CD23-TARGETED IMMUNOTHERAPY FOR GIANT CELL MYOCARDITIS

Giant cell myocarditis (GCM) is a rare, rapidly progressive cardiac disorder characterized by giant, multinucleated cells that contribute to severe myocardial damage. Existing combination immunosuppressive therapies, although directed at immune-mediated injury, lack precision and are associated with considerable adverse effects. A CD23-targeted intervention holds promise as a more selective, safer adjunctive treatment. This review evaluates a strategy centered on the low-affinity IgE receptor (CD23/FcεRII), predominantly expressed on alternatively activated (M2a) macrophages and B cells. The proposed method uses engineered anti-IgE–IgE complexes to engage CD23, inhibiting macrophage fusion—a defining feature of GCM—and fostering a more anti-inflammatory immune milieu. This therapy also aims to protect myocardial tissue by suppressing pathogenic T-cell responses and slowing disease progression. The review details the scientific basis for this approach, outlines laboratory testing protocols, suggests optimal delivery systems, and considers translational hurdles to clinical implementation.