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Kuchynka P, Krejci J, Palecek T. Tailored immunosuppression in biopsy-proven immune-mediated myocarditis. Eur J Heart Fail 2024. [PMID: 38700444 DOI: 10.1002/ejhf.3276] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Petr Kuchynka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
| | - Jan Krejci
- Department of Cardiovascular Diseases, St. Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
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Chen H, Jian Z, Xu T, Xu L, Deng L, Shao L, Zhang L, He L, Li Y, Zhu L. Advances in the mechanism of inflammasomes activation in herpes virus infection. Front Immunol 2024; 15:1346878. [PMID: 38590522 PMCID: PMC10999540 DOI: 10.3389/fimmu.2024.1346878] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
Herpesviruses, prevalent DNA viruses with a double-stranded structure, establish enduring infections and play a part in various diseases. Despite their deployment of multiple tactics to evade the immune system, both localized and systemic inflammatory responses are triggered by the innate immune system's recognition of them. Recent progress has offered more profound understandings of the mechanisms behind the activation of the innate immune system by herpesviruses, specifically through inflammatory signaling. This process encompasses the initiation of an intracellular nucleoprotein complex, the inflammasome associated with inflammation.Following activation, proinflammatory cytokines such as IL-1β and IL-18 are released by the inflammasome, concurrently instigating a programmed pathway for cell death. Despite the structural resemblances between herpesviruses, the distinctive methods of inflammatory activation and the ensuing outcomes in diseases linked to the virus exhibit variations.The objective of this review is to emphasize both the similarities and differences in the mechanisms of inflammatory activation among herpesviruses, elucidating their significance in diseases resulting from these viral infections.Additionally, it identifies areas requiring further research to comprehensively grasp the impact of this crucial innate immune signaling pathway on the pathogenesis of these prevalent viruses.
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Affiliation(s)
- Hourui Chen
- 4+4 Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhijie Jian
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Tong Xu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Lei Xu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Lishuang Deng
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Lina Shao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Leyi Zhang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Li He
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Youyou Li
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
| | - Ling Zhu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, China
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3
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Grimaldi F, Bonasoni MP, Pelletti G, Gabrielli L, Pelotti S. Diagnostic challenges and forensic implications in a case of infantile fatal myocarditis. Forensic Sci Med Pathol 2024; 20:219-225. [PMID: 37335504 PMCID: PMC10944382 DOI: 10.1007/s12024-023-00659-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
We present the case of a 23-month-old child who died less than 24 h after the onset of cardiac symptoms, despite being admitted to the hospital 72 h earlier. Autopsy revealed no significant macroscopic changes, and histologic examination revealed focal lymphocytic myocarditis with myocyte disruption, diffuse alveolar damage in the exudative phase, and generalized lymphocytic immune activation in other organs. Ante-mortem and post-mortem microbiological exams did not clearly prove a causative role of infectious agents. The peculiarity of this case was characterized by the contrast between the severe clinical features and the mild cardiac histological findings. This discrepancy, coupled with the suspicion of a viral causative role based on both ante-mortem and post-mortem microbiological examinations, presented significant challenges in reaching an etiological diagnosis. This case also confirms that the diagnosis of myocarditis in children cannot be made solely on the basis of histological cut-offs or microbiological results. Using abductive reasoning, various diagnostic hypotheses were formulated and evaluated to arrive at the final diagnosis of fatal myocarditis of viral or post-viral origin. Data from post-mortem examination are often the only source of information that is available to the experts, especially in cases of sudden infant death syndrome. In such cases, the forensic pathologists should accurately evaluate findings that may appear to indicate a different etiology, and, in the absence of clinical or radiological data, interpret post-mortem data in a logically correct manner. The autopsy is the first essential step to evaluate the cause of death and must be integrated with the results of ante- and post-mortem diagnostic tests in a holistic approach, which is crucial to allow forensic pathologists to provide an appropriate and relevant opinion.
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Affiliation(s)
- Federica Grimaldi
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
| | - Maria Paola Bonasoni
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, 42122, Italy
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy.
| | - Liliana Gabrielli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, Italy
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, 40126, Italy
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Aw YTV, Ooi M, Ekladious A. DRESS syndrome with multiorgan involvement and HHV-6 reactivation in the absence of a drug trigger. Intern Med J 2024; 54:499-502. [PMID: 38380836 DOI: 10.1111/imj.16346] [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] [Received: 09/30/2023] [Accepted: 12/12/2023] [Indexed: 02/22/2024]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction where patients present with fever, morbilliform rash and multiorgan manifestations, which may include acute renal failure, acute respiratory distress syndrome and eosinophilic myocarditis. We present a case of a 60-year-old woman with acute heart failure, DRESS syndrome features and human herpesvirus 6 reactivation in the absence of a drug trigger. She was diagnosed with eosinophilic myocarditis and successfully treated with corticosteroid therapy.
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Affiliation(s)
- Yi Tong Vincent Aw
- Department of General Medicine, Canberra Hospital, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- ANU Medical School, School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Meidelynn Ooi
- Division of Medicine, Canberra Hospital, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Adel Ekladious
- Department of General Medicine, Canberra Hospital, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Acute Medical Unit, Canberra Hospital, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
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Musigk N, Suwalski P, Golpour A, Fairweather D, Klingel K, Martin P, Frustaci A, Cooper LT, Lüscher TF, Landmesser U, Heidecker B. The inflammatory spectrum of cardiomyopathies. Front Cardiovasc Med 2024; 11:1251780. [PMID: 38464847 PMCID: PMC10921946 DOI: 10.3389/fcvm.2024.1251780] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Infiltration of the myocardium with various cell types, cytokines and chemokines plays a crucial role in the pathogenesis of cardiomyopathies including inflammatory cardiomyopathies and myocarditis. A more comprehensive understanding of the precise immune mechanisms involved in acute and chronic myocarditis is essential to develop novel therapeutic approaches. This review offers a comprehensive overview of the current knowledge of the immune landscape in cardiomyopathies based on etiology. It identifies gaps in our knowledge about cardiac inflammation and emphasizes the need for new translational approaches to improve our understanding thus enabling development of novel early detection methods and more effective treatments.
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Affiliation(s)
- Nicolas Musigk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Phillip Suwalski
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Ainoosh Golpour
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Pilar Martin
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Centro de Investigación Biomédica en Red Cardiovascular (CIBER-CV, ISCIII), Madrid, Spain
| | | | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas F. Lüscher
- GZO-Zurich Regional Health Centre, Wetzikon & Cardioimmunology, Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Bettina Heidecker
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
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Ferone E, Segev A, Tempo E, Gentile P, Elsanhoury A, Baggio C, Artico J, Bhatti P, Scott P, Bobbio E, Merlo M, Ameri P, Sinagra G, Tschöpe C, Bromage D, Cannata A. Current treatment and immunomodulation strategies in Acute Myocarditis. J Cardiovasc Pharmacol 2024; 83:00005344-990000000-00282. [PMID: 38335530 PMCID: PMC11067867 DOI: 10.1097/fjc.0000000000001542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
Myocarditis is an inflammatory disease of the myocardium characterized by a great heterogeneity of presentation and evolution. Treatment of myocarditis is often supportive and the evidence for immunosuppression is scarce and debated. Conventional treatment is based on clinical presentation, ranging from conservative to advanced mechanical assist devices. In this setting, immunosuppression and immunomodulation therapies are mostly reserved for patients presenting with major clinical syndromes. In this review, we will summarise the current evidence and strategies for conventional and immunosuppressive treatments for patients presenting with acute myocarditis.
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Affiliation(s)
- Emma Ferone
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Erika Tempo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Ahmed Elsanhoury
- Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology, and Intensive Medicine (CVK), German Heart Center at Charite (DHZC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Chiara Baggio
- CardioThoracoVascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Jessica Artico
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Prashan Bhatti
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul Scott
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marco Merlo
- CardioThoracoVascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiovascular Disease Unit, Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; and
| | - Gianfranco Sinagra
- CardioThoracoVascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Cardiology, Angiology, and Intensive Medicine (CVK), German Heart Center at Charite (DHZC), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Daniel Bromage
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Antonio Cannata
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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7
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Golob S, Nazeer H, Kadosh B, Goldberg R, Narula N, Moazami N, Rao S, Reyentovich A. HHV-6 Myocarditis Progressing to Ventricular Standstill Requiring Cardiac Transplant. JACC Case Rep 2023; 17:101896. [PMID: 37496724 PMCID: PMC10366501 DOI: 10.1016/j.jaccas.2023.101896] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 07/28/2023]
Abstract
Human herpesvirus-6 (HHV-6) is an increasingly recognized cause of myocarditis. We present the case of a 46-year-old woman who presented with fulminant HHV-6 myocarditis requiring heart transplantation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Stephanie Golob
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Haider Nazeer
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Bernard Kadosh
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Randal Goldberg
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Navneet Narula
- Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - Nader Moazami
- Division of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Shaline Rao
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
| | - Alex Reyentovich
- Division of Cardiology, NYU Langone Medical Center, New York, New York, USA
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Paul T, Klingel K, Tschöpe C, Bertram H, Seidel F. Leitlinie Myokarditis der Deutschen Gesellschaft für
Pädiatrische Kardiologie. Klin Padiatr 2023; 235:e1-e15. [PMID: 37094605 DOI: 10.1055/a-2039-2604] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This consensus statement presents updated recommendations on diagnosis and treatment of myocarditis in childhood.
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Affiliation(s)
- Thomas Paul
- Universitätsmedizin Göttingen Klinik für Pädiatrische Kardiologie und Intensivmedizin, Göttingen, Deutschland
| | - Karin Klingel
- Universitätshospital Tübingen, Institut für Pathologie und Neuropathologie, Tübingen, Deutschland
| | - Carsten Tschöpe
- Charité Universitätsmedizin Berlin, Kardiologie, Berlin, Deutschland
| | - Harald Bertram
- Medizinische Hochschule Hannover, Klinik für Pädiatrische Kardiologie und Pädiatrische Intensivmedizin, Hannover, Deutschland
| | - Franziska Seidel
- Charité Universitätsmedizn Berlin, Pädiatrische Kardiologie, Berlin, Deutschland
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Abstract
Viral infections are the culprit of many diseases, including inflammation of the heart muscle, known as myocarditis. Acute myocarditis cases have been described in scientific literature, and viruses, such as parvovirus B19, coxsackievirus B3, or more recently, SARS-CoV-2, were the direct cause of cardiac inflammation. If not treated, myocarditis could progress to dilated cardiomyopathy, which permanently impairs the heart and limits a person's lifespan. Accumulated evidence suggests that certain viruses may persist in cardiac tissue after the initial infection, which could open up the door to reactivation under favorable conditions. Whether this chronic infection contributes to, or initiates, cardiac damage over time, remains a pressing issue in the field of virus-induced heart pathology, and it is directly tied to patients' treatment. Previously, large case studies found that a few viruses: parvovirus B19, coxsackievirus, adenovirus, human herpesvirus 6, cytomegalovirus and Epstein-Barr virus, are most commonly found in human endomyocardial biopsy samples derived from patients experiencing cardiac inflammation, or dilated cardiomyopathy. SARS-CoV-2 infection has also been shown to have cardiovascular consequences. This review examines the role of viral persistence in cardiac inflammation and heart disease, and discusses its implications for patients' outcomes.
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Affiliation(s)
- Cristina Basso
- From the Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Tschöpe C, Nelki V, Trippel TD, Klingel K, Abawi D, Alogna A. Safety and usefulness of left ventricular endomyocardial biopsy in new- onset acute heart failure requiring mechanical support by an Impella® device. Int J Cardiol 2022. [DOI: 10.1016/j.ijcard.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/21/2022] [Accepted: 08/04/2022] [Indexed: 11/19/2022]
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Affiliation(s)
- Leslie T Cooper
- The Elizabeth C. Lane, Ph.D. and M. Nadine Zimmerman, Ph.D. Professor of Internal Medicine, Chair, Department of Cardiovascular Medicine, 4500 San Pablo, Jacksonville, FL, 32224
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