBN 978-3-030-35275-2. https://doi.org/10.1007/978-3-030-35276-9.)
What are the latest trends in immunological therapy of myocarditis, including its specific forms like giant-cell and eosinophilic myocarditis?
We successfully experienced the anti-CD20 monoclonal antibody Rituximab (used for therapy of different autoimmune diseases, targeted against B-lymphocytes producing antibodies; see this article) in the treatment of both giant-cell and eosinophilic myocarditis. In recent years, we also successfully treated several patients with eosinophilic myocarditis with anti-IL5 monoclonal antibody mepolizumab (eosinophils are involved, for example, in allergic reactions; under publication).
What would you like to communicate to the readers of myocarditis.eu?
To be confident. Myocarditis, when promptly and properly diagnosed by endomyocardial biopsy, is a treatable disease. In our experience, immune-mediated/virus-negative forms usually show an excellent response to immunosuppressive/immunomodulatory treatment, with a good prognosis.
Interview with dr. Giordani may be found here.
