Utility of Mechanistic Target of Rapamycin Inhibitors in Cardiac Sarcoidosis.

作者：Donald Richards, H. Fujito, A. Shanbhag, B. Akhavan, Elizabeth Frame, Sean W. Hayes, John D. Friedman, Louise Thomson, Piotr Slomka, Daniel Berman, Evan P. Kransdorf · 发表于：Journal of Cardiac Failure · 年份：2024 · DOI：10.1016/j.cardfail.2024.10.444 · 被引用次数：10 · 研究领域：Medicine

BACKGROUND Cardiac sarcoidosis is an uncommon but potentially devastating manifestation of sarcoidosis which is a multi-system inflammatory granulomatous disease. Although corticosteroids are the mainstay of treatment, given the number of complications associated with their long-term use, there is increasing interest in the use of steroid-sparing agents. Recent basic and translational studies have suggested a role for the mechanistic Target of Rapamycin (mTOR) pathway in cardiac sarcoidosis. METHODS We identified four patients treated at the Cedars-Sinai Cardiac Sarcoidosis Clinic with active cardiac sarcoidosis and contraindications to corticosteroid intensification. We sought to evaluate the role of mechanistic target of rapamycin (mTOR) inhibitors on the change in cardiac inflammation via cardiac 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging. RESULTS Among the four patients, two had substantial improvement in cardiac inflammation on follow-up FDG-PET imaging following six months of treatment with an mTOR inhibitor but without corticosteroid intensification. There was a greater than 80% reduction in the cardiometabolic activity. The other two patients treated with an mTOR inhibitor had persistent evidence of cardiac inflammation on follow-up FDG-PET, necessitating an augmented treatment regimen. DISCUSSION This case series represents the first clinical use of mTOR inhibitors for cardiac sarcoidosis, and suggests that these agents may have a r...