{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:15:15Z","timestamp":1785428115367,"version":"3.56.0"},"reference-count":72,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["5XMILLE_2022_17 project titled \u201c \tInibitori selettivi di PCSK9 e NLRP3 come strategie pre-ventive della cardiotossicit\u00e0 e aterosclerosi indotta da farmaci antitumorali: impatto del targeting lipidico ed infiammatorio in Cardio-Oncologia.\u201d"],"award-info":[{"award-number":["5XMILLE_2022_17 project titled \u201c \tInibitori selettivi di PCSK9 e NLRP3 come strategie pre-ventive della cardiotossicit\u00e0 e aterosclerosi indotta da farmaci antitumorali: impatto del targeting lipidico ed infiammatorio in Cardio-Oncologia.\u201d"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"award":["5XMILLE_2022_17 project titled \u201c \tInibitori selettivi di PCSK9 e NLRP3 come strategie pre-ventive della cardiotossicit\u00e0 e aterosclerosi indotta da farmaci antitumorali: impatto del targeting lipidico ed infiammatorio in Cardio-Oncologia.\u201d"],"award-info":[{"award-number":["5XMILLE_2022_17 project titled \u201c \tInibitori selettivi di PCSK9 e NLRP3 come strategie pre-ventive della cardiotossicit\u00e0 e aterosclerosi indotta da farmaci antitumorali: impatto del targeting lipidico ed infiammatorio in Cardio-Oncologia.\u201d"]}],"id":[{"id":"https:\/\/ror.org\/00789fa95","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of oncology but are increasingly associated with cardiovascular immune-related adverse events (irAEs), including myocarditis, heart failure, arrhythmias, and vascular complications. Among these, ICI-associated myocarditis represents the most severe manifestation, often characterized by high mortality and challenging early diagnosis. Detecting subclinical myocardial injury before irreversible cardiomyocyte necrosis occurs remains a major unmet need in contemporary cardio-oncology. This narrative expert review critically examines the biological rationale, preclinical evidence, and emerging clinical data supporting the potential role of heart-type fatty acid-binding protein (H-FABP) as an adjunctive biomarker of early immune-mediated myocardial injury during ICI therapy. H-FABP is a small cytosolic lipid chaperone abundantly expressed in cardiomyocytes and rapidly released into the circulation following subtle membrane destabilization and metabolic stress, frequently preceding detectable troponin elevation in other forms of myocardial injury. Experimental studies support a mechanistic association between H-FABP release, inflammasome activation, cytokine amplification, mitochondrial dysfunction, and immune\u2013metabolic cardiomyocyte stress. Preliminary clinical observations further suggest that H-FABP elevations may occur during ICI treatment even in the absence of overt myocarditis or concomitant increases in high-sensitivity cardiac troponins (hs-cTns). Although H-FABP cannot replace hs-cTn, which remains the cornerstone biomarker for the diagnosis of clinically significant ICI-associated myocarditis, its rapid kinetics and sensitivity to early metabolic membrane injury support its potential role as an investigational adjunctive biomarker for early surveillance and risk stratification. This approach may be particularly relevant in patients receiving high-risk combination ICI regimens or in individuals with pre-existing cardiovascular disease. However, current evidence remains limited, and large prospective multicenter studies integrating H-FABP with hs-cTns, natriuretic peptides, cardiac magnetic resonance imaging, and clinical outcomes are required before routine clinical implementation can be considered.<\/jats:p>","DOI":"10.3390\/ijms27114842","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:36:56Z","timestamp":1779892616000},"page":"4842","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart-Type Fatty Acid-Binding Protein (H-FABP) as a Candidate Adjunctive Biomarker for Immune Checkpoint Inhibitor-Related Cardiotoxicity: Linking Early Immune\u2013Metabolic Myocardial Injury with Translational Cardio-Oncology"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-5401","authenticated-orcid":false,"given":"Vincenzo","family":"Quagliariello","sequence":"first","affiliation":[{"name":"Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9837-9148","authenticated-orcid":false,"given":"Massimiliano","family":"Berretta","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Maurea","sequence":"additional","affiliation":[{"name":"Radiology Division, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0990-6397","authenticated-orcid":false,"given":"Maria Laura","family":"Canale","sequence":"additional","affiliation":[{"name":"U.O.C. Cardiologia, Ospedale Versilia, 55041 Lido di Camaiore, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Paccone","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0689-0695","authenticated-orcid":false,"given":"Irma","family":"Bisceglia","sequence":"additional","affiliation":[{"name":"Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0315-3304","authenticated-orcid":false,"given":"Andrea","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Cardiology, \u201cGuglielmo da Saliceto\u201d Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marino","family":"Scherillo","sequence":"additional","affiliation":[{"name":"Cardiologia Interventistica e UTIC, A.O. 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Pascale, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Oliva","sequence":"additional","affiliation":[{"name":"Cardio-Oncology Unit, IRCCS Istituto Tumori, \u201cGiovanni Paolo II\u201d, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2823-1797","authenticated-orcid":false,"given":"Christian","family":"Cadeddu Dessalvi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5759-1911","authenticated-orcid":false,"given":"Pietro","family":"Forte","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. 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