101
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Disse SC, Manuylova T, Adam K, Lechler A, Zant R, Klingel K, Aepinus C, Finkenzeller T, Wellmann S, Schneble F. COVID-19 in 28-Week Triplets Caused by Intrauterine Transmission of SARS-CoV-2-Case Report. Front Pediatr 2021; 9:812057. [PMID: 35004553 PMCID: PMC8740284 DOI: 10.3389/fped.2021.812057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, in-utero transmission of SARS-CoV-2 remains a rarity and only very few cases have been proven across the world. Here we depict the clinical, laboratory and radiologic findings of preterm triplets born at 28 6/7 weeks to a mother who contracted COVID-19 just 1 week before delivery. The triplets showed SARS-CoV-2 positivity right after birth, developed significant leukopenia and early-onset pulmonary interstitial emphysema. The most severely affected triplet I required 10 days of high-frequency oscillatory ventilation due to failure of conventional invasive ventilation, and circulatory support for 4 days. Despite a severe clinical course in two triplets (triplet I and II), clinical management without experimental, targeted antiviral drugs was successful. At discharge home, the triplets showed no signs of neurologic or pulmonary sequelae. Placental immunohistology with SARS-CoV-2 N-protein localized strongly to syncytiotrophoblast cells and, to a lesser extent, to fetal Hofbauer cells, proving intrauterine virus transmission. We discuss the role of maternal viremia as a potential risk factor for vertical transmission. To the best of our knowledge, our report presents the earliest unequivocally confirmed prenatal virus transmission in long-term surviving children, i.e., at the beginning of the third trimester.
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Affiliation(s)
- Sigrid C Disse
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Tatiana Manuylova
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Klaus Adam
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Annette Lechler
- Women's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Robert Zant
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Karin Klingel
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Christian Aepinus
- Institute of Laboratory Medicine and Microbiology, Synlab Medizinisches Versorgungszentrum (MVZ) Weiden, Weiden, Germany
| | - Thomas Finkenzeller
- Institute of Radiology, Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Fritz Schneble
- Children's Hospital Weiden, Kliniken Nordoberpfalz Aktiengesellschaft (AG), Weiden, Germany
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102
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Bohné M, Chung DU, Tigges E, van der Schalk H, Waddell D, Schenker N, Willems S, Klingel K, Kivelitz D, Bahlmann E. Short-term use of "ECMELLA" in the context of fulminant eosinophilic myocarditis with cardiogenic shock. BMC Cardiovasc Disord 2020; 20:519. [PMID: 33302874 PMCID: PMC7731477 DOI: 10.1186/s12872-020-01808-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the “ECMELLA” concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis.
Case presentation We report a case of a 38‐year‐old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno‐arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state. Conclusions In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.
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Affiliation(s)
- Mintje Bohné
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Eike Tigges
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Hendrick van der Schalk
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Daniela Waddell
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Niklas Schenker
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Dietmar Kivelitz
- Department of Radiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany.
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103
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Bojkova D, Wagner JUG, Shumliakivska M, Aslan GS, Saleem U, Hansen A, Luxán G, Günther S, Pham MD, Krishnan J, Harter PN, Ermel UH, Frangakis AS, Milting H, Zeiher AM, Klingel K, Cinatl J, Dendorfer A, Eschenhagen T, Tschöpe C, Ciesek S, Dimmeler S. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. Cardiovasc Res 2020; 116:2207-2215. [PMID: 32966582 PMCID: PMC7543363 DOI: 10.1093/cvr/cvaa267] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has emerged as a global pandemic. SARS-CoV-2 infection can lead to elevated markers of cardiac injury associated with higher risk of mortality. It is unclear whether cardiac injury is caused by direct infection of cardiomyocytes or is mainly secondary to lung injury and inflammation. Here, we investigate whether cardiomyocytes are permissive for SARS-CoV-2 infection. Methods and results Two strains of SARS-CoV-2 infected human induced pluripotent stem cell-derived cardiomyocytes (iPS-CMs) as demonstrated by detection of intracellular double-stranded viral RNA and viral spike glycoprotein expression. Increasing concentrations of viral RNA are detected in supernatants of infected cardiomyocytes, which induced infections in Caco-2 cell lines, documenting productive infections. SARS-COV-2 infection and induced cytotoxic and proapoptotic effects associated with it abolished cardiomyocyte beating. RNA sequencing confirmed a transcriptional response to viral infection as demonstrated by the up-regulation of genes associated with pathways related to viral response and interferon signalling, apoptosis, and reactive oxygen stress. SARS-CoV-2 infection and cardiotoxicity was confirmed in a 3D cardiosphere tissue model. Importantly, viral spike protein and viral particles were detected in living human heart slices after infection with SARS-CoV-2. Coronavirus particles were further observed in cardiomyocytes of a patient with COVID-19. Infection of iPS-CMs was dependent on cathepsins and angiotensin-converting enzyme 2 (ACE2), and was blocked by remdesivir. Conclusions This study demonstrates that SARS-CoV-2 infects cardiomyocytes in vitro in an ACE2- and cathepsin-dependent manner. SARS-CoV-2 infection of cardiomyocytes is inhibited by the antiviral drug remdesivir. Translational Perspective Although this study cannot address whether cardiac injury and dysfunction in COVID-19 patients is caused by direct infection of cardiomyocytes, the demonstration of direct cardiotoxicity in cardiomyocytes, organ mimics, human heart slices and human hearts warrants the further monitoring of cardiotoxic effects in COVID-19 patients.
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Affiliation(s)
- Denisa Bojkova
- Institute of Medical Virology, University of Frankfurt, Paul-Ehrlich-Str. 40, 60590 Frankfurt, Germany
| | - Julian U G Wagner
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Germany
| | - Mariana Shumliakivska
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Galip S Aslan
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Umber Saleem
- German Center for Cardiovascular Research (DZHK), Germany.,Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Arne Hansen
- German Center for Cardiovascular Research (DZHK), Germany.,Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Guillermo Luxán
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Stefan Günther
- Max Planck Institute Heart and Lung Research, Ludwigstrasse 43, 61231 Bad Nauheim, Germany.,Cardiopulmonary Institute (CPI), Frankfurt, Germany
| | - Minh Duc Pham
- Department of Medicine, Cardiology, Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Jaya Krishnan
- Cardiopulmonary Institute (CPI), Frankfurt, Germany.,Department of Medicine, Cardiology, Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University of Frankfurt, Heinrich-Hoffmann Strasse 7, 60528 Frankfurt, Germany
| | - Utz H Ermel
- Institute of Biophysics and BMLS, University of Frankfurt, Campus Riedberg, Maxvon-Laue Strasse 15, 60438 Frankfurt, Germany
| | - Achilleas S Frangakis
- Institute of Biophysics and BMLS, University of Frankfurt, Campus Riedberg, Maxvon-Laue Strasse 15, 60438 Frankfurt, Germany
| | - Hendrik Milting
- Heart and Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Clinic for Thoracic and Cardiovascular Surgery, Erich & Hanna Klessmann Institute, Georgstr. 11, 32545 Bad Oeyenhausen, Germany
| | - Andreas M Zeiher
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.,Cardiopulmonary Institute (CPI), Frankfurt, Germany.,Department of Medicine, Cardiology, Goethe University Hospital, Theodor Stern Kai 7, 60590 Frankfurt, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstraße 8, 72076 Tuebingen, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, University of Frankfurt, Paul-Ehrlich-Str. 40, 60590 Frankfurt, Germany
| | - Andreas Dendorfer
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.,Walter-Brendel-Centre of Experimental Medicine, University Hospital, LMU Munich, Marchioninistr. 27, 81377 Munich, Germany
| | - Thomas Eschenhagen
- German Center for Cardiovascular Research (DZHK), Germany.,Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Carsten Tschöpe
- German Center for Cardiovascular Research (DZHK), Germany.,Department of Cardiology, Campus Virchow Klinikum (CVK), Charité, and Berlin Institute of Health (BIH), Berlin Brandenburger Center for Regenerative Therapies (BCRT), University Medicine Berlin, Berlin, Germany
| | - Sandra Ciesek
- Institute of Medical Virology, University of Frankfurt, Paul-Ehrlich-Str. 40, 60590 Frankfurt, Germany.,Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Branch Translational Medicine and Pharmacology, Theodor Stern Kai 7, 60590 Frankfurt, Germany.,German Centre for Infection Research (DZIF), External partner site, Frankfurt, Germany
| | - Stefanie Dimmeler
- Institute for Cardiovascular Regeneration, Centre of Molecular Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.,German Center for Cardiovascular Research (DZHK), Germany.,Cardiopulmonary Institute (CPI), Frankfurt, Germany
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104
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Rüdebusch J, Benkner A, Nath N, Fleuch L, Kaderali L, Grube K, Klingel K, Eckstein G, Meitinger T, Fielitz J, Felix SB. Stimulation of soluble guanylyl cyclase (sGC) by riociguat attenuates heart failure and pathological cardiac remodelling. Br J Pharmacol 2020; 179:2430-2442. [PMID: 33247945 DOI: 10.1111/bph.15333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/16/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Heart failure is associated with an impaired NO-soluble guanylyl cyclase (sGC)-cGMP pathway and its augmentation is thought to be beneficial for its therapy. We hypothesized that stimulation of sGC by the sGC stimulator riociguat prevents pathological cardiac remodelling and heart failure in response to chronic pressure overload. EXPERIMENTAL APPROACH Transverse aortic constriction or sham surgery was performed in C57BL/6N mice. After 3 weeks of transverse aortic constriction when heart failure was established, animals receive either riociguat or its vehicle for 5 additional weeks. Cardiac function was evaluated weekly by echocardiography. Eight weeks after surgery, histological analyses were performed to evaluate remodelling and the transcriptome of the left ventricles (LVs) was analysed by RNA sequencing. Cell culture experiments were used for mechanistically studies. KEY RESULTS Transverse aortic constriction resulted in a continuous decrease of LV ejection fraction and an increase in LV mass until week 3. Five weeks of riociguat treatment resulted in an improved LV ejection fraction and a decrease in the ratio of left ventricular mass to total body weight (LVM/BW), myocardial fibrosis and myocyte cross-sectional area. RNA sequencing revealed that riociguat reduced the expression of myocardial stress and remodelling genes (e.g. Nppa, Nppb, Myh7 and collagen) and attenuated the activation of biological pathways associated with cardiac hypertrophy and heart failure. Riociguat reversed pathological stress response in cultivated myocytes and fibroblasts. CONCLUSION AND IMPLICATIONS Stimulation of the sGC reverses transverse aortic constriction-induced heart failure and remodelling, which is associated with improved myocardial gene expression.
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Affiliation(s)
- Julia Rüdebusch
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Alexander Benkner
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Neetika Nath
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Lina Fleuch
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Lars Kaderali
- DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany.,Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Karina Grube
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Gertrud Eckstein
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jens Fielitz
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research, partner site Greifswald), Greifswald, Germany
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105
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Rassaf T, Totzeck M, Mahabadi AA, Hendgen-Cotta U, Korste S, Settelmeier S, Luedike P, Dittmer U, Herbstreit F, Brenner T, Klingel K, Hasenberg M, Walkenfort B, Gunzer M, Schlosser T, Weymann A, Kamler M, Schmack B, Ruhparwar A. Ventricular assist device for a coronavirus disease 2019-affected heart. ESC Heart Fail 2020; 8:162-166. [PMID: 33219613 PMCID: PMC7753611 DOI: 10.1002/ehf2.13120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 12/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is challenging the care for cardiovascular patients, resulting in serious consequences with increasing mortality in pre-diseased heart failure patients. In the current state of the pandemic, the physiopathology of COVID-19 affecting pre-diseased hearts and the management of terminal heart failure in COVID-19 patients remain unclear. We outline the findings of a young COVID-19 patient suffering from idiopathic cardiomyopathy who was treated for acute multi-organ failure and required cardiac surgery with implantation of a temporary right ventricular and durable left ventricular assist device (LVAD). For deeper translational insights, we used in-depth tissue analysis by electron and light sheet fluorescence microscopy revealing evidence for spatial distribution of severe acute respiratory syndrome coronavirus 2 in the heart. This indicates that in-depth analysis may represent a valuable tool in understanding indistinct clinical cases. We conclude that COVID-19 directly affects pre-diseased hearts, but the consequences can be treated successfully with LVAD implantation.
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Affiliation(s)
- Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulrike Hendgen-Cotta
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Sebastian Korste
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
| | - Karin Klingel
- Department of Cardiopathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Mike Hasenberg
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Bernd Walkenfort
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital Essen, Essen, Germany
| | - Thomas Schlosser
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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106
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Seitz A, Martinez Pereyra V, Hubert A, Klingel K, Bekeredjian R, Sechtem U, Ong P. Mechanisms of angina in patients with biopsy-proven viral myocarditis: insights from intracoronary acetylcholine testing. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with myocarditis often present with angina pectoris despite unobstructed coronary arteries. The underlying pathophysiological mechanism of angina in these patients remains to be elucidated. Coronary artery spasm is a well-known cause of angina in patients with unobstructed coronary arteries. In this study, we sought to assess the frequency of coronary vasomotor disorders in patients with biopsy-proven viral myocarditis.
Methods
In total, 700 consecutive patients who underwent endomyocardial biopsy for suspected myocarditis between 2008 and 2018 were retrospectively screened. Of these patients, viral myocarditis was confirmed in 303 patients defined as histological/immunohistological evidence of myocardial inflammation and presence of viral genome confirmed by PCR. Of these patients, 34 patients had angina despite unobstructed coronary arteries and underwent intracoronary acetylcholine (ACh) provocation testing in search of coronary spasm. Epicardial spasm was defined as acetylcholine-induced reproduction of the patient's symptoms associated with ischemic ECG changes and >90% epicardial vasoconstriction. Microvascular spasm was defined as symptom reproduction and ECG changes in the absence of significant epicardial vasoconstriction.
Results
Patients were 49±16 years old, 62% were male and left ventricular ejection fraction was 54±16%. Most frequent viruses were parvovirus B19 (PVB19, 59%) and human herpes virus 6 (HHV6, 26%), 2 patients had combined PVB19/HHV6 infection and 3 patients other herpesviruses (CMV, EBV, VZV). Epicardial spasm was observed in 10 patients (29%) during ACh testing and microvascular spasm was found in 11 patients (32%). The rate of coronary spasm (epicardial and microvascular) was higher in the PVB19 subgroup compared to HHV6 (80% vs. 33%, p=0.031). In particular, there was a higher prevalence of microvascular spasm in PVB19 compared to HHV6 (45% vs. 0%, p=0.018).
Conclusion
We observed a high prevalence of microvascular and epicardial spasm in patients with biopsy-proven viral myocarditis suggesting coronary spasm as a potential underlying mechanism for angina in these patients. Microvascular spasm was most often observed in patients with PVB19-associated myocarditis.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Robert-Bosch-Stiftung; Berthold-Leibinger-Stiftung
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Affiliation(s)
- A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | | | - A Hubert
- Robert Bosch Hospital, Stuttgart, Germany
| | - K Klingel
- University Hospital of Tuebingen, Cardiopathology, Tuebingen, Germany
| | | | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
| | - P Ong
- Robert Bosch Hospital, Stuttgart, Germany
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107
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Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, Friedrich MG, Klingel K, Lehtonen J, Moslehi JJ, Pedrotti P, Rimoldi OE, Schultheiss HP, Tschöpe C, Cooper LT, Camici PG. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail 2020; 13:e007405. [PMID: 33176455 PMCID: PMC7673642 DOI: 10.1161/circheartfailure.120.007405] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Maria Frigerio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Eric D. Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (C.B.)
| | - David H. Birnie
- University of Ottawa Heart Institute, Ontario, Canada (D.H.B.)
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
- IONIS Pharmaceuticals, Carlsbad, CA (M.B.)
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada (M.G.F.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (K.K.)
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Finland (J.L.)
| | - Javid J. Moslehi
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.J.M.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | | | | | - Carsten Tschöpe
- Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany (C.T.)
- Department of Cardiology, Charité–University Medicine Berlin, Campus Virchow Klinikum, Germany (C.T.)
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital, Milano, Italy (P.G.C.)
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108
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Polito MV, Hagendorff A, Citro R, Prota C, Silverio A, De Angelis E, Klingel K, Metze M, Stöbe S, Hoffmann KT, Sabri O, Piscione F, Galasso G. Loeffler's Endocarditis: An Integrated Multimodality Approach. J Am Soc Echocardiogr 2020; 33:1427-1441. [PMID: 33129649 DOI: 10.1016/j.echo.2020.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/09/2023]
Abstract
Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients. The aim is to provide an updated state-of-the-art review focused on noninvasive and invasive imaging modalities for this rare and underdiagnosed disease. Standard and advanced echocardiography are typically the first cardiac imaging examinations when LE is suspected and they are also used later in follow-up for prognostic stratification and assessing response to treatment. Cardiac magnetic resonance provides a more detailed anatomical and functional evaluation of cardiac chambers, tissue characterization for the presence and extension of myocardial edema and fibrosis, and ventricular thrombi identification. Computed tomography scan and [18F]-fluoro-deoxy-glucose positron emission tomography may be helpful in selected cases to evaluate the cardiac involvement of LE as well as the other noncardiac manifestations of hypereosinophilic syndrome. Endomyocardial biopsy may be considered in patients with high clinical suspicion of LE if noninvasive imaging findings are confusing or not conclusive. The appropriate use of invasive and noninvasive imaging modalities, combining the available techniques with the patients' clinical features, will hopefully lead to early diagnosis, more accurate staging of disease, and timely treatment of LE that may prevent the irreversible myocardial damage of LE and adverse cardiovascular events.
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Affiliation(s)
- Maria Vincenza Polito
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
| | | | - Rodolfo Citro
- Department of Cardiology, A.O.U. "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Costantina Prota
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena De Angelis
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Federico Piscione
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Gennaro Galasso
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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109
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Ameling S, Bischof J, Dörr M, Könemann S, Empen K, Weitmann K, Klingel K, Beug D, Dhople VM, Völker U, Hammer E, Felix SB. Analysis of DCM associated protein alterations of human right and left ventricles. J Proteomics 2020; 231:104018. [PMID: 33075551 DOI: 10.1016/j.jprot.2020.104018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Dilated cardiomyopathy (DCM) is characterized by ventricular chamber enlargement and impaired myocardial function. Endomyocardial biopsies (EMB) enable immunohistochemical and molecular characterization of this disease. However, knowledge about specific molecular patterns and their relation to cardiac function in both ventricles is rare. Therefore, we performed a mass spectrometric analysis of 28 paired EMBs of left (LV) and right ventricles (RV) of patients with DCM or suspected myocarditis allowing quantitative profiling of 743 proteins. We analysed associations between protein abundance of LV and RV as well as the echocardiographic parameters LVEF, TAPSE, LVEDDI, and RVEDDI by linear regression models. Overall, more LV than RV proteins were associated with LV parameters or with RVEDDI. Most LV and RV proteins increasing in level with impairing of LVEF were annotated to structural components of cardiac tissue. Additionally, a high proportion of LV proteins with metabolic functions decreased in level with decreasing LVEF. Results were validated with LV heart sections of a genetic murine heart failure model. The study shows, that remodelling and systolic dysfunction in DCM is mirrored by distinct alterations in protein composition of both ventricles. Loss of LV systolic function is reflected predominantly by alterations in proteins assigned to metabolic functions in the LV whereas structural remodelling was more obvious in the RV. Alterations related to intermediate filaments were seen in both ventricles and highlight such proteins as early indicators of LV loss of function. SIGNIFICANCE: The present study report protein sets in the RV and the LV being associated with ventricular function and remodelling in DCM. Protein abundances in the LV and the RV emphasize and expand current knowledge on pathophysiological changes in heart failure and DCM. While RV and LV EMBs do not differ concerning diagnostic assessment of inflammatory status and virus persistence, additional information reflecting disease severity associated protein alterations can be gained by EMB protein profiling. RV and LV protein data provided complementary information. The protein pattern of the LV reflects metabolic changes and an impaired energy production, which is associated with the degree of LV systolic dysfunction and remodelling and may yield important information about the disease status in DCM. On the other hand, at this disease stage of DCM with still preserved RV function, RV alterations in structural proteins may reflect myocardial compensatory protective mechanisms for maintenance of structure and cellular function. The study highlight particular proteins being of interest as heart failure biomarkers in both ventricles which seem to reflect the severity of the disease. Further comparative studies between different HF aetiologies have to evaluate those proteins as markers specific for DCM.
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Affiliation(s)
- Sabine Ameling
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Straße 8, D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Julia Bischof
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Straße 8, D-17475 Greifswald, Germany
| | - Marcus Dörr
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephanie Könemann
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Klaus Empen
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., D-17475 Greifswald, Germany
| | - Kerstin Weitmann
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1, D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Molecular Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstr. 8, D-72076 Tübingen, Germany
| | - Daniel Beug
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., D-17475 Greifswald, Germany
| | - Vishnu Mukund Dhople
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Straße 8, D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Straße 8, D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Elke Hammer
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Felix-Hausdorff-Straße 8, D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
| | - Stephan B Felix
- Department for Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., D-17475 Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
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110
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Tschöpe C, Alogna A, Faragli A, Klingel K, Schmidt G, Heilmann TW, B Bastos M, Spillmann F. Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®. Front Cardiovasc Med 2020; 7:563448. [PMID: 33102536 PMCID: PMC7545402 DOI: 10.3389/fcvm.2020.563448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/13/2020] [Indexed: 12/03/2022] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in bi-ventricular failure with cardiogenic shock to maintain systemic perfusion. Nonetheless, it tends to increase left ventricular (LV) afterload and myocardial oxygen demand. In order to mitigate these negative effects on the myocardium, an Impella CP® (3.5 L/min Cardiac Output) can be used in conjunction with V-A ECMO (ECMELLA approach). We implemented this strategy in a patient with severe acute myocarditis complicated by cardiogenic shock. Due to a hemolysis crisis, Impella CP® had to be substituted with PulseCath iVAC2L®, which applies pulsatile flow to unload the LV. A subsequent improvement in LV systolic function was noted, with increased LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD) reduction, and a reduction in plasma free hemoglobin. This case documents the efficacy of iVAC2L in replacing Impella CP as a LV vent during V-A ECMO, with less hemolysis.
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Affiliation(s)
- Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Alessio Alogna
- Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Alessandro Faragli
- Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology University of Tübingen, Tübingen, Germany
| | - Gunther Schmidt
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany
| | | | - Marcelo B Bastos
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frank Spillmann
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.,Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
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111
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Lang P, Eichholz T, Bakchoul T, Streiter M, Petrasch M, Bösmüller H, Klein R, Rabsteyn A, Lang AM, Adams C, Klingel K, Gessner M, Rosenberger P, Ruef P, Handgretinger R. Defibrotide for the Treatment of Pediatric Inflammatory Multisystem Syndrome Temporally Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2 Pediatric Patients. J Pediatric Infect Dis Soc 2020; 9:622-625. [PMID: 32951037 PMCID: PMC7543556 DOI: 10.1093/jpids/piaa117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023]
Abstract
The pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection is a severe complication of coronavirus disease 2019. Since impaired coagulation and thrombosis/endotheliitis are suspected pathomechanisms, we treated 2 patients with defibrotide, a profibrinolytic, antithrombotic, antiinflammatory oligonucleotide. Symptoms resolved during treatment. Moreover, coagulation parameters indicating hypofibrinolysis and complement activation normalized. The pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection is a severe complication of coronavirus disease 2019. Since impaired coagulation and thrombosis/endotheliitis are suspected pathomechanisms, 2 patients received defibrotide, a profibrinolytic, antithrombotic, antiinflammatory oligonucleotide. Symptoms resolved and hypofibrinolysis/complement activation normalized during treatment.
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Affiliation(s)
- Peter Lang
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Thomas Eichholz
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Institute of Transfusion Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Monika Streiter
- Children’s Hospital, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Maurice Petrasch
- Children’s Hospital, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Hans Bösmüller
- Institute of Pathology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Reinhild Klein
- Department of Haematology/Oncology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Armin Rabsteyn
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Anne-Marie Lang
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Constantin Adams
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Karin Klingel
- Institute of Pathology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Michaela Gessner
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Rosenberger
- University Hospital for Intensive Care and Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Peter Ruef
- Children’s Hospital, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Rupert Handgretinger
- Children’s University Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany,Correspondence: Rupert Handgretinger, Children’s University Hospital Tuebingen, Hoppe-Seyler Str. 1, 72076 Tuebingen, Germany ()
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112
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Heitmeier T, Sydykov A, Lukas C, Vroom C, Korfei M, Petrovic A, Klingel K, Günther A, Eickelberg O, Weissmann N, Ghofrani HA, Seeger W, Grimminger F, Schermuly RT, Meiners S, Kosanovic D. Altered proteasome function in right ventricular hypertrophy. Cardiovasc Res 2020; 116:406-415. [PMID: 31020333 DOI: 10.1093/cvr/cvz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/01/2019] [Accepted: 04/16/2019] [Indexed: 01/29/2023] Open
Abstract
AIMS In patients with pulmonary hypertension, right ventricular hypertrophy (RVH) is a detrimental condition that ultimately results in right heart failure and death. The ubiquitin proteasome system has been identified as a major protein degradation system to regulate cardiac remodelling in the left heart. Its role in right heart hypertrophy, however, is still ambiguous. METHODS AND RESULTS RVH was induced in mice by pulmonary artery banding (PAB). Both, expression and activity of the proteasome was found to be up-regulated in the hypertrophied right ventricle (RV) compared to healthy controls. Catalytic inhibition of the proteasome by the two proteasome inhibitors Bortezomib (BTZ) and ONX-0912 partially improved RVH both in preventive and therapeutic applications. Native gel analysis revealed that specifically the 26S proteasome complexes were activated in experimental RVH. Increased assembly of 26S proteasomes was accompanied by elevated expression of Rpn6, a rate-limiting subunit of 26S proteasome assembly, in hypertrophied cardiomyocytes of the right heart. Intriguingly, patients with RVH also showed increased expression of Rpn6 in hypertrophied cardiomyocytes of the RV as identified by immunohistochemical staining. CONCLUSION Our data demonstrate that alterations in expression and activity of proteasomal subunits play a critical role in the development of RVH. Moreover, this study provides an improved understanding on the selective activation of the 26S proteasome in RVH that might be driven by the rate-limiting subunit Rpn6. In RVH, Rpn6 therefore represents a more specific target to interfere with proteasome function than the commonly used catalytic proteasome inhibitors.
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Affiliation(s)
- Tanja Heitmeier
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Akylbek Sydykov
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Christina Lukas
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians-University and Helmholtz Zentrum München, Max-Lebsche-Platz 31, 81377 Munich, Germany
| | - Christina Vroom
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Martina Korfei
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Aleksandar Petrovic
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University of Tübingen, Germany
| | - Andreas Günther
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany.,Agaplesion Lung Clinic Waldhof Elgershausen, Greifenstein, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians-University and Helmholtz Zentrum München, Max-Lebsche-Platz 31, 81377 Munich, Germany.,University of Colorado at Denver - Anschutz Medical Campus, 129263, Pulmonary and Critical Care Medicine University, Denver, CO, USA
| | - Norbert Weissmann
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | | | - Werner Seeger
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany.,Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Friedrich Grimminger
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Ralph Theo Schermuly
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany
| | - Silke Meiners
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians-University and Helmholtz Zentrum München, Max-Lebsche-Platz 31, 81377 Munich, Germany
| | - Djuro Kosanovic
- Universities of Giessen and Marburg Lung Center (UGMLC), Aulweg 130, 35392 Giessen, Germany.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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113
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Hou X, Chen G, Bracamonte-Baran W, Choi HS, Diny NL, Sung J, Hughes D, Won T, Wood MK, Talor MV, Hackam DJ, Klingel K, Davogustto G, Taegtmeyer H, Coppens I, Barin JG, Čiháková D. The Cardiac Microenvironment Instructs Divergent Monocyte Fates and Functions in Myocarditis. Cell Rep 2020; 28:172-189.e7. [PMID: 31269438 PMCID: PMC6813836 DOI: 10.1016/j.celrep.2019.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 05/07/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022] Open
Abstract
Two types of monocytes, Ly6Chi and Ly6Clo, infiltrate the heart in murine experimental autoimmune myocarditis (EAM). We discovered a role for cardiac fibroblasts in facilitating monocyte-to-macrophage differentiation of both Ly6Chi and Ly6Clo cells, allowing these macrophages to perform divergent functions in myocarditis progression. During the acute phase of EAM, IL-17A is highly abundant. It signals through cardiac fibroblasts to attenuate efferocytosis of Ly6Chi monocyte-derived macrophages (MDMs) and simultaneously prevents Ly6Clo monocyte-to-macrophage differentiation. We demonstrated an inverse clinical correlation between heart IL-17A levels and efferocytic receptor expressions in humans with heart failure (HF). In the absence of IL-17A signaling, Ly6Chi MDMs act as robust phagocytes and are less proinflammatory, whereas Ly6Clo monocytes resume their differentiation into MHCII+ macrophages. We propose that MHCII+Ly6Clo MDMs are associated with the reduction of cardiac fibrosis and prevention of the myocarditis sequalae. Hou et al. show that cardiac fibroblasts facilitate infiltrating Ly6Chi and Ly6Clo monocytes to become macrophages. IL-17A trans-signaling through cardiac fibroblasts increases MerTK shedding and promotes a pro-inflammatory and pro-tissue remodeling gene expression profile in Ly6Chi monocyte-derived macrophages. Paradoxically, IL-17A signaling through cardiac fibroblasts can substantially inhibit Ly6Clo monocyte-to-macrophage differentiation.
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Affiliation(s)
- Xuezhou Hou
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Guobao Chen
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | - Hee Sun Choi
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nicola L Diny
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jungeun Sung
- Institute of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - David Hughes
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Taejoon Won
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Megan Kay Wood
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Monica V Talor
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - David Joel Hackam
- Division of General Pediatric Surgery, Johns Hopkins University and Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD 21218, USA
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, 72076 Tübingen, Germany
| | - Giovanni Davogustto
- Department of Internal Medicine, Division of Cardiovascular Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Heinrich Taegtmeyer
- Department of Internal Medicine, Division of Cardiovascular Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Isabelle Coppens
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jobert G Barin
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Daniela Čiháková
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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114
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Greulich S, Seitz A, Müller KAL, Grün S, Ong P, Ebadi N, Kreisselmeier KP, Seizer P, Bekeredjian R, Zwadlo C, Gräni C, Klingel K, Gawaz M, Sechtem U, Mahrholdt H. Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data. J Am Heart Assoc 2020; 9:e015351. [PMID: 32787653 PMCID: PMC7660832 DOI: 10.1161/jaha.119.015351] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is scarce data about the long‐term mortality as well as the prognostic value of cardiovascular magnetic resonance and late gadolinium enhancement (LGE) in patients with biopsy‐proven viral myocarditis. We sought to investigate: (1) mortality and (2) prognostic value of LGEcardiovascular magnetic resonance (location, pattern, extent, and distribution) in a >10‐year follow‐up in patients with biopsy‐proven myocarditis. Methods and Results Two‐hundred three consecutive patients with biopsy‐proven viral myocarditis and cardiovascular magnetic resonance were enrolled; 183 patients were eligible for standardized follow‐up. The median follow‐up was 10.1 years. End points were all‐cause death, cardiac death, and sudden cardiac death (SCD). We found substantial long‐term mortality in patients with biopsy‐proven myocarditis (39.3% all cause, 27.3% cardiac, and 10.9% SCD); 101 patients (55.2%) demonstrated LGE. The presence of LGE was associated with a more than a doubled risk of death (hazard ratio [HR], 2.40; 95% CI], 1.30–4.43), escalating to a HR of 3.00 (95% CI, 1.41–6.42) for cardiac death, and a HR of 14.79 (95% CI, 1.95–112.00) for SCD; all P≤0.009. Specifically, midwall, (antero‐) septal LGE, and extent of LGE were highly associated with death, all P<0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38–15.24; P=0.01). Conclusions In patients with biopsy‐proven viral myocarditis, the presence of midwall LGE in the (antero‐) septal segments is associated with a higher rate of mortality (including SCD) compared with absent LGE or other LGE patterns, underlining the prognostic benefit of a distinct LGE analysis in these patients.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Andreas Seitz
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Karin A L Müller
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Stefan Grün
- Department of Cardiology Rems-Murr-Klinikum Winnenden Winnenden Germany
| | - Peter Ong
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Nawid Ebadi
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | | | - Peter Seizer
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Raffi Bekeredjian
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Carolin Zwadlo
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Christoph Gräni
- Department of Cardiology Bern University Hospital Bern Switzerland.,Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Karin Klingel
- Cardiopathology Institute for Pathology and Neuropathology University of Tübingen Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Udo Sechtem
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Heiko Mahrholdt
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
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115
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Maier A, Braig M, Jakob K, Bienert T, Schäper M, Merkle A, Wadle C, Menza M, Neudorfer I, Bojti I, Stachon P, Duerschmied D, Hilgendorf I, Heidt T, Bode C, Peter K, Klingel K, von Elverfeldt D, von Zur Mühlen C. Molecular magnetic resonance imaging of activated platelets allows noninvasive detection of early myocarditis in mice. Sci Rep 2020; 10:13211. [PMID: 32764735 PMCID: PMC7413393 DOI: 10.1038/s41598-020-70043-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/22/2020] [Indexed: 11/09/2022] Open
Abstract
MRI sensitivity for diagnosis and localization of early myocarditis is limited, although it is of central clinical interest. The aim of this project was to test a contrast agent targeting activated platelets consisting of microparticles of iron oxide (MPIO) conjugated to a single-chain antibody directed against ligand-induced binding sites (LIBS) of activated glycoprotein IIb/IIIa (= LIBS-MPIO). Myocarditis was induced by subcutaneous injection of an emulsion of porcine cardiac myosin and complete Freund’s adjuvant in mice. 3D 7 T in-vivo MRI showed focal signal effects in LIBS-MPIO injected mice 2 days after induction of myocarditis, whereas in control-MPIO injected mice no signal was detectable. Histology confirmed CD41-positive staining, indicating platelet involvement in myocarditis in mice as well as in human specimens with significantly higher LIBS-MPIO binding compared to control-MPIO in both species. Quantification of the myocardial MRI signal confirmed a signal decrease after LIBS-MPIO injection and significant less signal in comparison to control-MPIO injection. These data show, that platelets are involved in inflammation during the course of myocarditis in mice and humans. They can be imaged non-invasively with LIBS-MPIO by molecular MRI at an early time point of the inflammation in mice, which is a valuable approach for preclinical models and of interest for both diagnostic and prognostic purposes.
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Affiliation(s)
- Alexander Maier
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Moritz Braig
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Jakob
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Thomas Bienert
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michaela Schäper
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annette Merkle
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carolin Wadle
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Marius Menza
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Irene Neudorfer
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - István Bojti
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Peter Stachon
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Timo Heidt
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | | | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Dominik von Elverfeldt
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
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116
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Bösmüller H, Traxler S, Bitzer M, Häberle H, Raiser W, Nann D, Frauenfeld L, Vogelsberg A, Klingel K, Fend F. The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation. Virchows Arch 2020; 477:349-357. [PMID: 32607684 PMCID: PMC7324489 DOI: 10.1007/s00428-020-02881-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 02/06/2023]
Abstract
The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy.
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Affiliation(s)
- Hans Bösmüller
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany.
| | - Selina Traxler
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Michael Bitzer
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Helene Häberle
- Department of Anaesthesiology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dominik Nann
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Leonie Frauenfeld
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Antonio Vogelsberg
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Karin Klingel
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
| | - Falko Fend
- Department of Pathology and Neuropathology, University Hospital Tübingen and Eberhard Karls University Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Germany
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117
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Van Linthout S, Klingel K, Tschöpe C. SARS-CoV-2-related myocarditis-like syndromes Shakespeare's question: what's in a name? Eur J Heart Fail 2020; 22:922-925. [PMID: 32430971 PMCID: PMC7276849 DOI: 10.1002/ejhf.1899] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
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118
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Kindermann M, Sood N, Ehrlich P, Klingel K. Fast spontaneous recovery from acute necrotizing eosinophilic myopericarditis without need for immunosuppressive therapy: a case report of a 27-year-old male. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974437 DOI: 10.1093/ehjcr/ytaa153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/19/2020] [Accepted: 05/07/2020] [Indexed: 11/12/2022]
Abstract
Background Eosinophilic myocarditis (EM) is rare but accounts for 12-22% of histologically proven acute myocarditis cases. Acute necrotizing EM is considered an aggressive, life-threatening disease which is usually treated by high-dose corticosteroid therapy. Case summary We report the case of a 27-year-old man with acute severe pericarditic chest pain, moderately reduced left ventricular (LV) ejection fraction, and a small pericardial effusion. Troponin I level was highly elevated in the absence of coronary artery disease, leading to the diagnosis of acute myopericarditis. In the absence of blood eosinophilia and despite a negative cardiac magnetic resonance study, LV endomyocardial biopsy revealed an acute necrotizing EM. With conventional antiphlogistic and heart failure therapy, the patient became symptom-free and inflammatory and cardiac necrosis markers as well as LV ejection fraction normalized within days. Thus, in the absence of a systemic hypereosinophilic disorder, there was no need for steroid therapy. Long-term follow-up over 12 months showed sustained normalization of cardiac structure and function. Discussion Acute necrotizing eosinophilic myopericarditis is not always a dreadful cardiac disease. There are idiopathic cases which may quickly resolve without immunosuppression. There seems to be a publication bias towards critical cases.
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Affiliation(s)
- Michael Kindermann
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Nitin Sood
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Peter Ehrlich
- Department of Cardiology, Angiology and Pneumology, CaritasKlinikum St. Theresia, Academic teaching hospital of the Saarland University Faculty of Medicine, Rheinstr. 2, 66113 Saarbrücken, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology, University Hospital Tübingen, Liebermeisterstr. 8, 72076 Tübingen, Germany
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119
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Bockstahler M, Fischer A, Goetzke CC, Neumaier HL, Sauter M, Kespohl M, Müller AM, Meckes C, Salbach C, Schenk M, Heuser A, Landmesser U, Weiner J, Meder B, Lehmann L, Kratzer A, Klingel K, Katus HA, Kaya Z, Beling A. Heart-Specific Immune Responses in an Animal Model of Autoimmune-Related Myocarditis Mitigated by an Immunoproteasome Inhibitor and Genetic Ablation. Circulation 2020; 141:1885-1902. [DOI: 10.1161/circulationaha.119.043171] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background:
Immune checkpoint inhibitor (ICI) therapy is often accompanied by immune-related pathology, with an increasing occurrence of high-risk ICI-related myocarditis. Understanding the mechanisms involved in this side effect could enable the development of management strategies. In mouse models, immune checkpoints, such as PD-1 (programmed cell death protein 1), control the threshold of self-antigen responses directed against cardiac TnI (troponin I). We aimed to identify how the immunoproteasome, the main proteolytic machinery in immune cells harboring 3 distinct protease activities in the LMP2 (low-molecular-weight protein 2), LMP7 (low-molecular-weight protein 7), and MECL1 (multicatalytic endopeptidase complex subunit 1) subunit, affects TnI-directed autoimmune pathology of the heart.
Methods:
TnI-directed autoimmune myocarditis (TnI-AM), a CD4
+
T-cell–mediated disease, was induced in mice lacking all 3 immunoproteasome subunits (triple-ip
−/−
) or lacking either the gene encoding LMP2 and LMP7 by immunization with a cardiac TnI peptide. Alternatively, before induction of TnI-AM or after establishment of autoimmune myocarditis, mice were treated with the immunoproteasome inhibitor ONX 0914. Immune parameters defining heart-specific autoimmunity were investigated in experimental TnI-AM and in 2 cases of ICI-related myocarditis.
Results:
All immunoproteasome-deficient strains showed mitigated autoimmune-related cardiac pathology with less inflammation, lower proinflammatory and chemotactic cytokines, less interleukin-17 production, and reduced fibrosis formation. Protection from TnI-directed autoimmune heart pathology with improved cardiac function in LMP7
−/−
mice involved a changed balance between effector and regulatory CD4
+
T cells in the spleen, with CD4
+
T cells from LMP7
−
/−
mice showing a higher expression of inhibitory PD-1 molecules. Blocked immunoproteasome proteolysis, by treatment of TLR2 (Toll-like receptor 2)–engaged and TLR7 (Toll-like receptor 7)/TLR8 (Toll-like receptor 8)–engaged CD14
+
monocytes with ONX 0914, diminished proinflammatory cytokine responses, thereby reducing the boost for the expansion of self-reactive CD4
+
T cells. Correspondingly, in mice, ONX 0914 treatment reversed cardiac autoimmune pathology, preventing the induction and progression of TnI-AM when self-reactive CD4
+
T cells were primed. The autoimmune signature during experimental TnI-AM, with high immunoproteasome expression, immunoglobulin G deposition, interleukin-17 production in heart tissue, and TnI-directed humoral autoimmune responses, was also present in 2 cases of ICI-related myocarditis, demonstrating the activation of heart-specific autoimmune reactions by ICI therapy.
Conclusions:
By reversing heart-specific autoimmune responses, immunoproteasome inhibitors applied to a mouse model demonstrate their potential to aid in the management of autoimmune myocarditis in humans, possibly including patients with ICI-related heart-specific autoimmunity.
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Affiliation(s)
- Mariella Bockstahler
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
| | - Andrea Fischer
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
| | - Carl Christoph Goetzke
- Institute of Biochemistry (C.C.G., H.L.N., M.K., A.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, Germany (C.C.G., M.K., U.L., A.K., A.B.)
| | - Hannah Louise Neumaier
- Institute of Biochemistry (C.C.G., H.L.N., M.K., A.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
| | - Martina Sauter
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (M.S., K.K.)
| | - Meike Kespohl
- Institute of Biochemistry (C.C.G., H.L.N., M.K., A.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, Germany (C.C.G., M.K., U.L., A.K., A.B.)
| | - Anna-Maria Müller
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
| | - Christin Meckes
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
| | - Christian Salbach
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
| | - Mirjam Schenk
- Institute of Pathology, University of Bern, Switzerland (M.S.)
| | - Arnd Heuser
- Core Unit Pathophysiology (A.H.), Max-Delbrueck-Center for Molecular Medicine, Berlin, Germany
| | - Ulf Landmesser
- Medizinische Klinik für Kardiologie Campus Benjamin Franklin (U.L., A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, Germany (C.C.G., M.K., U.L., A.K., A.B.)
| | - January Weiner
- Core Unit Bioinformatics (J.W.), Max-Delbrueck-Center for Molecular Medicine, Berlin, Germany
| | - Benjamin Meder
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Heidelberg/Mannheim, Heidelberg, Germany (B.M., L.L., H.A.K., Z.K.)
| | - Lorenz Lehmann
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Heidelberg/Mannheim, Heidelberg, Germany (B.M., L.L., H.A.K., Z.K.)
- Cardio-Oncology Unit, University Hospital of Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany (L.L.)
| | - Adelheid Kratzer
- Medizinische Klinik für Kardiologie Campus Benjamin Franklin (U.L., A.K.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, Germany (C.C.G., M.K., U.L., A.K., A.B.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (M.S., K.K.)
| | - Hugo A. Katus
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Heidelberg/Mannheim, Heidelberg, Germany (B.M., L.L., H.A.K., Z.K.)
| | - Ziya Kaya
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Germany (M.B., A.F., A.-M.M., C.M., C.S., B.M., L.L., H.A.K., Z.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Heidelberg/Mannheim, Heidelberg, Germany (B.M., L.L., H.A.K., Z.K.)
| | - Antje Beling
- Institute of Biochemistry (C.C.G., H.L.N., M.K., A.B.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health (BIH), Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, Germany (C.C.G., M.K., U.L., A.K., A.B.)
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120
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Popa MA, Klingel K, Hadamitzky M, Deisenhofer I, Hessling G. An unusual case of severe myocarditis in a genetic cardiomyopathy: a case report. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 32974466 PMCID: PMC7501922 DOI: 10.1093/ehjcr/ytaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/10/2019] [Accepted: 04/23/2020] [Indexed: 11/13/2022]
Abstract
Background Myocarditis is an inflammatory disease of the myocardium caused by infectious pathogens, immune-mediated conditions, or toxic agents. This report explores a rare case of severe myocarditis occurring in an inherited cardiomyopathy. Case summary A 24-year-old female patient presented with progressing dyspnoea and chest discomfort. Echocardiography and cardiac magnetic resonance imaging revealed dilated cardiomyopathy (DCM) with severe biventricular dysfunction [left ventricle ejection fraction (LV-EF) 10%]. Myocardial inflammation was suspected due to extensive subendocardial to transmural late gadolinium enhancement. Endomyocardial biopsy (EMB) showed severe chronic lymphocytic myocarditis. As inflammatory DCM was assumed, immunosuppressive therapy with prednisolone was initiated in addition to standard heart failure therapy. Endomyocardial biopsy after 3 months showed resolving inflammation. However, a marked architectural disarray observed in all biopsies raised the suspicion of an inherited cardiomyopathy. Genetic testing revealed a de novo mutation with effect on splicing of lysosome-associated membrane protein 2, as found in Danon disease. Periodic acid–Schiff (PAS) staining confirmed a glycogen storage disorder. Immunosuppressive therapy was intensified due to reactivation of myocardial inflammation and led to improvement of LV-EF and to significant symptom relief over a 16-month follow-up period. Discussion This is the first report of Danon disease initially presenting as a severe myocarditis. It illustrates the clinical value of EMB for diagnosis and immunosuppressive therapy monitoring in chronic myocarditis. Increasing evidence suggests that myocardial inflammation may modify disease progression and prognosis in inherited cardiomyopathies. The causal role of cardiac protein mutations in the pathophysiology of myocarditis remains to be determined.
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Affiliation(s)
- Miruna-Andreea Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
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121
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Imazio M, Klingel K, Kindermann I, Brucato A, De Rosa FG, Adler Y, De Ferrari GM. COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Heart 2020; 106:1127-1131. [PMID: 32499236 DOI: 10.1136/heartjnl-2020-317186] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022] Open
Abstract
The initial mechanism for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is the binding of the virus to the membrane-bound form of ACE2, which is mainly expressed in the lung. Since the heart and the vessels also express ACE2, they both could become targets of the virus. However, at present the extent and importance of this potential involvement are unknown. Cardiac troponin levels are significantly higher in patients with more severe infections, patients admitted to intensive care units or in those who have died. In the setting of COVID-19, myocardial injury, defined by an increased troponin level, occurs especially due to non-ischaemic myocardial processes, including severe respiratory infection with hypoxia, sepsis, systemic inflammation, pulmonary thrombosis and embolism, cardiac adrenergic hyperstimulation during cytokine storm syndrome, and myocarditis. At present, there are limited reports on definite diagnosis of myocarditis caused by SARS-CoV-2 in humans and limited demonstration of the virus in the myocardium. In conclusion, although the heart and the vessels are potential targets in COVID-19, there is currently limited evidence on the direct infection of the myocardium by SARS-CoV-2. Additional pathological studies and autopsy series will be very helpful to clarify the potentiality of COVID-19 to directly infect the myocardium and cause myocarditis.
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Affiliation(s)
- Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy .,Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Karin Klingel
- Cardiopathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Homburg/Saar, Germany
| | - Antonio Brucato
- Department of biomedical and clinical sciences, Fatebenefratelli Hospital and University of Milano, Milano, Italy
| | | | - Yehuda Adler
- College of Law and Business, Ramat Gan, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gaetano Maria De Ferrari
- University Cardiology, AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University of Torino, Torino, Italy
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Affiliation(s)
- Philipp Schellhorn
- Department of Internal Medicine V, Sports Medicine, University Hospital Tübingen, and Interfaculty Research Institute for Sport & Physical Activity, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Christof Burgstahler
- Department of Internal Medicine V, Sports Medicine, University Hospital Tübingen, and Interfaculty Research Institute for Sport & Physical Activity, Eberhard Karls University of Tübingen, Tübingen, Germany
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123
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Poller W, Haas J, Klingel K, Kühnisch J, Gast M, Kaya Z, Escher F, Kayvanpour E, Degener F, Opgen-Rhein B, Berger F, Mochmann HC, Skurk C, Heidecker B, Schultheiss HP, Monserrat L, Meder B, Landmesser U, Klaassen S. Familial Recurrent Myocarditis Triggered by Exercise in Patients With a Truncating Variant of the Desmoplakin Gene. J Am Heart Assoc 2020; 9:e015289. [PMID: 32410525 PMCID: PMC7660888 DOI: 10.1161/jaha.119.015289] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Variants of the desmosomal protein desmoplakin are associated with arrhythmogenic cardiomyopathy, an important cause of ventricular arrhythmias in children and young adults. Disease penetrance of desmoplakin variants is incomplete and variant carriers may display noncardiac, dermatologic phenotypes. We describe a novel cardiac phenotype associated with a truncating desmoplakin variant, likely causing mechanical instability of myocardial desmosomes. Methods and Results In 2 young brothers with recurrent myocarditis triggered by physical exercise, screening of 218 cardiomyopathy‐related genes identified the heterozygous truncating variant p.Arg1458Ter in desmoplakin. Screening for infections yielded no evidence of viral or nonviral infections. Myosin and troponin I autoantibodies were detected at high titers. Immunohistology failed to detect any residual DSP protein in endomyocardial biopsies, and none of the histologic criteria of arrhythmogenic cardiomyopathy were fulfilled. Cardiac magnetic resonance imaging revealed no features associated with right ventricular arrhythmogenic cardiomyopathy, but multifocal subepicardial late gadolinium enhancement was present in the left ventricles of both brothers. Screening of adult cardiomyopathy cohorts for truncating variants identified the rare genetic variants p.Gln307Ter, p.Tyr1391Ter, and p.Tyr1512Ter, suggesting that over subsequent decades critical genetic/exogenous modifiers drive pathogenesis from desmoplakin truncations toward different end points. Conclusions The described novel phenotype of familial recurrent myocarditis associated with a desmoplakin truncation in adolescents likely represents a serendipitously revealed subtype of arrhythmogenic cardiomyopathy. It may be caused by a distinctive adverse effect of the variant desmoplakin upon the mechanical stability of myocardial desmosomes. Variant screening is advisable to allow early detection of patients with similar phenotypes.
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Affiliation(s)
- Wolfgang Poller
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany.,Berlin-Brandenburg Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin Germany.,German Center for Cardiovascular Research (DZHK) partner site Berlin Germany
| | - Jan Haas
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology Department of Pathology University Hospital Tübingen Germany
| | - Jirko Kühnisch
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Experimental and Clinical Research Center (ECRC) Universitätsmedizin Berlin Germany
| | - Martina Gast
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | - Ziya Kaya
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Felicitas Escher
- Department of Cardiology Campus Virchow Klinikum Universitätsmedizin Berlin Germany.,Institute for Clinical Diagnostics and Therapy (IKDT) Berlin Germany
| | - Elham Kayvanpour
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany
| | - Franziska Degener
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,German Heart Center (DHZB) Berlin Germany
| | - Bernd Opgen-Rhein
- Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
| | - Felix Berger
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,German Heart Center (DHZB) Berlin Germany.,Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
| | | | - Carsten Skurk
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | - Bettina Heidecker
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany
| | | | | | - Benjamin Meder
- German Center for Cardiovascular Research (DZHK) partner site Heidelberg Germany.,Department of Cardiology University Hospital Heidelberg Mannheim Germany.,Department of Genetics Stanford University School of Medicine Palo Alto CA
| | - Ulf Landmesser
- Department of Cardiology Campus Benjamin Franklin Universitätsmedizin Berlin Germany.,German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Sabine Klaassen
- German Center for Cardiovascular Research (DZHK) partner site Berlin Germany.,Experimental and Clinical Research Center (ECRC) Universitätsmedizin Berlin Germany.,Department of Pediatric Cardiology Universitätsmedizin Berlin Germany
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Neumaier HL, Harel S, Klingel K, Kaya Z, Heuser A, Kespohl M, Beling A. ONX 0914 Lacks Selectivity for the Cardiac Immunoproteasome in CoxsackievirusB3 Myocarditis of NMRI Mice and Promotes Virus-Mediated Tissue Damage. Cells 2020; 9:cells9051093. [PMID: 32354159 PMCID: PMC7290815 DOI: 10.3390/cells9051093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022] Open
Abstract
: Inhibition of proteasome function by small molecules is highly efficacious in cancer treatment. Other than non-selective proteasome inhibitors, immunoproteasome-specific inhibitors allow for specific targeting of the proteasome in immune cells and the profound anti-inflammatory potential of such compounds revealed implications for inflammatory scenarios. For pathogen-triggered inflammation, however, the efficacy of immunoproteasome inhibitors is controversial. In this study, we investigated how ONX 0914, an immunoproteasome-selective inhibitor, influences CoxsackievirusB3 infection in NMRI mice, resulting in the development of acute and chronic myocarditis, which is accompanied by formation of the immunoproteasome in heart tissue. In groups in which ONX 0914 treatment was initiated once viral cytotoxicity had emerged in the heart, ONX 0914 had no anti-inflammatory effect in the acute or chronic stages. ONX 0914 treatment initiated prior to infection, however, increased viral cytotoxicity in cardiomyocytes, promoting infiltration of myeloid immune cells into the heart. At this stage, ONX 0914 completely inhibited the β5 subunit of the standard cardiac proteasome and less efficiently blocked its immunoproteasome counterpart LMP7. In conclusion, ONX 0914 unselectively perturbs cardiac proteasome function in viral myocarditis of NMRI mice, reduces the capacity of the host to control the viral burden and promotes cardiac inflammation.
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Affiliation(s)
- Hannah Louise Neumaier
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, 10117 Berlin, Germany; (H.L.N.); (S.H.); (M.K.)
| | - Shelly Harel
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, 10117 Berlin, Germany; (H.L.N.); (S.H.); (M.K.)
| | - Karin Klingel
- Institute for Cardiopathology, University of Tuebingen, 72074 Tuebingen, Germany;
| | - Ziya Kaya
- Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, 69120 Heidelberg, Germany;
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Arnd Heuser
- Max-Delbrueck-Center for Molecular Medicine, 10115 Berlin, Germany;
| | - Meike Kespohl
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, 10117 Berlin, Germany; (H.L.N.); (S.H.); (M.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, 10785 Berlin, Germany
| | - Antje Beling
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, 10117 Berlin, Germany; (H.L.N.); (S.H.); (M.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner side Berlin, 10785 Berlin, Germany
- Correspondence:
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125
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Degener F, Salameh A, Manuylova T, Pickardt T, Kostelka M, Daehnert I, Berger F, Messroghli D, Schubert S, Klingel K. First paediatric cohort for the evaluation of inflammation in endomyocardial biopsies derived from congenital heart surgery. Int J Cardiol 2020; 303:36-40. [DOI: 10.1016/j.ijcard.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/08/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
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126
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Kespohl M, Bredow C, Klingel K, Voß M, Paeschke A, Zickler M, Poller W, Kaya Z, Eckstein J, Fechner H, Spranger J, Fähling M, Wirth EK, Radoshevich L, Thery F, Impens F, Berndt N, Knobeloch KP, Beling A. Protein modification with ISG15 blocks coxsackievirus pathology by antiviral and metabolic reprogramming. Sci Adv 2020; 6:eaay1109. [PMID: 32195343 PMCID: PMC7065878 DOI: 10.1126/sciadv.aay1109] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/13/2019] [Indexed: 05/10/2023]
Abstract
Protein modification with ISG15 (ISGylation) represents a major type I IFN-induced antimicrobial system. Common mechanisms of action and species-specific aspects of ISGylation, however, are still ill defined and controversial. We used a multiphasic coxsackievirus B3 (CV) infection model with a first wave resulting in hepatic injury of the liver, followed by a second wave culminating in cardiac damage. This study shows that ISGylation sets nonhematopoietic cells into a resistant state, being indispensable for CV control, which is accomplished by synergistic activity of ISG15 on antiviral IFIT1/3 proteins. Concurrent with altered energy demands, ISG15 also adapts liver metabolism during infection. Shotgun proteomics, in combination with metabolic network modeling, revealed that ISG15 increases the oxidative capacity and promotes gluconeogenesis in liver cells. Cells lacking the activity of the ISG15-specific protease USP18 exhibit increased resistance to clinically relevant CV strains, therefore suggesting that stabilizing ISGylation by inhibiting USP18 could be exploited for CV-associated human pathologies.
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Affiliation(s)
- Meike Kespohl
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany
| | - Clara Bredow
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
| | - Karin Klingel
- University of Tuebingen, Cardiopathology, Institute for Pathology and Neuropathology, Tuebingen, Germany
| | - Martin Voß
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
| | - Anna Paeschke
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
| | - Martin Zickler
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
| | - Wolfgang Poller
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Clinic for Cardiology, Campus Benjamin Franklin, Berlin, Germany
| | - Ziya Kaya
- Universitätsklinikum Heidelberg, Medizinische Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Heidelberg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Heidelberg, Germany
| | - Johannes Eckstein
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
| | - Henry Fechner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Berlin, Germany
| | - Joachim Spranger
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
| | - Michael Fähling
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Vegetative Physiology, Berlin, Germany
| | - Eva Katrin Wirth
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
| | - Lilliana Radoshevich
- Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa, USA
| | - Fabien Thery
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- VIB Center for Medical Biotechnology, Ghent, Belgium
| | - Francis Impens
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- VIB Center for Medical Biotechnology, Ghent, Belgium
- VIB Proteomics Core, Ghent, Belgium
| | - Nikolaus Berndt
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | | | - Antje Beling
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany
- Corresponding author.
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Zarak-Crnkovic M, Kania G, Jaźwa-Kusior A, Czepiel M, Wijnen WJ, Czyż J, Müller-Edenborn B, Vdovenko D, Lindner D, Gil-Cruz C, Bachmann M, Westermann D, Ludewig B, Distler O, Lüscher TF, Klingel K, Eriksson U, Błyszczuk P. Heart non-specific effector CD4 + T cells protect from postinflammatory fibrosis and cardiac dysfunction in experimental autoimmune myocarditis. Basic Res Cardiol 2019; 115:6. [PMID: 31863205 PMCID: PMC6925074 DOI: 10.1007/s00395-019-0766-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 12/04/2019] [Indexed: 12/14/2022]
Abstract
Heart-specific CD4+ T cells have been implicated in development and progression of myocarditis in mice and in humans. Here, using mouse models of experimental autoimmune myocarditis (EAM) we investigated the role of heart non-specific CD4+ T cells in the progression of the disease. Heart non-specific CD4+ T cells were obtained from DO11.10 mice expressing transgenic T cell receptor recognizing chicken ovalbumin. We found that heart infiltrating CD4+ T cells expressed exclusively effector (Teff) phenotype in the EAM model and in hearts of patients with lymphocytic myocarditis. Adoptive transfer experiments showed that while heart-specific Teff infiltrated the heart shortly after injection, heart non-specific Teff effectively accumulated during myocarditis and became the major heart-infiltrating CD4+ T cell subset at later stage. Restimulation of co-cultured heart-specific and heart non-specific CD4+ T cells with alpha-myosin heavy chain antigen showed mainly Th1/Th17 response for heart-specific Teff and up-regulation of a distinct set of extracellular signalling molecules in heart non-specific Teff. Adoptive transfer of heart non-specific Teff in mice with myocarditis did not affect inflammation severity at the peak of disease, but protected the heart from adverse post-inflammatory fibrotic remodelling and cardiac dysfunction at later stages of disease. Furthermore, mouse and human Teff stimulated in vitro with common gamma cytokines suppressed expression of profibrotic genes, reduced amount of α-smooth muscle actin filaments and decreased contraction of cardiac fibroblasts. In this study, we provided a proof-of-concept that heart non-specific Teff cells could effectively contribute to myocarditis and protect the heart from the dilated cardiomyopathy outcome.
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Affiliation(s)
- Martina Zarak-Crnkovic
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Gabriela Kania
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marcin Czepiel
- Department of Clinical Immunology, Jagiellonian University Medical College, University Children's Hospital, Wielicka 265, 30-663, Cracow, Poland
| | - Winandus J Wijnen
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Jarosław Czyż
- Department of Cell Biology, Jagiellonian University, Cracow, Poland
| | - Björn Müller-Edenborn
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Medicine, GZO-Zurich Regional Health Center, Wetzikon, Switzerland
| | - Daria Vdovenko
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Diana Lindner
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Cristina Gil-Cruz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marta Bachmann
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Dirk Westermann
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tubingen, Tubingen, Germany
| | - Urs Eriksson
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Medicine, GZO-Zurich Regional Health Center, Wetzikon, Switzerland
| | - Przemysław Błyszczuk
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland.
- Department of Clinical Immunology, Jagiellonian University Medical College, University Children's Hospital, Wielicka 265, 30-663, Cracow, Poland.
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Sepehri Shamloo A, Husser D, Buettner P, Klingel K, Hindricks G, Bollmann A. Atrial septum biopsy for direct substrate characterization in atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:308-312. [PMID: 31808221 DOI: 10.1111/jce.14308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 11/30/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe and illustrate the technique of performing interatrial septum biopsy and to demonstrate its use for direct histological substrate characterization in atrial fibrillation (AF). METHODS AND RESULTS Biopsies were performed in four patients who underwent AF catheter ablation. Bipal 7 bioptome was directed through a steerable sheath directly onto the septum. Fluoroscopic views as well as echocardiography-guided techniques were utilized to confirm that the tip was oriented towards the interatrial septum. The bioptome was then placed on the right atrial (RA) septum and maneuvered to obtain the specimens (at least 1 mm in size) from the posterior septal region of the RA, adjacent to the fossa ovalis. Bioptome placement and sample acquisition were successful in all patients at the first attempt. No patient developed any minor or major complications during the procedure and hospital stay. All the biopsy specimens had proper qualities for histological assessments and revealed a variety of pathologies including fibrosis, inflammation, and fatty infiltration. CONCLUSION Atrial septum biopsies could be safely performed guided by fluoroscopy and transesophageal echocardiography. The obtained specimens allowed for a detailed localized substrate characterization which is of great interest in AF.
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Affiliation(s)
- Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Petra Buettner
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karin Klingel
- Cardiopathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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Pinkert S, Dieringer B, Klopfleisch R, Savvatis K, Van Linthout S, Pryshliak M, Tschöpe C, Klingel K, Kurreck J, Beling A, Fechner H. Early Treatment of Coxsackievirus B3-Infected Animals With Soluble Coxsackievirus-Adenovirus Receptor Inhibits Development of Chronic Coxsackievirus B3 Cardiomyopathy. Circ Heart Fail 2019; 12:e005250. [PMID: 31718319 DOI: 10.1161/circheartfailure.119.005250] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coxsackie-B-viruses (CVB) are frequent causes of acute myocarditis and dilated cardiomyopathy, but an effective antiviral therapy is still not available. Previously, we and others have demonstrated that treatment with an engineered sCAR-Fc (soluble coxsackievirus-adenovirus receptor fused to the carboxyl-terminus of human IgG) efficiently neutralizes CVB3 and inhibits the development of cardiac dysfunction in mice with acute CVB3-induced myocarditis. In this study, we analyzed the potential of sCAR-Fc for treatment of chronic CVB3-induced myocarditis in an outbred NMRI mouse model. METHODS NMRI mice were infected with the CVB3 strain 31-1-93 and treated with a sCAR-Fc expressing adeno-associated virus 9 vector 1, 3, and 7 days after CVB3 infection. Chronic myocarditis was analyzed on day 28 after infection. RESULTS Initial investigations showed that NMRI mice develop pronounced chronic myocarditis between day 18 and day 28 after infection with the CVB3 strain 31-1-93. Chronic cardiac infection was characterized by inflammation and fibrosis as well as persistence of viral genomes in the heart tissue and by cardiac dysfunction. Treatment of NMRI mice resulted in a distinct reduction of cardiac inflammation and fibrosis and almost complete elimination of virus RNA from the heart by day 28 after infection. Moreover, hemodynamic measurement revealed improved cardiac contractility and diastolic relaxation in treated mice compared with mice treated with a control vector (mean±SD; maximal pressure, 81.9±9.2 versus 69.4±8.6 mm Hg, P=0.02; left ventricular ejection fraction, 68.9±8.5 versus 54.2±11.5%, P=0.02; dP/dtmax, 7275.2±1674 versus 4432.6±1107 mm Hg/s, P=0.004; dP/dtmin, -4046.9±776 versus -3146.3±642 mm Hg/s, P=0.046). The therapeutic potential of sCAR-Fc is limited, however, since postponed start of sCAR-Fc treatment either 3 or 7 days after infection could not attenuate myocardial injury. CONCLUSIONS Early therapeutic employment of sCAR-Fc, initiated at the beginning of the primary viremia, inhibits the development of chronic CVB3-induced myocarditis and improves the cardiac function to a level equivalent to that of uninfected animals.
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Affiliation(s)
- Sandra Pinkert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Biochemistry, Germany (S.P., A.B.).,Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., B.D., M.P., J.K., H.F.)
| | - Babette Dieringer
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., B.D., M.P., J.K., H.F.)
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Germany (R.K.)
| | - Konstantinos Savvatis
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (K.S.).,William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (K.S.)
| | - Sophie Van Linthout
- Berlin-Brandenburg Center for Regenerative Therapies, Campus Virchow Klinikum, Germany (S.V.L., C.T.)
| | - Markian Pryshliak
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., B.D., M.P., J.K., H.F.)
| | - Carsten Tschöpe
- Berlin-Brandenburg Center for Regenerative Therapies, Campus Virchow Klinikum, Germany (S.V.L., C.T.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Germany (K.K.)
| | - Jens Kurreck
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., B.D., M.P., J.K., H.F.)
| | - Antje Beling
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany (A.B.)
| | - Henry Fechner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Germany (S.P., B.D., M.P., J.K., H.F.)
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Schubert S, Opgen-Rhein B, Boehne M, Weigelt A, Wagner R, Müller G, Rentzsch A, Zu Knyphausen E, Fischer M, Papakostas K, Wiegand G, Ruf B, Hannes T, Reineker K, Kiski D, Khalil M, Steinmetz M, Fischer G, Pickardt T, Klingel K, Messroghli DR, Degener F. Severe heart failure and the need for mechanical circulatory support and heart transplantation in pediatric patients with myocarditis: Results from the prospective multicenter registry "MYKKE". Pediatr Transplant 2019; 23:e13548. [PMID: 31297930 DOI: 10.1111/petr.13548] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/16/2019] [Accepted: 06/22/2019] [Indexed: 01/01/2023]
Abstract
Myocarditis represents an important cause for acute heart failure. MYKKE, a prospective multicenter registry of pediatric patients with myocarditis, aims to gain knowledge on courses, diagnostics, and therapy of pediatric myocarditis. The role of mechanical circulatory support (MCS) in children with severe heart failure and myocarditis is unclear. The aim of this study was to determine characteristics and outcome of patients with severe heart failure requiring MCS and/or heart transplantation. The MYKKE cohort between September 2013 and 2016 was analyzed. A total of 195 patients were prospectively enrolled by 17 German hospitals. Twenty-eight patients (14%) received MCS (median 1.5 years), more frequently in the youngest age group (0-2 years) than in the older groups (P < 0.001; 2-12 and 13-18 years). In the MCS group, 50% received a VAD, 36% ECMO, and 14% both, with a survival rate of 79%. The weaning rate was 43% (12/28). Nine (32%) patients were transplanted, one had ongoing support, and six (21%) died. Histology was positive for myocarditis in 63% of the MCS group. Patients within the whole cohort with age <2 years and/or ejection fraction <30% had a significantly worse survival with high risk for MCS, transplantation, and death (P < 0.001). Myocarditis represents a life-threatening disease with an overall mortality of 4.6% in this cohort. The fulminant form more often affected the youngest, leading to significantly higher rate of MCS, transplantation, and mortality. MCS represents an important and life-saving therapeutic option in children with myocarditis with a weaning rate of 43%.
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Affiliation(s)
- Stephan Schubert
- Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Bernd Opgen-Rhein
- Department for Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Annika Weigelt
- Department for Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Robert Wagner
- Department for Pediatric Cardiology, Herzzentrum Leipzig, Leipzig, Germany
| | - Götz Müller
- Department for Pediatric Cardiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Axel Rentzsch
- Department for Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Edzard Zu Knyphausen
- Department for Pediatric Cardiology, Herz- und Diabetes-zentrum NRW, Bad Oeynhausen, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | | | - Gesa Wiegand
- Department for Pediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Bettina Ruf
- Department for Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Tobias Hannes
- Department for Pediatric Cardiology, University Hospital Köln, Köln, Germany
| | - Katja Reineker
- Department for Pediatric Cardiology, Universitäts-Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - Daniela Kiski
- Department for Pediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Markus Khalil
- Department for Pediatric Cardiology, University Hospital Gießen, Giessen, Germany
| | - Michael Steinmetz
- Department for Pediatric Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Gunther Fischer
- Department for Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department for Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department for Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Degener
- Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Institute for Cardiovascular Computer-assisted Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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131
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Kaltenecker E, Schleihauf J, Meierhofer C, Shehu N, Mkrtchyan N, Hager A, Kühn A, Cleuziou J, Klingel K, Seidel H, Zenker M, Ewert P, Hessling G, Wolf CM. Long-term outcomes of childhood onset Noonan compared to sarcomere hypertrophic cardiomyopathy. Cardiovasc Diagn Ther 2019; 9:S299-S309. [PMID: 31737538 DOI: 10.21037/cdt.2019.05.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To compare outcome and cardiac pathology between patients with Noonan syndrome (N-HCM) and sarcomere protein-associated (S-HCM) childhood onset hypertrophic cardiomyopathy (HCM). Methods Clinical data were recorded from medical charts. Primary endpoint was survival. Secondary endpoints were survival without hospitalization, without intervention or without arrhythmic events. Functional clinical status and results from genetic testing, imaging, electrocardiographic (ECG) studies, cardiopulmonary exercise testing (CPET) and histopathology were compared between groups. Results Childhood HCM was diagnosed in 29 N-HCM and 34 S-HCM patients. Follow-up time was greater than 10 years in more than half of all patients. Mortality was below 7% and not different between groups. Children with N-HCM presented at a younger age and there was less time of survival without hospitalization for heart failure or intervention in N-HCM compared to S-HCM patients. Clinical functional status improved over time in N-HCM patients. On long-term follow-up, left ventricular posterior wall thickness indexed to body surface area decreased in N-HCM and increased in S-HCM patients. There was a trend to lower risk for severe arrhythmic events in N-HCM patients and only S-HCM individuals received an implantable cardioverter-defibrillator. There were no differences between groups in ventricular function, ECG and CPET parameters. Myocardial fibrosis as assessed by histopathology of myocardial specimens and cardiovascular magnetic resonance with late gadolinium enhancement or T1 mapping was present in both groups. Conclusions When compared to S-HCM patients, children with N-HCM have increased morbidity during early disease course, but favorable long-term outcome with low mortality, stagnation of myocardial hypertrophy, and low risk for malignant arrhythmias.
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Affiliation(s)
- Emanuel Kaltenecker
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Julia Schleihauf
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Naira Mkrtchyan
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andreas Kühn
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany.,(INSURE) Institute for Translational Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Heide Seidel
- Institute of Human Genetics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Cordula M Wolf
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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132
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Maier A, Jakob K, Von Elverfeldt D, Braig M, Bienert T, Peter K, Klingel K, Bode C, Von Zur Muehlen C. 4323Detection of early inflammation in myocarditis by molecular magnetic resonance imaging of activated platelets. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
A noninvasive imaging strategy for diagnosis and localization of early myocarditis would be of great clinical interest. However, resolution of current imaging techniques is limited. Platelets play an important role in inflammatory processes but the role in myocarditis is unknown. Therefore, the aim of this project was to examine the role of platelets in myocarditis and establish a sensitive non-invasive molecular MRI in-vivo imaging strategy for diagnosis of myocarditis with a contrast agent against activated platelets in mice.
Methods
Myocarditis was induced by subcutaneous injection of an emulsion of porcine cardiac myosin and complete freud's adjuvant (CFA) in Balb/c mice. Inflammatory activity was targeted with a contrast agent against activated platelets consisting of microparticles of iron oxide (MPIO) conjugated to a single chain antibody directed against ligand-induced binding sites (LIBS) on activated glycoprotein IIb/IIIa (=LIBS-MPIO). In comparison, we applied an unspecific control antibody linked to microparticles of iron oxide (control-MPIO) and injected LIBS-MPIO to mice subjected to incomplete freud's adjuvant (iCFA). All imaging results were correlated to immunohistochemistry findings.
Results
Histological evaluation showed significantly higher binding of LIBS-MPIOs to platelet enriched, CD41-positive inflamed myocardium two days after induction of myocarditis in comparison to later time points (7d, 14d, 21d) (p<0.05) and control-MPIO (p<0.05) injection. In iCFA injected mice no significant LIBS-MPIO binding was found (p<0.05). In 3D in-vivo MRI we could specifically detect focal signal effects in LIBS-MPIO injected mice 2 days after induction of myocarditis, whereas in control-MPIO injected mice no signal effect was visible. Quantification of the myocardial MRI signal confirmed a signal decrease after LIBS-MPIO injection and significant fewer signals in comparison to control-MPIO injection (p<0.05).
As a perspective, we also found CD41 positive areas in histology of human myocarditis specimens.
Conclusions
Platelets are involved in the inflammation of myocarditis. Molecular MRI with LIBS-MPIO can image them at an early time point. This noninvasive imaging strategy is of clinical interest for both diagnostic and prognostic purposes, and highlights the potential of molecular MRI for characterization of cardiovascular pathologies such as myocardial inflammation.
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Affiliation(s)
- A Maier
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | - K Jakob
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | | | - M Braig
- University of Freiburg, Freiburg im Breisgau, Germany
| | - T Bienert
- University of Freiburg, Freiburg im Breisgau, Germany
| | - K Peter
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K Klingel
- University Hospital of Tubingen, Cardiopathology, Institute for Pathology and Neuropathology, Tubingen, Germany
| | - C Bode
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
| | - C Von Zur Muehlen
- University of Freiburg, University Heart Center Freiburg, Freiburg, Germany
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133
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Poller W, Klaassen S, Haas J, Kaya Z, Mochmann HC, Gast M, Escher F, Kayvanpour E, Berger F, Monserrat L, Klingel K, Meder B, Landmesser U. P3688Familial recurrent autoimmune myocarditis associated with a truncating nonsense mutation of the desmoplakin gene. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arrhythmogenic cardiomyopathy (AC) is an important cause of ventricular arrhythmias in children and young adults. AC is associated with mutation of desmosomal proteins, however, cardiac disease penetrance is incomplete and the clinical course varies widely without recognizable exogenous or epi/genetic co-factors. Importantly, DSP mutation carriers may also display entirely non-cardiac e.g. dermatological phenotypes.
Methods and results
In two brothers with recurrent fulminant myocarditis, mutation screening of 218 cardiomyopathy-related genes identified a truncating mutation Arg1458* of desmoplakin (DSP). DSP immunhistology unexpectedly revealed complete loss (“knockout”) of DSP protein in endomyocardial biopsies (EMBs), but none of the histological anomalies of AC. Criteria for histological diagnosis of myocarditis were not either fulfilled, and cardiac MRI revealed no features associated with AC. Screening for infections was negative, there was no substance abuse, medication or vaccination. Possible disease triggers were competitive sport events. Myosin and troponin I autoantibodies were detected at titers up to 1:320.
We used allele-specific RT-PCR to distinguish if the patients' allele classified as “normal” was actually defective due to promotor mutation or epigenetic silencing. RT-PCRs were done on EMBs and peripheral blood mononuclear cells (PBMCs). In a cohort of dilated cardiomyopathy (DCM) patients we were able to detect DSP transcripts in both, PBMC and left-ventricular heart tissue. RNA sequencing of human PBMC subpopulations suggested that DSP transcription may be restricted to certain immune cell subtypes. RT-PCRs revealed that both Arg1458* carriers have a functional second DSP allele, indicating that their “DSP knockout” occurs at the protein level and may be due to protein instability and degradation within desmosomes.
We screened additional existing cohorts for such variants and identified stopgain variant Gln307Ter in a 37-yrs-old woman with ARVC. This patient's sister died from heart failure at the age of 39. In a 59-yrs-old female LVNC patient, stopgain variant Y1391X was identified. Here, family history was unclear, her brother probably died from coronary artery disease. In a 71-yrs-old female DCM patient with no family history, stopgain variant Tyr1512Ter was identified.
Conclusions
The described patients with DSP truncations strongly suggest the existence of additional genetic or exogenous modifiers driving pathogenesis either way. DSP defects may cause recurrent myocarditis, and mutation screening is advisable to enable early detection of high-risk patients with similar phenotypes. Our finding of complete myocardial DSP protein loss emphasizes that DNA sequencing may miss critical molecular disturbances. It is indispensable to also analyze transcriptome and protein level in the tissue actually affected in a patient in order to recognize his/her individual pathogenesis.
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Affiliation(s)
- W Poller
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - S Klaassen
- Charite University Hospital, Pediatric Cardiology, Berlin, Germany
| | - J Haas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - Z Kaya
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | | | - M Gast
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - F Escher
- Charité - Universitätsmedizin Berlin, Cardiology, Berlin, Germany
| | - E Kayvanpour
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - F Berger
- Charite University Hospital, Pediatric Cardiology, Berlin, Germany
| | - L Monserrat
- Instituto Universitario de Ciencias de la Salud, Health in Code, A Coruna, Spain
| | - K Klingel
- University Hospital, Pathology, Tübingen, Germany
| | - B Meder
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
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134
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Zainal Abidin HA, Klingel K, Rolf A, Keller T, Zhou H, Vasquez M, Escher F, Lassner D, Vasa-Nicotera M, Zeiher A, Schultheiss P, Nagel E, Puntmann V. 5035Comparative assessment of diagnostic algorithms of myocardial inflammation by endomyocardial biopsy and tissue mapping by CMR against high-sensitive troponin in viral myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Myocarditis is defined by inflammatory involvement of the myocardium, either histologically by evidence of myocardial necrosis and cellular infiltration on endomyocardial biopsy (EMB), or non-invasively by presence of myocardial oedema using tissue mapping with cardiovascular magnetic resonance (CMR). Objective: to undertake intra-individual comparisons of EMB vs. CMR diagnostic algorithms of myocardial inflammation, as well as against an independent gold-standard of myocardial injury, high-sensitive troponin (hs-TropT).
Methods
Prospective multicentre study of consecutive patients (n=109) with clinical diagnosis of myocarditis. EMBs were analysed by 2 reference centres using the ESC diagnostic and their local algorithms. The CMR criteria used sequence-specific cut-offs for native T1 and T2 (standard deviation, SD); myocardial inflammation T1 ≥2SD, T2 ≥2SD and no inflammation: T1 and T2<2SD, with subcategories for acute/high-grade: T1 ≥5SD, T2 ≥2SD; chronic/low-grade: T1 ≥2SD, T2 ≥2SD; healed: T1 <2SD, T2 <2SD but myocardial impairment and non-inflammatory cardiomyopathy: T1 ≥2SD, T2 <2SD.
Results
The agreement between ESC criteria and CMR criteria (AUC: 0.56, p=0.381) was poor. There was a significant agreement between myocardial injury (hs-TropT ≥13.9 ng/L) and CMR criteria (AUC: 0.84, p<0.001), but not ESC algorithm. hs-TropT levels had significant associations with native T1 and T2 (r=0.37 and 0.35, p<0.001), but not with immunohistochemical inflammatory markers. Viral presence was similarly proportioned between inflammatory/non-inflammatory subjects, irrespective of the algorithm.
AUC of CMR and EMB versus hs-TroponinT
Conclusions
Poor agreement between CMR and EMB-based diagnostic algorithms suggests non-overlapping definitions of myocardial inflammatory involvement. Excellent agreement between CMR algorithm and hs-TropT reiterates its high sensitivity for inflammatory myocardial injury.
Acknowledgement/Funding
1. National Institute for Health Research (NIHR) Biomedical Research Centre 2. German Centre for Cardiovascular Research (DZHK)
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Affiliation(s)
- H A Zainal Abidin
- Department of Cardiology, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - K Klingel
- Institute for Pathology and Neuropathology, University Hospital Tubingen, Tubingen, Germany
| | - A Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - T Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - H Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, China
| | - M Vasquez
- Department of Cardiology, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica
| | - F Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - M Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Zeiher
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - V Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
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Reinke Y, Könemann S, Chamling B, Gross S, Weitmann K, Hoffmann W, Klingel K, Nauck M, Fielitz J, Dörr M, Felix SB. Sugars make the difference - Glycosylation of cardiodepressant antibodies regulates their activity in dilated cardiomyopathy. Int J Cardiol 2019; 292:156-159. [PMID: 31005416 DOI: 10.1016/j.ijcard.2019.04.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 04/08/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cardiodepressant antibodies contribute to cardiac dysfunction in dilated cardiomyopathy (DCM). Changes in immunoglobulin G (IgG) glycosylation modulate the activity of various autoimmune diseases and influence disease activity as well as severity of various autoimmune diseases. We hypothesized that alterations in IgG glycosylation are involved in the disease course of DCM. METHODS AND RESULTS IgG glycosylation was analyzed in plasma samples of 50 DCM patients using a lectin-based ELISA. Negative inotropic (cardiodepressant) activity (NIA) of antibodies was assessed by measuring the effect of purified DCM-IgG on the shortening of isolated rat cardiomyocytes by means of a video-edge detection system. IgG obtained from plasma of healthy blood donors served as control. DCM-IgG contained significantly less sialic acid (-25%) and galactose (-16%; both P < 0.001), but showed no significant differences in core-fucosylation compared to controls. Interestingly, IgG with NIA displayed a lower percentage of sialylation (-16%, P < 0.001) core-fucosylation (-15%, P = 0.015) and galactosylation (-10%, P = 0.129) than IgG without NIA. The extent of NIA was directly associated with IgG sialylation (r = 0.68; P < 0.001) and galactosylation (r = 0.37; P = 0.001). CONCLUSION Reduced sialylation and galactosylation of IgGs enhances their cardiodepressant activity in DCM indicating that changes in IgG glycosylation may be involved in the pathogenesis of DCM.
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Affiliation(s)
- Yvonne Reinke
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Stephanie Könemann
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Bishwas Chamling
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Stefan Gross
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Kerstin Weitmann
- Institute for Community Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Jens Fielitz
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany.
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136
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Ruedebusch J, Benkner A, Nath N, Kaderali L, Klingel K, Eckstein G, Meitinger T, Fielitz J, Grube K, Felix SB. P1614Soluble guanylate cyclase as a therapeutic target in heart failure: myocardial gene expression in response to sGC stimulation in pressure overload. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart Failure (HF) is associated with endothelial dysfunction and reduced bioavailability of NO with insufficient stimulation of sGC and reduced production of cGMP. Therefore, the impairment of the NO-sGC-cGMP pathway results in vasoconstriction, platelet aggregation, inflammation, fibrosis and most importantly maladaptive cardiac hypertrophy. The restoration of the NO-sGC -cGMP pathway is an attractive pharmacological target for HF therapy.
Purpose
Riociguat is an NO independent stimulator of the sGC that sensitizes the sGC to endogenous NO and directly stimulates sGC to produce cGMP. We therefore hypothesized that Riociguat prevents pathological effects occurring during HF.
Methods
Pressure overload was induced by transverse aortic constriction (TAC) in 8 weeks old male C57Bl6/N mice. Three weeks after TAC when cardiac hypertrophy has developed either Riociguat (RIO; 3 mg/kg) or a Solvent was administered daily for 5 more weeks (n=12 per group). Animals with sham surgery and same drug regime served as controls. The heart function in all groups was evaluated weekly by small animal echocardiography. Eight weeks after surgery, the transcriptome of the left ventricles (LV) of sham and TAC mice were analysed by RNA Sequencing. Differentially expressed genes (DEG) were categorised using Ingenuity Pathway Analysis (IPA).
Results
TAC resulted in a steady decrease of left ventricular fractional shortening (FS) in the mice until week 3. When Riociguat treatment commenced, the systolic LV function of the TAC+Rio group recovered significantly whereas the solvent group showed a further decline until week 8 (FS 21.4±3.4% vs. 9.5±2%, p<0.001). Both sham groups (Sham+Sol and Sham+Rio) showed no changes in the heart function over timer. Regarding the hypertrophic response to LV pressure overload, Riociguat treatment attenuated significantly the increase of the left ventricular mass (LVM 208.3±15.8mg vs. 148.9±11.8mg, p<0.001) after TAC. In line with the reduced LVM, histological staining showed a significantly reduced fibrosis and myocyte cross sectional area in the TAC+Rio group compared to TAC+Sol group. Regarding the myocardial transcriptome, the treatment with Riociguat resulted in less changes of gene expression pattern after TAC (TAC+Sol vs. Sham+Sol 3160 DEG; TAC+Rio vs. Sham+Rio 2237 DEG). The expression of heart failure marker genes like ANP (Nppa), BNP (Nppb), β-Myosin Heavy Chain (Myh7) and the Collagens 1 and 3 (Col1a1, Col1a2, Col3a1) were significantly decreased in TAC+Rio, when compared to TAC+Sol. IPA analysis revealed that the activation of biological pathways in response to TAC, like actin cytoskeleton- and Integrin signalling, renin-angiotensin or cardiac hypertrophy signalling was attenuated when Riociguat was administered.
Conclusion
Riociguat attenuates pressure overload induced LV remodelling resulting in less hypertrophy, improved heart function and less alteration of gene expression pattern.
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Affiliation(s)
- J Ruedebusch
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - A Benkner
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - N Nath
- University of Greifswald, Institute of Bioinformatics, Greifswald, Germany
| | - L Kaderali
- University of Greifswald, Institute of Bioinformatics, Greifswald, Germany
| | - K Klingel
- University Hospital Tübingen, Molecular Pathology, Tübingen, Germany
| | - G Eckstein
- Helmholtz Center Munich - German Research Center for Environment and Health, Institute of Human Genetics, Munich, Germany
| | - T Meitinger
- Helmholtz Center Munich - German Research Center for Environment and Health, Institute of Human Genetics, Munich, Germany
| | - J Fielitz
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - K Grube
- Universitaetsmedizin Greifswald, Greifswald, Germany
| | - S B Felix
- Universitaetsmedizin Greifswald, Greifswald, Germany
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Seitz A, Greulich S, Ebadi N, Gruen S, Klingel K, Gawaz MP, Sechtem U, Bekeredjian R, Mahrholdt H. 2424Long-term outcome of patients with biopsy-proven viral myocarditis: 12-year results from a late gadolinium enhancement cardiac magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Myocarditis is a common cardiac disease that is associated with significant mortality as demonstrated by several studies. Late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) is a valuable tool for risk stratification of patients with suspected myocarditis. Previous studies using CMR-LGE have reported a good negative predictive value over follow-up periods of 4–6 years, while its positive predictive value was only modest. However, there is a lack of data regarding the long-term prognosis (>10 years) of these patients. This study reports an extended long-term follow-up of a large cohort of patients with biopsy-proven viral myocarditis.
Methods
At initial presentation, all patients underwent endomyocardial biopsy and CMR for the work-up of suspected myocarditis or unclear cardiomyopathy and had evidence of virus in PCR analyses. The primary endpoints were: all-cause death, cardiac death, and the occurrence of sudden cardiac death (SCD).
Results
183 patients with biopsy-proven viral myocarditis were followed for a median of 11.5 years. At baseline, patients were 52 years old, 31% were females, and the median ejection fraction was moderately reduced (44%). Initial CMR assessment revealed LGE in 101 (55%) patients, while 82 (45%) patients had LGE-negative CMR. During the follow-up period, the following endpoints occurred in the overall cohort: all-cause death (n=71, 39%), cardiac death (n=50, 27%) and SCD (n=20, 11%). Most importantly, only a single LGE-negative patient experienced a SCD during this 12-year follow-up, while all other SCDs occurred in patients with LGE-positive CMR (1% vs. 19%, p<0.001). Consequently, the negative predictive value (NPV) of normal CMR-LGE regarding SCD was 98%. In addition, cardiac mortality (12% vs. 40%, p<0.001, NPV=88%) and all-cause mortality (20% vs. 54%, p<0.001, NPV=79%) were significantly lower in patients without LGE.
Conclusion
This cohort of biopsy-proven viral myocarditis demonstrates substantial mortality (39% in 11.5 years). However, absence of LGE on CMR was associated with favorable prognosis. This was applicable regarding all-cause and cardiac mortality, but most importantly with regard to SCD with a NPV of 98% over almost 12 years median follow-up.
Acknowledgement/Funding
This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
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Affiliation(s)
- A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Greulich
- University of Tübingen, Tübingen, Germany
| | - N Ebadi
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Gruen
- Rems-Murr-Klinikum, Winnenden, Germany
| | - K Klingel
- University of Tübingen, Tübingen, Germany
| | - M P Gawaz
- University of Tübingen, Tübingen, Germany
| | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
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Ashraf MI, Sarwar A, Kühl AA, Hunger E, Sattler A, Aigner F, Regele H, Sauter M, Klingel K, Schneeberger S, Resch T, Kotsch K. Natural Killer Cells Promote Kidney Graft Rejection Independently of Cyclosporine A Therapy. Front Immunol 2019; 10:2279. [PMID: 31616441 PMCID: PMC6769038 DOI: 10.3389/fimmu.2019.02279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
Natural Killer (NK) cells have recently been recognized as key players in antibody-mediated chronic allograft failure, thus requiring a comprehensive understanding whether NK cells can escape conventional immunosuppressive regimens. Influence of cyclosporine A (CyA) on NK cell function was studied in a mouse model of allogeneic kidney transplantation (KTX, BALB/c to C57BL/6). Recipients were treated daily with CyA (10 mg/kg) for seven or 14 days for long term survival (day 56). Administration of CyA in recipients resulted in significantly reduced frequencies of intragraft and splenic CD8+ T cells, whereas the latter illustrated reduced IFNγ production. In contrast, intragraft and splenic NK cell frequencies remained unaffected in CyA recipients and IFNγ production and degranulation of NK cells were not reduced as compared with controls. Depletion of NK cells in combination with CyA resulted in an improvement in kidney function until day 7 and prolonged graft survival until day 56 as compared to untreated controls. Surviving animals demonstrated higher intragraft frequencies of proliferating CD4+FoxP3+Ki67+ regulatory T (TREG) cells as well as higher frequencies of CD8+CD122+ TREG. We here demonstrate that NK cell depletion combined with CyA synergistically improves graft function and prolongs graft survival, suggesting that NK cell targeting constitutes a novel approach for improving KTX outcomes.
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Affiliation(s)
| | - Attia Sarwar
- Department of General, Visceral and Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anja A Kühl
- iPath.Berlin-Immunopathology for Experimental Models, Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Hunger
- Department of General, Visceral and Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Arne Sattler
- Department of General, Visceral and Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Martina Sauter
- Department of Molecular Pathology, Tübingen University Hospital, Tübingen, Germany
| | - Karin Klingel
- Department of Molecular Pathology, Tübingen University Hospital, Tübingen, Germany
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Resch
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Katja Kotsch
- Department of General, Visceral and Vascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Abstract
BACKGROUND Clozapine is an alternative antipsychotic medication used to control symptoms of schizophrenia and to reduce risks of suicidal behavior in patients who did not adequately respond to standard medication. Due to severe side effects including cardiomyopathy and myocarditis its clinical use is limited. CASE REPORT A 31-year-old man of east European descent presented to the emergency medical department with fatigue, shortness of breath and chest pain. Due to a schizoaffective disorder he was treated with clozapine and lithium. Echocardiography revealed severely impaired left ventricular systolic function. After exclusion of coronary artery disease by coronary angiography an endomyocardial biopsy was performed according to the guidelines. This confirmed the clinically suspected toxic cardiomyopathy. Therefore, antipsychotic treatment was immediately changed and state of the art heart failure medication was started resulting in a clear improvement of left ventricular function. CONCLUSION In patients treated with clozapine or lithium and clinical signs of heart failure, toxic cardiomyopathy should be considered.
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Affiliation(s)
- L Mizera
- Medizinische Klinik III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - K Klingel
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Gawaz
- Medizinische Klinik III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - S Greulich
- Medizinische Klinik III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
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Baessler B, Luecke C, Lurz J, Klingel K, Das A, von Roeder M, de Waha-Thiele S, Besler C, Rommel KP, Maintz D, Gutberlet M, Thiele H, Lurz P. Cardiac MRI and Texture Analysis of Myocardial T1 and T2 Maps in Myocarditis with Acute versus Chronic Symptoms of Heart Failure. Radiology 2019; 292:608-617. [PMID: 31361205 DOI: 10.1148/radiol.2019190101] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BackgroundThe establishment of a timely and correct diagnosis in heart failure-like myocarditis remains one of the most challenging in clinical cardiology.PurposeTo assess the diagnostic potential of texture analysis in heart failure-like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard.Materials and MethodsSeventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial (ClinicalTrials.gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1.5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 and T2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation.ResultsIn participants with acute heart failure-like myocarditis (n = 31; mean age, 47 years ± 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2_GLNU) showed diagnostic performance similar to that of mean myocardial T2 time (AUC, 0.69 for both). The combination of mean T2 time and T2_GLNU had the highest AUC (0.76; 95% confidence interval [CI]: 0.43, 0.95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure-like myocarditis (n = 40; mean age, 48 years ± 13; 12 women), the histogram feature T2_kurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0.81; 95% CI: 0.66, 0.96). The combination of the two texture features, T2_kurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0.85; 95% CI: 0.57, 0.90; sensitivity, 90% [36 of 40]; and specificity, 72% [29 of 40]).ConclusionIn this proof-of-concept study, texture analysis applied on cardiac MRI T1 and T2 mapping delivers quantitative imaging parameters for the diagnosis of acute or chronic heart failure-like myocarditis and might be superior to Lake Louise criteria or averaged myocardial T1 or T2 values.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by de Roos in this issue.
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Affiliation(s)
- Bettina Baessler
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Christian Luecke
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Julia Lurz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Karin Klingel
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Arijit Das
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Maximilian von Roeder
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Suzanne de Waha-Thiele
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Christian Besler
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Karl-Philipp Rommel
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - David Maintz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Matthias Gutberlet
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Holger Thiele
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
| | - Philipp Lurz
- From the Institute of Diagnostic and Interventional Radiology, University of Cologne, Medical Faculty and University Hospital Cologne, Kerpener Str 62, D-50937 Cologne, Germany (B.B., A.D., D.M.); Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany (C.L., M.G.); Department of Internal Medicine/Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany (J.L., M.v.R., C.B., K.P.R., H.T., P.L.); Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany (K.K.); Institute of Medical Statistics and Computational Biology, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany (A.D.); Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany (S.d.W.T.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany (S.d.W.T.); and Leipzig Heart Institute, Leipzig, Germany (M.G., H.T., P.L.)
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Gaertner-Rommel A, Tiesmeier J, Jakob T, Strickmann B, Veit G, Bachmann-Mennenga B, Paluszkiewicz L, Klingel K, Schulz U, Laser KT, Karger B, Pfeiffer H, Milting H. Molecular autopsy and family screening in a young case of sudden cardiac death reveals an unusually severe case of FHL1 related hypertrophic cardiomyopathy. Mol Genet Genomic Med 2019; 7:e841. [PMID: 31293105 PMCID: PMC6687666 DOI: 10.1002/mgg3.841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy with a prevalence of about 1:200. It is characterized by left ventricular hypertrophy, diastolic dysfunction and interstitial fibrosis; HCM might lead to sudden cardiac death (SCD) especially in the young. Due to low autopsy frequencies of sudden unexplained deaths (SUD) the true prevalence of SCD and especially of HCM among SUD remains unclear. Even in cases of proven SCD genetic testing is not a routine procedure precluding appropriate risk stratification and counseling of relatives. METHODS Here we report a case of SCD in a 19-year-old investigated by combined forensic and molecular autopsy. RESULTS During autopsy of the index-patient HCM was detected. As no other possible cause of death could be uncovered by forensic autopsy the event was classified as SCD. Molecular autopsy identified two (probably) pathogenic genetic variants in FHL1 and MYBPC3. The MYBPC3 variant had an incomplete penetrance. The FHL1 variant was a de novo mutation. We detected reduced FHL1 mRNA levels and no FHL1 protein in muscle samples suggesting nonsense-mediated mRNA decay and/or degradation of the truncated protein in the SCD victim revealing a plausible disease mechanism. CONCLUSION The identification of the genetic cause of the SCD contributed to the rational counseling of the relatives and risk assessment within the family. Furthermore our study revealed evidences for the pathomechanism of FHL1 mutations.
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Affiliation(s)
- Anna Gaertner-Rommel
- Klinikum der Ruhr-Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie und Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Jens Tiesmeier
- Mühlenkreiskliniken, Krankenhaus Lübbecke-Rahden, Institut für Anästhesiologie, Intensiv- und Notfallmedizin, Medizin Campus OWL, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Jakob
- Klinikum Herford, Universitätsklinik für Anästhesiologie, Medizin Campus OWL, Ruhr-Universität Bochum, Herford, Germany
| | | | - Gunter Veit
- Mühlenkreiskliniken, Krankenhaus Lübbecke-Rahden, Institut für Anästhesiologie, Intensiv- und Notfallmedizin, Medizin Campus OWL, Ruhr-Universität Bochum, Bochum, Germany
| | - Bernd Bachmann-Mennenga
- Mühlenkreiskliniken, Johannes Wesling Klinikum, Universitätsinstitut für Anästhesiologie, Intensiv- und Notfallmedizin, Medizin Campus OWL, Ruhr-Universität Bochum, Minden, Germany
| | - Lech Paluszkiewicz
- Klinikum der Ruhr-Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie und Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Karin Klingel
- Kardiopathologie, Universitätsklinikum Tübingen, Institut für Pathologie und Neuropathologie, Tubingen, Germany
| | - Uwe Schulz
- Klinikum der Ruhr-Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie und Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - Kai T Laser
- Zentrum für angeborene Herzfehler, Herz- und Diabeteszentrum NRW, Klinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Bernd Karger
- Universitätsklinikum Münster, Institut für Rechtsmedizin, Münster, Germany
| | - Heidi Pfeiffer
- Universitätsklinikum Münster, Institut für Rechtsmedizin, Münster, Germany
| | - Hendrik Milting
- Klinikum der Ruhr-Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie und Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
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142
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Skog O, Klingel K, Roivainen M, Korsgren O. Large enteroviral vaccination studies to prevent type 1 diabetes should be well founded and rely on scientific evidence. Diabetologia 2019; 62:1097-1099. [PMID: 30810767 DOI: 10.1007/s00125-019-4841-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Oskar Skog
- Department of Immunology, Genetics and Pathology, The Rudbeck Laboratory C11, Clinical Immunology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden.
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Merja Roivainen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olle Korsgren
- Department of Immunology, Genetics and Pathology, The Rudbeck Laboratory C11, Clinical Immunology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
- Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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143
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Stempfl J, Schumacher F, Doering M, Wolf H, Streithoff F, Tacke J, Fahn H, Ehlermann P, Raake P, Klingel K, Elsner D, Groebner M. [Atrioventricular block and left ventricular wall mobility disorder in a 44-year-old female patient : A case report of a rarity with pitfalls]. Internist (Berl) 2019; 60:973-981. [PMID: 31123761 DOI: 10.1007/s00108-019-0608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.
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Affiliation(s)
- J Stempfl
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.
| | - F Schumacher
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Doering
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - H Wolf
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - F Streithoff
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - J Tacke
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - H Fahn
- Klinik für Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie und Stoffwechselerkrankungen, Klinikum Passau, Passau, Deutschland
| | - P Ehlermann
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - P Raake
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - K Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - D Elsner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Groebner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
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144
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Metze M, Davierwala PM, Andreas H, Klingel K, Laufs U, Klöter T. Progression of left ventricular thrombus in Loeffler's endocarditis without eosinophilia-case report and review of the literature. Clin Res Cardiol 2019; 108:1163-1170. [PMID: 31089810 DOI: 10.1007/s00392-019-01483-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Piroze M Davierwala
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Strümpellstrasse 38, 04289, Leipzig, Germany
| | - Hagendorff Andreas
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Karin Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Tristan Klöter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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145
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Veronese G, Cipriani M, Petrella D, Geniere Nigra S, Pedrotti P, Garascia A, Masciocco G, Bramerio MA, Klingel K, Frigerio M, Ammirati E. Recurrent cardiac sarcoidosis after heart transplantation. Clin Res Cardiol 2019; 108:1171-1173. [PMID: 31073636 DOI: 10.1007/s00392-019-01485-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/29/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Giacomo Veronese
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. .,Department of Health Science, University of Milano-Bicocca, Milan, Italy.
| | - Manlio Cipriani
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Duccio Petrella
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | | | - Patrizia Pedrotti
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Garascia
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Gabriella Masciocco
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Manuela A Bramerio
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Frigerio
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
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146
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Veronese G, Cipriani M, Petrella D, Pedrotti P, Giannattasio C, Garascia A, Oliva F, Klingel K, Frigerio M, Ammirati E. Not every fulminant lymphocytic myocarditis fully recovers. J Cardiovasc Med (Hagerstown) 2019; 19:453-454. [PMID: 29889166 DOI: 10.2459/jcm.0000000000000664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Giacomo Veronese
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda.,Department of Health Science, University of Milano-Bicocca, Milan, Italy
| | - Manlio Cipriani
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Duccio Petrella
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Patrizia Pedrotti
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Cristina Giannattasio
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda.,Department of Health Science, University of Milano-Bicocca, Milan, Italy
| | - Andrea Garascia
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Fabrizio Oliva
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Frigerio
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Enrico Ammirati
- 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
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147
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Kraft L, Erdenesukh T, Sauter M, Tschöpe C, Klingel K. Blocking the IL-1β signalling pathway prevents chronic viral myocarditis and cardiac remodeling. Basic Res Cardiol 2019; 114:11. [DOI: 10.1007/s00395-019-0719-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022]
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148
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Weckbach LT, Grabmaier U, Uhl A, Gess S, Boehm F, Zehrer A, Pick R, Salvermoser M, Czermak T, Pircher J, Sorrelle N, Migliorini M, Strickland DK, Klingel K, Brinkmann V, Abu Abed U, Eriksson U, Massberg S, Brunner S, Walzog B. Midkine drives cardiac inflammation by promoting neutrophil trafficking and NETosis in myocarditis. J Exp Med 2019; 216:350-368. [PMID: 30647120 PMCID: PMC6363424 DOI: 10.1084/jem.20181102] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/21/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022] Open
Abstract
Heart failure due to dilated cardiomyopathy is frequently caused by myocarditis. However, the pathogenesis of myocarditis remains incompletely understood. Here, we report the presence of neutrophil extracellular traps (NETs) in cardiac tissue of patients and mice with myocarditis. Inhibition of NET formation in experimental autoimmune myocarditis (EAM) of mice substantially reduces inflammation in the acute phase of the disease. Targeting the cytokine midkine (MK), which mediates NET formation in vitro, not only attenuates NET formation in vivo and the infiltration of polymorphonuclear neutrophils (PMNs) but also reduces fibrosis and preserves systolic function during EAM. Low-density lipoprotein receptor-related protein 1 (LRP1) acts as the functionally relevant receptor for MK-induced PMN recruitment as well as NET formation. In summary, NETosis substantially contributes to the pathogenesis of myocarditis and drives cardiac inflammation, probably via MK, which promotes PMN trafficking and NETosis. Thus, MK as well as NETs may represent novel therapeutic targets for the treatment of cardiac inflammation.
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Affiliation(s)
- Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany .,Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Ulrich Grabmaier
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany.,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Andreas Uhl
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany.,Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Sebastian Gess
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Felicitas Boehm
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Annette Zehrer
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Robert Pick
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Melanie Salvermoser
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
| | - Thomas Czermak
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Joachim Pircher
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Noah Sorrelle
- Hamon Center for Therapeutic Oncology Research, Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary Migliorini
- Center for Vascular and Inflammatory Disease, Departments of Surgery and Physiology, University of Maryland School of Medicine, Baltimore, MD
| | - Dudley K Strickland
- Center for Vascular and Inflammatory Disease, Departments of Surgery and Physiology, University of Maryland School of Medicine, Baltimore, MD
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Volker Brinkmann
- Microscopy Core Facility, Max Planck Institute for Infection Biology, Berlin, Germany.,Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Ulrike Abu Abed
- Microscopy Core Facility, Max Planck Institute for Infection Biology, Berlin, Germany.,Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Urs Eriksson
- Cardioimmunology, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Department of Medicine, Gesundheitsversorgung Zürcher Oberland-Zurich Regional Health Center, Wetzikon, Switzerland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany.,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Barbara Walzog
- Walter Brendel Centre of Experimental Medicine, University Hospital, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany .,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
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149
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Bültmann B, Klingel K. [Reinhard Kandolf : 10 September 1948-31 March 2017]. Pathologe 2018; 39:350-351. [PMID: 30302564 DOI: 10.1007/s00292-018-0512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- B Bültmann
- , Römerhofweg 9, 72108, Rottenburg a. N., Deutschland.
| | - K Klingel
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstraße 8, 72076, Tübingen, Deutschland.
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150
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Meyer IS, Goetzke CC, Kespohl M, Sauter M, Heuser A, Eckstein V, Vornlocher HP, Anderson DG, Haas J, Meder B, Katus HA, Klingel K, Beling A, Leuschner F. Silencing the CSF-1 Axis Using Nanoparticle Encapsulated siRNA Mitigates Viral and Autoimmune Myocarditis. Front Immunol 2018; 9:2303. [PMID: 30349538 PMCID: PMC6186826 DOI: 10.3389/fimmu.2018.02303] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022] Open
Abstract
Myocarditis is an inflammatory disease of the heart muscle most commonly caused by viral infection and often maintained by autoimmunity. Virus-induced tissue damage triggers chemokine production and, subsequently, immune cell infiltration with pro-inflammatory and pro-fibrotic cytokine production follows. In patients, the overall inflammatory burden determines the disease outcome. Following the aim to define specific molecules that drive both immunopathology and/or autoimmunity in inflammatory heart disease, here we report on increased expression of colony stimulating factor 1 (CSF-1) in patients with myocarditis. CSF-1 controls monocytes originating from hematopoietic stem cells and subsequent progenitor stages. Both, monocytes and macrophages are centrally involved in mediating tissue damage and fibrotic scarring in the heart. CSF-1 influences monocytes via engagement of CSF-1 receptor, and it is also produced by cells of the mononuclear phagocyte system themselves. Based on this, we sought to modulate the virus-triggered inflammatory response in an experimental model of Coxsackievirus B3-induced myocarditis by silencing the CSF-1 axis in myeloid cells using nanoparticle-encapsulated siRNA. siCSF-1 inverted virus-mediated immunopathology as reflected by lower troponin T levels, a reduction of accumulating myeloid cells in heart tissue and improved cardiac function. Importantly, pathogen control was maintained and the virus was efficiently cleared from heart tissue. Since viral heart disease triggers heart-directed autoimmunity, in a second approach we investigated the influence of CSF-1 upon manifestation of heart tissue inflammation during experimental autoimmune myocarditis (EAM). EAM was induced in Balb/c mice by immunization with a myocarditogenic myosin-heavy chain-derived peptide dissolved in complete Freund's adjuvant. siCSF-1 treatment initiated upon established disease inhibited monocyte infiltration into heart tissue and this suppressed cardiac injury as reflected by diminished cardiac fibrosis and improved cardiac function at later states. Mechanistically, we found that suppression of CSF-1 production arrested both differentiation and maturation of monocytes and their precursors in the bone marrow. In conclusion, during viral and autoimmune myocarditis silencing of the myeloid CSF-1 axis by nanoparticle-encapsulated siRNA is beneficial for preventing inflammatory tissue damage in the heart and preserving cardiac function without compromising innate immunity's critical defense mechanisms.
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Affiliation(s)
- Ingmar Sören Meyer
- Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Heidelberg, Germany
| | - Carl Christoph Goetzke
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Meike Kespohl
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martina Sauter
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Arnd Heuser
- Max-Delbrueck-Center for Molecular Medicine Berlin, Berlin, Germany
| | - Volker Eckstein
- Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Daniel G Anderson
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, United States
| | - Jan Haas
- Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Heidelberg, Germany
| | - Benjamin Meder
- Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Heidelberg, Germany
| | - Hugo Albert Katus
- Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Heidelberg, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Antje Beling
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Florian Leuschner
- Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Heidelberg, Germany
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