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Review

Inflammasomes as Potential Therapeutic Targets to Prevent Chronic Active Viral Myocarditis—Translating Basic Science into Clinical Practice

by
Natalia Przytuła
1,
Jakub Podolec
2,3,
Tadeusz Przewłocki
3,4,
Piotr Podolec
1,4 and
Anna Kabłak-Ziembicka
1,4,5,*
1
Department of Cardiac and Vascular Diseases, The St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
2
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
3
Department of Interventional Cardiology, The St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
4
Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
5
Noninvasive Cardiovascular Laboratory, The St. John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2025, 26(22), 11003; https://doi.org/10.3390/ijms262211003 (registering DOI)
Submission received: 19 September 2025 / Revised: 3 November 2025 / Accepted: 10 November 2025 / Published: 13 November 2025
(This article belongs to the Special Issue Molecular Research in Myocarditis)

Abstract

Despite substantial progress in medical care, acute myocarditis remains a life-threatening disorder with a sudden onset, often unexpectedly complicating a simple and common upper respiratory tract infection. In most cases, myocarditis is triggered by viral infections (over 80%), with an estimated incidence of 10–106 per 100,000 annually. The clinical course may worsen in cases of mixed etiology, where a primary viral infection is complicated by secondary bacterial pathogens, leading to prolonged inflammation and an increased risk of progression to chronic active myocarditis or dilated cardiomyopathy. We present a case report illustrating the clinical problem of acute myocarditis progression into a chronic active form. A central element of host defense is the inflammasome—an intracellular complex that activates pyroptosis and cytokine release (IL-1β, IL-18). While these processes help combat pathogens, their persistent activation may sustain inflammation and trigger heart failure and cardiac fibrosis, eventually leading to dilated cardiomyopathy. In this review, we summarize the current understanding of inflammasome pathways and their dual clinical role in myocarditis: they are essential for controlling acute infection but may become harmful when overactivated, contributing to chronic myocardial injury. Additionally, we discuss both novel and established therapeutic strategies targeting inflammatory and anti-fibrotic mechanisms, including IL-1 receptor blockers (anakinra, canakinumab), NOD-like receptor protein 3 (NLRP3) inhibitors (colchicine, MCC950, dapansutrile, INF200), NF-κB inhibitors, and angiotensin receptor-neprilysin inhibitors (ARNI), as well as microRNAs. Our aim is to emphasize the clinical importance of early identification of patients at risk of transitioning from acute to chronic inflammation, elucidate the role of inflammasomes, and present emerging therapies that may improve outcomes by balancing effective pathogen clearance with limitation of chronic cardiac damage.
Keywords: myocarditis; inflammasomes; microRNAs; Interleukins; viral; bacterial; chronic active; pharmacological strategies myocarditis; inflammasomes; microRNAs; Interleukins; viral; bacterial; chronic active; pharmacological strategies

Share and Cite

MDPI and ACS Style

Przytuła, N.; Podolec, J.; Przewłocki, T.; Podolec, P.; Kabłak-Ziembicka, A. Inflammasomes as Potential Therapeutic Targets to Prevent Chronic Active Viral Myocarditis—Translating Basic Science into Clinical Practice. Int. J. Mol. Sci. 2025, 26, 11003. https://doi.org/10.3390/ijms262211003

AMA Style

Przytuła N, Podolec J, Przewłocki T, Podolec P, Kabłak-Ziembicka A. Inflammasomes as Potential Therapeutic Targets to Prevent Chronic Active Viral Myocarditis—Translating Basic Science into Clinical Practice. International Journal of Molecular Sciences. 2025; 26(22):11003. https://doi.org/10.3390/ijms262211003

Chicago/Turabian Style

Przytuła, Natalia, Jakub Podolec, Tadeusz Przewłocki, Piotr Podolec, and Anna Kabłak-Ziembicka. 2025. "Inflammasomes as Potential Therapeutic Targets to Prevent Chronic Active Viral Myocarditis—Translating Basic Science into Clinical Practice" International Journal of Molecular Sciences 26, no. 22: 11003. https://doi.org/10.3390/ijms262211003

APA Style

Przytuła, N., Podolec, J., Przewłocki, T., Podolec, P., & Kabłak-Ziembicka, A. (2025). Inflammasomes as Potential Therapeutic Targets to Prevent Chronic Active Viral Myocarditis—Translating Basic Science into Clinical Practice. International Journal of Molecular Sciences, 26(22), 11003. https://doi.org/10.3390/ijms262211003

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