Immune checkpoint inhibitor-associated myocarditis: clinical and mechanistic insights.

Authors

Heng Liu, Weili Li, Yunxia Wu, Nannan Tan, Jingmei Zhang, Yawen Zhang, Guanjing Ling, Yilin Li, Zhishu Tang, Wei Wang, Yong Wang

Published in

Inflammation research : official journal of the European Histamine Research Society ... [et al.]. Volume 75. Issue 1. Oct 17, 2026. Epub Oct 17, 2026.

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but can cause immune-related adverse events, including potentially severe cardiovascular toxicities. Although rare, immune checkpoint inhibitor-associated myocarditis (ICIM) can present early and may be rapidly fatal, posing a significant challenge at the crossroads of oncology, immunology, and cardiology.
This review synthesizes emerging clinical and experimental evidence to refine understanding of risk factors for immune checkpoint inhibitor-associated myocarditis and to outline a practical clinic-to-bench framework linking surveillance and diagnostic decision-making to pathogenic cellular programs.
We highlight the cardiac immune microenvironment as a network of multicellular interactions in which cytotoxic T cells and inflammatory myeloid subsets engage with cardiomyocytes, endothelial cells, and fibroblasts through reinforcing feedback loops. Specifically, interferon-γ (IFN-γ)-driven myeloid activation and chemokine programs (CXCR3-CXCL9/10, CXCL16-CXCR6) coordinate immune cell trafficking and promote tissue injury, while stress-related cell death pathways can trigger innate immune sensing via the cGAS-STING axis. Current management remains centered on early recognition and corticosteroid-based immunosuppression, but emerging mechanistic insights reveal opportunities to improve therapy by targeting immune cell trafficking and inflammatory amplification pathways. Together, these advances support a more integrated cardio-oncology approach to ICIM, in which mechanistic insights inform risk stratification, earlier diagnosis, and the development of more precise immunomodulatory therapies.

PMID:
42892627
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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