Estudio de los síndromes de la medicina tradicional china en el modelo murino de miocarditis asociada a inhibidores de puntos de control inmunitario

  • role: First author第一作者
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

  • Introduction:
LIU Heng,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

GE Fei,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

LI Weili,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

ZHANG Yawen,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

WU Yunxia,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

ZHANG Yuqin,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

LI Yilin,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

LING Guanjing,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

WEI Yan,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

GUO Shujuan,  
  • Affiliation:

    School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China

    Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China

    Beijing Key Laboratory of Fundamental Research on TCM Syndrome and Formula,Beijing 100029,China

    Key Laboratory of TCM Syndrome and Formula,Ministry of Education,Beijing 100029,China

  • Email:wangyong@bucm. edu. cn
  • Introduction:E-mailwangyong@bucm. edu. cn
WANG Yong

resumen

Objetivo: Construir un modelo combinado estable de enfermedad y síndrome en ratones con miocarditis asociada a inhibidores de puntos de control inmunitario (ICIM), evaluar de manera integral las características macroscópicas e indicadores microscópicos, y explorar la evolución de los síndromes en la medicina tradicional china. Métodos: 20 ratones machos C57BL/6J SPF se dividieron aleatoriamente en grupo modelo y grupo control, 10 por grupo. El grupo modelo recibió inyecciones intraperitoneales de anticuerpos anti-PD-1 (25 mg/kg) y anti-CTLA-4 (25 mg/kg) a partir del día 8, cada 3 días, un total de 5 veces. El grupo control recibió inyecciones intraperitoneales de anticuerpos IgG2a isotípicos (50 mg/kg). En el día 28, se evaluó la función cardíaca mediante ecocardiografía, incluyendo fracción de eyección ventricular izquierda (LVEF), fracción de acortamiento (LVFS), volumen telesistólico (LVESV) y volumen telediastólico (LVEDV). Se observaron los tejidos cardíacos con tinciones HE y Masson; mediante ELISA se midieron los niveles séricos de cTnI, TNF-α e IL-6. Se observaron semanalmente los signos macros y los síndromes en MTC durante 4 semanas. Cada jueves (días 4, 11, 18, 25) se evaluó el estado general, la fuerza de agarre, la distancia recorrida en 5 minutos en campo abierto y la temperatura rectal; cada viernes (días 5, 12, 19, 26) se realizó prueba de natación agotadora con carga, temperatura en las patas y valores RGB de la lengua y extremidades. Resultados: comparado con el control, el grupo modelo mostró disminución de LVEF y LVFS, aumento de LVESV y LVEDV (P<0.05), aumento en cTnI, TNF-α e IL-6 (P<0.05). La histología mostró desorden en la estructura del tejido cardíaco, infiltración inmune y fibrosis evidente. En las semanas 3 y 4, los ratones modelo mostraron pelaje seco y amarillento, letargo, disminución de actividad y uñas deterioradas; disminución del tiempo de natación agotadora y fuerza de agarre, aumento de temperatura rectal (P<0.05). En la semana 4, la distancia recorrida en campo abierto disminuyó (P<0.05). En comparación con la semana 1, el valor rojo (r) de la lengua aumentó, el verde (g) disminuyó (P<0.05), sin diferencia significativa en azul (b). Conclusión: La evolución del síndrome en MTC en el modelo ICIM es dinámica, pasando del síndrome de deficiencia de Qi en la semana 3 al síndrome de deficiencia de Qi y Yin en la semana 4.

palabra clave

miocarditis asociada a inhibidores de puntos de control inmunitario;modelo combinado;síndrome de deficiencia de Qi y Yin;ratón

References

  1. [1].
    POSTOW MA,CALLAHAN MK,WOLCHOK JD. Immune checkpoint blockade in cancer therapy[J]. J Clin Oncol,2015,33(17):1974-1982.
  2. [2].
    TOPALIAN SL,DRAKE CG,PARDOLL DM. Immune checkpoint blockade:a common denominator approach to cancer therapy [ J ]. Cancer Cell,2015,27(4):450-461.
  3. [3].
    MUNIR AZ,GUTIERREZ A,QIN J,et al. Immunecheckpoint inhibitor-mediated myocarditis:CTLA4,PD1 and LAG3 in the heart[J]. Nat Rev Cancer,2024,24(8):540-553.
  4. [4].
    THOMPSON JA,SCHNEIDER BJ,BRAHMER J,et al. NCCN guidelines® insights:management of immunotherapy related toxicities,version 2. 2024:featured updates to the NCCN guidelines[J]. J Natl Compr Cancer Netw,2024,22(9):582-592.
  5. [5].
    NAQASH AR,MOEY MYY,CHERIE TAN XW,et al. Major adverse cardiac events with immune checkpoint inhibitors:a pooled analysis of trials sponsored by the national cancer institute-cancer therapy evaluation program [J]. J Clin Oncol,2022,40(29):3439-3452.
  6. [6].
    NIELSEN DL,JUHL CB,NIELSEN OH,et al. Immune checkpoint inhibitor-induced cardiotoxicity:a systematic review and meta-analysis [ J ]. JAMA Oncol,2024,10(10):1390-1399.
  7. [7].
    DOLLADILLE C,AKROUN J,MORICE PM,et al. Cardiovascular immunotoxicities associated with immune checkpoint inhibitors:a safety meta-analysis [ J]. Eur Heart J,2021,42(48):4964-4977.
  8. [8].
    JOHNSON DB,BALKO JM,COMPTON ML,et al. Fulminant myocarditis with combination immune checkpoint blockade [ J ]. N Engl J Med,2016,375(18):1749-1755.
  9. [9].
    BONACA MP,OLENCHOCK BA,SALEM JE,et al. Myocarditis in the setting of cancer therapeutics:proposed case definitions for emerging clinical syndromes in cardiooncology[J]. Circulation,2019,140(1):80-91.
  10. [10].
    HERRMANN J,LENIHAN D,ARMENIAN S,et al. Defining cardiovascular toxicities of cancer therapies:an International Cardio-Oncology Society(IC-OS)consensus statement[J]. Eur Heart J,2022,43(4):280-299.
  11. [11].
    MAHMOOD SS,FRADLEY MG,COHEN JV,et al. Myocarditis in patients treated with immune checkpoint inhibitors [ J ]. J Am Coll Cardiol,2018,71(16):1755-1764.
  12. [12].
    BRAHMER JR,LACCHETTI C,SCHNEIDER BJ,et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy:American Society of Clinical Oncology clinical practice guideline [ J ]. J Clin Oncol,2018,36(17):1714-1768.
  13. [13].
    DAETWYLER E,WALLRABENSTEIN T,KÖNIG D,et al. Corticosteroid-resistant immune-related adverse events:a systematic review[ J]. J Immunother Cancer,2024,12(1):e007409.
  14. [14].
    NGUYEN LS,BRETAGNE M,ARRONDEAU J,et al. Reversal of immune-checkpoint inhibitor fulminant myocarditis using personalized-dose-adjusted abatacept and ruxolitinib:proof of concept[J]. J Immunother Cancer,2022,10(4):e004699.
  15. [15].
    LYON AR,LÓPEZ-FERNÁNDEZ T,COUCH LS,et al.2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association(EHA),the European Society for Therapeutic Radiology and Oncology(ESTRO)and the International Cardio-Oncology Society(IC-OS)[J]. Eur Heart J,2022,43(41):4229-4361.
  16. [16].
    WEI SC,MEIJERS WC,AXELROD ML,et al. A genetic mouse model recapitulates immune checkpoint inhibitor-associated myocarditis and supports a mechanism-based therapeutic intervention [ J ]. Cancer Discov,2021,11(3):614-625.
  17. [17].
    FANKHAUSER RG,JOHNSON DB,MOSLEHI JJ,et al. Preclinical mouse models of immune checkpoint inhibitor-associated myocarditis[J]. Nat Cardiovasc Res,2025,4(5):526-538.
  18. [18].
    ZHANG YH,SUN CC,LI YJ,et al. Hormonal therapies up-regulate MANF and overcome female susceptibility to immune checkpoint inhibitor myocarditis[ J]. Sci Transl Med,2022,14(669):eabo1981.
  19. [19].
    MA P,LIU J,QIN J,et al. Expansion of pathogenic cardiac macrophages in immune checkpoint inhibitor myocarditis[J]. Circulation,2024,149(1):48-66.
  20. [20].
    张亚雯,王晓平,李伟利,等.阿霉素诱导的心脏毒性小鼠模型中医证候探究[J].北京中医药大学学报,2023,46(10):1374-1381.
  21. [21].
    沈自尹,王文健.中医虚证辨证参考标准[J].中西医结合杂志,1986,6(10):598.
  22. [22].
    世界中医药学会联合会.国际血瘀证诊断指南(2021-12-16)[J].世界中医药,2022,17(1):31-36.
  23. [23].
    崔钰伟,臧凝子,李品,等.病证结合动物模型宏观表征指标评价方法研究进展[J].中华中医药学刊,2024,42(6):195-198.
  24. [24].
    孙晓霞,任威铭,崔荣兴,等.阴虚证动物模型的建立与评价[J].中医杂志,2021,62(13):1156-1163.
  25. [25].
    刘亚益,贾云凤,左一鸣,等.心气阴两虚证动物模型的构建方法与评价进展[J].实验动物与比较医学,2025,45(4):411-421.
  26. [26].
    高云霄.心肌梗死气阴两虚证大鼠模型构建及益心舒胶囊干预机制研究[ D].北京:中国中医科学院,2024.
  27. [27].
    袁樵.国际照明委员会照明标准——室内工作场所照明[J].照明工程学报,2002,13(4):55-60.
  28. [28].
    袁月,高云霄,张秋艳,等.基于代谢组学的脑梗死气阴两虚证小鼠模型的构建及评价[ J].中国实验方剂学杂志,2025,31(12):62-71.
  29. [29].
    刘志恒,陈雨立,刘羽,等.基于“病-证-药”探讨卒中后抑郁病证结合模型构建及评估[ J].中国实验动物学报,2025,33(3):388-398.
  30. [30].
    熊宇麒,李学军.心血管疾病与恶性肿瘤的共同危险因素及药物的影响[J].药学学报,2020,55(1):1-7.
  31. [31].
    中国抗癌协会整合肿瘤心脏病学分会,中华医学会心血管病学分会肿瘤心脏病学学组,中国医师协会心血管内科医师分会肿瘤心脏病学专业委员会,等.免疫检查点抑制剂相关心肌炎监测与管理中国专家共识(2020版)[ J ].中国肿瘤临床,2020,47(20):1027-1038.
  32. [32].
    张译心. 2种病证结合动物模型的建立及评价[D].长春:长春中医药大学,2021.
  33. [33].
    罗慧,焦文超,唐家杨,等.缺血性脑卒中气虚证动物模型的建立[ J ].中华中医药杂志,2022,37(1):420-424.
  34. [34].
    ČIHÁKOVÁ D. T cells and macrophages drive pathogenesis of immune checkpoint inhibitor myocarditis[J]. Circulation,2024,149(1):67-69.
  35. [35].
    KALINOSKI H,DAOUD A,RUSINKEVICH V,et al. Injury-induced myosin-specific tissue-resident memory T cells drive immune checkpoint inhibitor myocarditis [ J]. Proc Natl Acad Sci USA,2024,121(42):e2323052121.
  36. [36].
    ZHU H,GALDOS FX,LEE D,et al. Identification of pathogenic immune cell subsets associated with checkpoint inhibitor-induced myocarditis [ J ]. Circulation,2022,146(4):316-335.
  37. [37].
    吴朦,胡镜清,江丽杰,等.冠心病中医证分类及其关联理化指标的研究[ J].世界科学技术—中医药现代化,2016,18(5):776-785.

Leer el texto completo

The above content is generated by Large Model Translation. The translated content is for reference only. We do not assume any commercial or legal responsibilty for any consequences arising from the use of our website