title: Host-directed therapies for tuberculous pericarditis.
abstract: TB Pericarditis is associated with significant inflammatory and immune responses which can paradoxically cause injury to the pericardium and myocardium. Management with anti-TB therapy alone does not prevent complications or reduce mortality. Thus the prevailing view is that adjunct host-directed therapies such as use of glucocorticoid treatment could attenuate destructive inflammatory responses and improve morbidity and mortality rates. A recent trial showed no advantage of using adjunct corticosteroid treatment on the combined endpoint of death, cardiac tamponade or constriction. The current lack of effective medical treatment for reducing the significant morbidity and mortality associated with TB pericarditis, highlights the urgent need for newer approaches to treating the disease. Newer treatment options for pericarditis using adjunct host-directed therapies, including autologous bone-marrow-derived Mesenchymal Stromal Cells (MSCs) therapy, now require evaluation in randomized placebo-controlled controlled trials.
authors: Center for Clinical Microbiology, Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre at UCL Hospital, London, United Kingdom. Electronic address: a.zumla@ucl.ac.uk.
authors: Alimuddin
authors: A
authors: Zumla
authors: Department of Laboratory Medicine, Karolinska Institute and CAST (Center for allogeneic stem cell transplantation), Karolinska Hospital, Stockholm, Sweden. Electronic address: Markus.Maeurer@ki.se.
authors: Markus
authors: M
authors: Maeurer
authors: Department of Laboratory Medicine, Karolinska Institute and CAST (Center for allogeneic stem cell transplantation), Karolinska Hospital, Stockholm, Sweden. Electronic address: guido.moll@ki.se.
authors: Guido
authors: G
authors: Moll
authors: The Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Electronic address: Bongani.Mayosi@uct.ac.za.
authors: Bongani M
authors: BM
authors: Mayosi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D010495:Pericarditis, Tuberculous / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids
keywords: Bone marrow; Host-directed; Infection; Pericarditis; Stromal cells; Treatment; Tuberculosis