Targeting inflammation in dilated cardiomyopathy leads to ‘striking’ recovery
Italian physicians reported what they believe to be “unprecedented clinical improvement” from interleukin-1 suppression in a patient with dilated cardiomyopathy.
Writing in the Annals of Internal Medicine, the authors detailed the case of a 57-year-old man with a two-year history of dilated cardiomyopathy who had been hospitalized for chronic fatigue and dyspnea secondary to heart failure. Echocardiography showed a severely dilated left ventricle and left ventricular ejection fraction (LVEF) of 28 percent, but cardiac catheterization showed normal coronary arteries.
After six months of optimal medical therapy, the symptoms remained similar, prompting the researchers to try subcutaneous injections of anakinra—which blocks the interleukin-1 family of inflammatory cytokines.
“The clinical response was striking,” reported Giacomo De Luca, MD, with San Raffaele Scientific Institute in Milan, Italy, and colleagues.
Within two weeks, the patient’s New York Heart Association class improved from III to I and ejection fraction increased to 38 percent. At four weeks, LVEF further jumped to 42 percent and serum biomarkers dropped significantly.
“This patient with dilated cardiomyopathy experienced what we believe to be unprecedented clinical improvement with use of anakinra to inhibit interleukin-1,” the authors wrote. “Improvement began soon after anakinra administration and was obvious by every measure. The patient felt better and was able to lead a more normal life. The arrhythmia improved; serum biomarkers of cardiac dysfunction decreased; and findings on echocardiography and magnetic resonance imaging– including those that measured LVEF–were more normal.”
Interleukin-1 has been found to weaken the contractility of heart cells and mediate chronic inflammation in cardiomyopathy, causing “progressive loss of contractile tissue and fibrosis,” the authors reported. Dampening this inflammation may have been the key to the patient's dramatic recovery, De Luca et al. hypothesized.
“Interleukin-1 suppression may prevent or partially reverse disease progression and fibrotic damage,” they continued. “Because of our experience and what is already known about anakinra, we believe that this treatment and the role of chronic low-grade inflammation in dilated cardiomyopathy deserve further investigation.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.