Abstract
A growing body of evidence supports the view that some forms of human myocarditis and dilated cardiomyopathy result from a pathogenic autoimmune response. The evidence is based first on the presence of heart-specific antibodies in many patients with these diseases, including antibodies with demonstrated functional effects. These antibodies may be present before the onset of dilated cardiomyopathy and may be predictive of the course of disease in terms of deterioration of cardiac function. Depletion of the heart-specific antibodies by extracorporeal immunoadsorption may result in amelioration of disease in some patients, often continuing for long periods of time. Clinical investigations show that a subpopulation of patients with dilated cardiomyopathy benefit from immunosuppressive treatment. In one report, this subpopulation was identified as autoantibody-positive and virus-negative. Finally, animal experiments have shown that autoimmune myocarditis can be induced by viral infection and that this autoimmune response can be duplicated by immunization with a well-characterized antigen, cardiac myosin. Based on this evidence, we propose that some forms of dilated cardiomyopathy and myocarditis result from pathogenic autoimmune responses that represent the final common pathogenetic pathway of various infectious and even non-infectious injuries.
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References
Afanasyeva M, Georgakopoulos D, Rose NR (2004) Autoimmune myocarditis: cellular mediators of cardiac dysfunction. Autoimmun Rev 3:476–486
Afanasyeva M, Georgakopoulos D, Belardi DF, Bedja D, Fairweather D, Warig Y, Kaya Z, Gabrielson KL, Rodriguez ER, Caturegli P, Kass DA, Rose NR (2005) Impaired up-regulation of CD25 on CD4+ T cells in IFN-gamma knockout mice is associated with progression of myocarditis to heart failure. Proc Natl Acad Sci U S A 102:180–185
Ansari AA, Neckelmann N, Villinger F, Leung P, Danner DJ, Brar SS, Zhao S, Gravanis MB, Mayne A, Gershwin ME, et al (1994) Epitope mapping of the branched chain alpha-ketoacid dehydrogenase dihydrolipoyl transacylase (BCKD-E2) protein that reacts with sera from patients with idiopathic dilated cardiomyopathy. J Immunol 153:4754–4765
Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ Jr, Olsen EG, Schoen FJ (1987) Myocarditis: a histopathological definition and classification. Am J Cardiovasc Pathol 1:3–14
Caforio AL, Grazzini M, Mann JM, Keeling PJ, Bottazzo GF, McKenna WJ, Schiaffino S (1992) Identification of alpha-and beta-cardiac myosin heavy chain isoforms as major autoantigens in dilated cardiomyopathy. Circulation 85:1734–1742
Caforio AL, Mahon NJ, Mckenna WJ (2001) Cardiac autoantibodies to myosin and other heart-specific autoantigens in myocarditis and dilated cardiomyopathy. Autoimmunity 34:199–204
Caforio AL, Mahon NJ, Tona F, McKenna WJ (2002) Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenic and clinical significance. Eur J Heart Fail 4:411–417
Chiale PA, Rosenbaum MB, Elizari MV, Hjalmarson A, Magnussen Y, Wallukat G, Hoebeke J (1995) High prevalence of antibodies against beta 1-and beta 2-adrenoceptors in patients with primary electrical cardiac abnormalities. J Am Coll Cardiol 26:864–869
Dorffel WV, Wallukat G, Dorffel Y, Felix SB, Baumann G (2004) Immunoad-sorption in idiopathic dilated cardiomyopathy, a 3-year follow-up. Int J Cardiol 97:529–534
Drory Y, Turetz Y, Hiss Y, Lev B, Fisman EZ, Pines A, Kramer MR (1991) Sudden unexpected death in persons less than 40 years of age. Am J Cardiol 68:1388–1392
Fairweather D, Kaya Z, Shellam GR, Lawson CM, Rose NR (2001) From infection to autoimmunity. J Autoimmun 16:175–186
Fairweather D, Frisancho-Kiss S, Rose NR (2004) Viruses as adjuvants for autoimmunity: evidence from Coxsackievirus-induced myocarditis. Rev Med Virol 15:17–27
Feldman AM, McNamara D (2000) Myocarditis. N Engl J Med 343:1388–1398
Felix SB, Staudt A, Friedrich GB (2001) Improvement of cardiac function after immunoadsorption in patients with dilated cardiomyopathy. Autoimmunity 34:211–215
Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A (2003) Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders. Circulation 107:857–863
Grist NR, Bell EJ (1969) Coxsackie viruses and the heart. Am Heart J 77:295–300
Heider AL, Kuller JA, Strauss RA, Wells SR (1999) Peripartum cardiomyopathy: a review of the literature. Obstet Gynecol Surv 54:526–531
Konstadoulakis MM, Kroumbouzou H, Tsiamis E, Trikas A, Toutouzas P (1993) Clinical significance of antibodies against tropomyosin, actin and myosin in patients with dilated cardiomyopathy. J Clin Lab Immunol 40:61–67
Kühl U, Lauer B, Souvatzoglu M, Vosberg H, Schultheiss HP (1998) Antimyosin scintigraphy and immunohistologic analysis of endomyocardial biopsy in patients with clinically suspected myocarditis C evidence of myocardial cell damage and inflammation in the absence of histologic signs of myocarditis. J Am Coll Cardiol 32:1371–1376
Lane JR, Neumann DA, Lafond-Walker A, Herskowitz A, Rose NR (1992) Interleukin 1 or tumor necrosis factor can promote Coxsackie B3-induced myocarditis in resistant B10.A mice. J Exp Med 175:1123–1129
Lane JR, Neumann DA, Lafond-Walker A, Herskowitz A, Rose NR (1993) Role of IL-1 and tumor necrosis factor in coxsackie virus-induced autoimmune myocarditis. J Immunol 151:1682–1690
Lauer B, Schanwell M, Kühl U, Strauer BE, Schultheiss HP (2000) Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis. J Am Coll Cardiol 35:11–18
Limas CJ, Limas C (1991) Beta-adrenoceptor antibodies and genetics in dilated cardiomyopathy C an overview and review. Eur Heart J 12(Suppl D):175–177
Limas CJ, Goldenberg IF, Limas C (1990) Influence of anti-beta receptor antibodies on cardiac adenylate cyclase in patients with idiopathic dilated cardiomyopathy. Am Heart J 119:1322–1328
Magnusson Y, Marullo S, Hoyer S, Waagstein F, Andersson B, Vahlne A, Guillet JG, Strossberg AD, Hjalmarson A, Hoebeke J (1990) Mapping of a functional autoimmune epitope on the beta 1-adrenergic receptor in patients with idiopathic dilated cardiomyopathy. J Clin Invest 86:1658–1663
Mahon NG, Madden BP, Caforio ALP, Elliott PM, Haven AJ, Keogh BE, Davies MJ, McKenna WJ (2002) Immunohistologic evidence ofmyocardial disease in apparently healthy relatives of patients with dilated cardiomyopathy. J Am Coll Cardiol 39:455–562
Mason JW, O’Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME, Moon TE (1995) A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med 333:269–275
Neu N, Rose NR, Beisel KW, Herskowitz A, Gurri-Glass G, Craig SW (1987) Cardiac myosin induces myocarditis in genetically predisposed mice. J Immunol 139:3630–3636
Neumann DA, Burek CL, Baughman KL, ROSE NR, Herskowitz A (1990) Circulating heart-reactive antibodies in patients with myocarditis or cardiomyopathy. J Am Coll Cardiol 16:839–846
Okazaki T, Tanaka Y, Nishio R, Mitsuiye T, Mizoguchi A, Wang J, Ishida M, Hiai H, Matsumori A, Minato N, Honjho T (2003) Autoantibodies against cardiac troponin I are responsible for dilated cardiomyopathy in PD-1 deficient mice. Nat Med 9:1477–1483
Rose NR, Baughman K (1998) Immune-mediated cardiovascular disease. In: Rose NR, Mackay IR (eds) Autoimmune diseases, 3rd edn. Academic Press, San Diego, pp 623–636
Rose NR, Beisel KW, Herskowitz A, Neu N, Wolfgram LJ, Alvarez FL, Traystman MD, Craig SW (1987) Cardiac myosin and autoimmune myocarditis. In: Evered D, Whelan J (eds) Autoimmunity and autoimmune disease. Ciba Foundation Symposium 129. John Wiley and Sons, Chichester, pp 3–24
Schulze K, Becker BF, Schauer R, Schultheiss P (1990) Antibodies to ADP-ATP carrier — an autoantigen in myocarditis and dilated cardiomyopathy — impair cardiac function. Circulation 81:959–969
Smith SC, Allen PM (1991) Myosin-induced acute myocarditis is a T cellmediated disease. J Immunol 147:2141–2147
Smith SC, Allen PM (1992) Neutralization of endogenous tumor necrosis factor ameliorates the severity of myosin-induced myocarditis. Circ Res 70:856–863
Staudt A, Böhm M, Knebel F, Grosse Y, Bischoff C, Hummel A, Dahm JB, Borges A, Jochmann N, Wernecke K, Wallukat G, Baumann G, Felix SB (2002) Potential role of autoantibodies belonging to the immunoglobulin G-3 subclass in cardiac dysfunction among patients with dilated cardiomyopathy. Circulation 106:2448–2453
Sundstrom JB, Fett JD, Carraway RD, Ansari AA (2002) Is peripartum cardiomyopathy an organ-specific autoimmune disease? Autoimmun Rev 1:73–77
Towbin JA, Bowles KR, Bowles NE (1999) Etiologies of cardiomyopathies and heart failure. Nat Med 5:266–267
Wallukat G, Podlowski S, Nissen E, Morwinski R, Csonka C, Tosaki A, Blasig IE (2003) Functional and structural characterization of anti-beta1-adrenoceptor autoantibodies of spontaneously hypertensive rats. Mol Cell Biochem 251:67–75
Warraich RS, Dunn MJ, Yacoub MH (1999) Subclass specificity of autoantibodies against myosin in patients with idiopathic dilated cardiomyopathy: pro-inflammatory antibodies in DCM patients. Biochem Biophys Res Commun 259:255–261
Warraich RS, Pomerance A, Stanley A, Banner NR, Dunn MJ, Yacoub MH (2000) Cardiac myosin autoantibodies and acute rejection after heart transplantation in patients with dilated cardiomyopathy. Transplantation 69:1609–1617
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Rose, N.R. (2006). The Significance of Autoimmunity in Myocarditis. In: Schultheiss, H.P., Kapp, J.F., Grötzbach, G. (eds) Chronic Viral and Inflammatory Cardiomyopathy. Ernst Schering Research Foundation Workshop, vol 55. Springer, Berlin, Heidelberg . https://doi.org/10.1007/3-540-30822-9_9
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DOI: https://doi.org/10.1007/3-540-30822-9_9
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