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Cholesterol-embolization syndrome: current perspectives

Authors Ozkok A

Received 7 February 2019

Accepted for publication 10 May 2019

Published 8 July 2019 Volume 2019:15 Pages 209—220

DOI https://doi.org/10.2147/VHRM.S175150

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Konstantinos Tziomalos


Abdullah Ozkok

Department of Internal Medicine and Nephrology, Memorial Şişli Hospital, Istanbul, Turkey

Abstract: Cholesterol-embolization syndrome (CES) is a multisystemic disease with various clinical manifestations. CES is caused by embolization of cholesterol crystals (CCs) from atherosclerotic plaques located in the major arteries, and is induced mostly iatrogenically by interventional and surgical procedures; however, it may also occur spontaneously. Embolized CCs lead to both ischemic and inflammatory damage to the target organ. Therefore, anti-inflammatory agents, such as corticosteroids and cyclophosphamide, have been investigated as treatment for CES in several studies, with conflicting results. Recent research has revealed that CES is actually a kind of autoinflammatory disease in which inflammasome pathways, such as NLRP3 and IL1, are induced by CCs. These recent findings may have clinical implications such that colchicine and IL1 inhibitors, namely canakinumab, may be beneficial in the early stages of CES.

Keywords: cholesterol crystals, atherosclerosis, inflammation, autoinflammation, corticosteroids, interleukin 1, NLRP3, colchicine, canakinumab

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