Journal: Journal of Cardiovascular Pharmacology
Article Title: Evidence of Cardiotoxic Immune Activation by Triple Immune Checkpoint Blockade: A Translational Alert for Clinical Surveillance in Patients With Cancer
doi: 10.1097/FJC.0000000000001798
Figure Lengend Snippet: Proposed mechanism of immune checkpoint inhibitor (ICI)-driven disruption of immune tolerance and cardiomyocyte injury. Under physiologic conditions, regulatory T cells (Tregs) and inhibitory checkpoint pathways—including cytotoxic T-lymphocyte–associated protein 4 (CTLA-4), lymphocyte activation gene-3 (LAG-3), and programmed cell death-1/programmed cell death-ligand 1 (PD-1/PD-L1)—cooperate to maintain peripheral tolerance and protect cardiac tissue from autoreactive immune responses. ICI therapy blocks these inhibitory signals at multiple levels: (I) anti-CTLA-4 antibodies prevent CTLA-4 engagement on both activated T cells and Tregs, thereby dampening Treg-mediated suppression and enhancing effector T-cell activation; (ii) anti-LAG-3 antibodies abrogate an additional inhibitory checkpoint on activated T cells, further potentiating T-cell cytotoxicity; and (iii) antibodies targeting PD-1 or PD-L1 disrupt the PD-1/PD-L1 axis, which normally delivers inhibitory signals on engagement of PD-1 on activated T cells with PD-L1 expressed on cardiomyocytes. Cumulative blockade of these checkpoints removes critical layers of peripheral tolerance and unleashes effector T cells that recognize cardiac antigens as targets, leading to immune attack against cardiomyocytes. This loss of tolerance contributes to proinflammatory cytokine secretion (eg, IL-2, IL-1β, IL-6, IL-8, CCL2, IL-17), enhanced cytotoxic mediator release such as granzyme B, and activation of the cardiomyocyte NLRP3–MyD88–NF-κB axis, ultimately driving myocardial inflammation and injury. The figure summarizes the central paradigm supported by our coculture experiments, wherein triplet checkpoint blockade (anti-CTLA-4 + anti-PD-1 + anti-LAG-3 or anti-PD-L1) produced the strongest disruption of immune tolerance and the most pronounced cardiotoxic effects.
Article Snippet: Supernatants were collected after 48 hours of coculture and analyzed for IL-2 (DY202) and granzyme B (DY2906) concentrations using DuoSet ELISA kits (R&D Systems, Minneapolis, MN) endowed with a sensitivity of 50 pg/mL.
Techniques: Disruption, Activation Assay, Produced