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Autoimmune diseases in patients undergoing percutaneous coronary intervention: A risk factor for in-stent restenosis?

  • Author Footnotes
    1 These authors contributed equally to this work.
    Martino Pepe
    Correspondence
    Corresponding author. Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari, 70120, Bari, Italy.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Gianluigi Napoli
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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  • Eugenio Carulli
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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  • Marco Moscarelli
    Affiliations
    Cardiothoracic and Vascular Department, Maria Cecilia Hospital GVM Care & Research, Via Via Corriera 1,Cotignola, 48033, Ravenna, Italy
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  • Cinzia Forleo
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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  • Palma Luisa Nestola
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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  • Giuseppe Biondi-Zoccai
    Affiliations
    Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Republica 79, Latina, 04100,Latina, Italy

    Mediterranea Cardiocentro, Via Orazio 2, Napoli, 80122, Napoli, Italy
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  • Arturo Giordano
    Affiliations
    Invasive Cardiology Unit, “Pineta Grande” Hospital, Via Domitiana km 30, Castel Volturno, 81030, Caserta, Italy
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  • Stefano Favale
    Affiliations
    Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Piazza G. Cesare 11, Bari (BA), 70120, Italy
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  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • Patients with autoimmune diseases are more prone to develop in-stent restenosis.
      • Insulin stimulates vascular smooth muscle cells after coronary revascularization.
      • Systemic lupus erythematosus is associated with more repeated revascularizations.
      • Antibodies against adhesion molecules reduce neointimal proliferation.
      • Endothelial dysfunction seems the final pathway of autoimmune induced restenosis.

      Abstract

      Background and aims

      Despite the relation between autoimmune diseases and increased atherosclerotic risk is established, the influence of autoimmune disorders on in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) is only partly known. ISR is an aberrant reparative process mainly characterized by an increased number of vascular smooth muscle cells and excessive deposition of extracellular proteoglycans and type III collagen. Chronic inflammation, always present in autoimmune diseases, modulates the endothelial response to PCI. Aim of this review is to resume the current evidence on the association between ISR and autoimmune diseases, focusing on pathogenic mechanisms and therapeutic targets.

      Methods

      We conducted a comprehensive review of the literature on the relationship between ISR and insulin-dependent diabetes mellitus (IDDM), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), antiphospholipid-antibodies syndrome (APS), inflammatory bowel diseases (IBD), and Hashimoto's thyroiditis (HT).

      Results

      Patients affected with IDDM, RA, SLE, APS, IBD and HT proved to face higher rates of ISR compared to the general population. The endothelial dysfunction seems the principal common pathogenic pathway for ISR and is attributed to both the immune system disorder and the systemic inflammation. Some evidence suggested that methotrexate and anti-tumor necrosis factor treatments can be effective in reducing ISR, while antibodies against vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 showed to reduce neointimal hyperplasia in animal models.

      Conclusions

      Autoimmune diseases are a risk factor for ISR. The study of the potential cardiovascular benefits of the current therapies, mainly anti-inflammatory drugs, and the pursuit of innovative treatments appear of paramount interest.

      Graphical abstract

      Keywords

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