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Geissen S, Braumann S, Adler J, Nettersheim FS, Mehrkens D, Hof A, Guthoff H, von Stein P, Witkowski S, Gerdes N, Tellkamp F, Krüger M, Isermann L, Trifunovic A, Bunck AC, Mollenhauer M, Winkels H, Adam M, Klinke A, Buch G, Ten Cate V, Hellmich M, Kelm M, Rudolph V, Wild PS, Rosenkranz S, Baldus S. Inhibition of myeloperoxidase to treat left ventricular dysfunction in non-ischaemic cardiomyopathy. Eur J Heart Fail 2024. [PMID: 39212229 DOI: 10.1002/ejhf.3435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 07/22/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS Non-ischaemic cardiomyopathy (NICMP), an incurable disease terminating in systolic heart failure (heart failure with reduced ejection fraction [HFrEF]), causes immune activation, however anti-inflammatory treatment strategies so far have failed to alter the course of this disease. Myeloperoxidase (MPO), the principal enzyme in neutrophils, has cytotoxic, pro-fibrotic and nitric oxide oxidizing effects. Whether MPO inhibition ameliorates the phenotype in NICMP remains elusive. METHODS AND RESULTS Prognostic information from MPO was derived from proteomic data of a large human cardiovascular health cohort (n = 3289). In a murine model of NICMP, we studied the mechanisms of MPO in this disease. In a case series, the MPO inhibitor was also evaluated in NICMP patients. Individuals with increased MPO revealed higher long-term mortality and worsening of heart failure, with impaired prognosis when MPO increased during follow-up. MPO infusion attenuated left ventricular ejection fraction (LVEF) in mice with NICMP, whereas genetic ablation or inhibition of MPO decreased systemic vascular resistance (SVR, 9.4 ± 0.7 mmHg*min/ml in NICMP vs. 6.7 ± 0.8 mmHg*min/ml in NICMP/Mpo-/-mice, n = 8, p = 0.006, data expressed as mean ± standard error of the mean) and improved left ventricular function (LVEF 30.3 ± 2.2% in NICMP vs. 40.7 ± 1.1% in NICMP/Mpo-/- mice, n = 16, p < 0.0001). Four patients diagnosed with NICMP and treated with an MPO inhibitor over 12 weeks showed increase in LVEF, decline in natriuretic peptides and improved 6-min walking distance. MPO inhibitor-related changes in the proteome of NICMP patients predicted reduced mortality when related to the changes in the proteome of the above referenced cardiovascular health cohort. CONCLUSIONS Myeloperoxidase predicts long-term outcome in HFrEF and its inhibition elicits systemic anti-inflammatory and vasodilating effects which translate into improved left ventricular function. MPO inhibition deserves further evaluation as a novel, complementary treatment strategy for HFrEF.
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Affiliation(s)
- Simon Geissen
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Simon Braumann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Joana Adler
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Felix Sebastian Nettersheim
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Dennis Mehrkens
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Alexander Hof
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Henning Guthoff
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Philipp von Stein
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Sven Witkowski
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Norbert Gerdes
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frederik Tellkamp
- Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD) and Institute for Mitochondrial Diseases and Ageing, Medical Faculty, University of Cologne, Cologne, Germany
- University of Cologne, Department of Biology, Institute for Genetics, Cologne, Germany
| | - Marcus Krüger
- Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD) and Institute for Mitochondrial Diseases and Ageing, Medical Faculty, University of Cologne, Cologne, Germany
- University of Cologne, Department of Biology, Institute for Genetics, Cologne, Germany
| | - Lea Isermann
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD) and Institute for Mitochondrial Diseases and Ageing, Medical Faculty, University of Cologne, Cologne, Germany
| | - Aleksandra Trifunovic
- Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD) and Institute for Mitochondrial Diseases and Ageing, Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Mollenhauer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Holger Winkels
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Anna Klinke
- Agnes Wittenborg Institute for Translational Cardiovascular Research, Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, University Hospital of the Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Gregor Buch
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Vincent Ten Cate
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Volker Rudolph
- Agnes Wittenborg Institute for Translational Cardiovascular Research, Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, University Hospital of the Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stephan Rosenkranz
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and Faculty of Mathematics and Natural Sciences, University of Cologne, Cologne, Germany
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Neagu O, Chirică V, Luca L, Bosa M, Tița A, Ceaușu MC. Novel Immunohistochemical and Morphological Approaches in a Retrospective Study of Post-Mortem Myocarditis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1312. [PMID: 39202593 PMCID: PMC11356551 DOI: 10.3390/medicina60081312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: This study presents a retrospective analysis of 26 autopsy cases from a single centre, primarily focusing on forensic cases, with a majority of male individuals. Materials and Methods: We systematically analysed autopsy reports and cardiac tissue slides using haematoxylin-eosin stain and immunohistochemistry for CD3, CD163, and IL-6. The histological assessment evaluated key variables such as inflammation severity, necrosis, and background changes using a standardised grading system. Quantitative analysis of immunohistochemical markers was performed, calculating the percentage of positively stained cells within the inflammatory infiltrate. Results: The average age was 51.6 years, slightly skewed towards older males. The fatalities varied widely, with sudden death and drug abuse being the most common conditions linked to myocarditis findings on histological examination. A strong correlation was found between the severity of inflammation (measured by size within a myocardium section) and the scoring system based on the number of inflammatory foci per section (p ≤ 0.001). Most cases showed mild to minimal fibrosis, with some exhibiting moderate to severe fibrosis, arteriosclerosis, and myocyte hypertrophy. The presence of protein CD3 in the inflammatory infiltrate revealed a moderate inverse correlation between the CD3 values and the severity of inflammation and necrosis, and a strong inverse correlation with neutrophil levels. CD3 levels were higher in sudden death cases and lower in cases with numerous inflammatory foci, highlighting the discreet nature of lymphocytic myocarditis. Macrophage presence, assessed using CD163, showed a moderate inverse correlation with neutrophil levels and significant differences between sudden death and non-sudden death cases. Macrophage-rich inflammation was observed in cases with pneumonia/bronchopneumonia-associated lesions. IL-6 expression showed a moderate direct correlation with inflammation severity (p = 0.028), severity of necrosis (p = 0.005), and the number of inflammatory foci per section (p = 0.047). A moderate inverse correlation was found between CD3 and IL-6 expression (p = 0.005). Conclusions: These findings highlight the need for a unique immunohistochemical approach in forensic cases of myocarditis, differing from guidelines for endomyocardial biopsies due to diverse inflammatory cells. The study suggests exploring inflammatory chemokines within myocarditis foci for their significance in clinical scenarios. Specifically, IL-6, a crucial pro-inflammatory interleukin, correlated significantly with the severity of inflammation and necrosis (p < 0.05). This study provides novel and valuable insights into the histopathological and immunological markers of myocarditis in autopsy cases.
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Affiliation(s)
- Oana Neagu
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Emergency Hospital for Children Grigore Alexandrescu, 011743 Bucharest, Romania
| | - Violeta Chirică
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- National Institute of Legal Medicine Mina Minovici, 077160 Bucharest, Romania
| | - Lăcrămioara Luca
- National Institute of Legal Medicine Mina Minovici, 077160 Bucharest, Romania
| | - Maria Bosa
- National Institute of Legal Medicine Mina Minovici, 077160 Bucharest, Romania
| | - Alina Tița
- National Institute of Legal Medicine Mina Minovici, 077160 Bucharest, Romania
| | - Mihail Constantin Ceaușu
- Department of Pathology, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- National Institute of Endocrinology C.I. Parhon, 011863 Bucharest, Romania
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3
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Hashimoto K, Yamamoto H, Ikeda Y, Isogai J, Hashimoto T. A case of biopsy-proven inflammatory dilated cardiomyopathy following heterologous mRNA-1273 third-dose immunization. ESC Heart Fail 2024. [PMID: 38946583 DOI: 10.1002/ehf2.14924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/10/2024] [Accepted: 06/15/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Katsuya Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, Chiba, Japan
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4
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Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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5
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Almohaimeed GM, Alonazi AS, Bin Dayel AF, Alshammari TK, Alghibiwi HK, Alamin MA, Almotairi AR, Alrasheed NM. Interplay between Senescence and Macrophages in Diabetic Cardiomyopathy: A Review of the Potential Role of GDF-15 and Klotho. Biomedicines 2024; 12:759. [PMID: 38672115 PMCID: PMC11048311 DOI: 10.3390/biomedicines12040759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a critical health problem, with 700 million diagnoses expected worldwide by 2045. Uncontrolled high blood glucose levels can lead to serious complications, including diabetic cardiomyopathy (DCM). Diabetes induces cardiovascular aging and inflammation, increasing cardiomyopathy risk. DCM is characterized by structural and functional abnormalities in the heart. Growing evidence suggests that cellular senescence and macrophage-mediated inflammation participate in the pathogenesis and progression of DCM. Evidence indicates that growth differentiation factor-15 (GDF-15), a protein that belongs to the transforming growth factor-beta (TGF-β) superfamily, is associated with age-related diseases and exerts an anti-inflammatory role in various disease models. Although further evidence suggests that GDF-15 can preserve Klotho, a transmembrane antiaging protein, emerging research has elucidated the potential involvement of GDF-15 and Klotho in the interplay between macrophages-induced inflammation and cellular senescence in the context of DCM. This review explores the intricate relationship between senescence and macrophages in DCM while highlighting the possible contributions of GDF-15 and Klotho.
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Affiliation(s)
- Ghada M. Almohaimeed
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Asma S. Alonazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Anfal F. Bin Dayel
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Tahani K. Alshammari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Hanan K. Alghibiwi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Maha A. Alamin
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
| | - Ahmad R. Almotairi
- Department of Pathology, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Nouf M. Alrasheed
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (G.M.A.); (A.S.A.); (A.F.B.D.); (T.K.A.); (H.K.A.); (M.A.A.)
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6
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Klimentova J, Rehulka P, Stulik J, Vozandychova V, Rehulkova H, Jurcova I, Lazarova M, Aiglova R, Dokoupil J, Hrecko J, Pudil R. Proteomic Profiling of Dilated Cardiomyopathy Plasma Samples ─ Searching for Biomarkers with Potential to Predict the Outcome of Therapy. J Proteome Res 2024; 23:971-984. [PMID: 38363107 PMCID: PMC10913098 DOI: 10.1021/acs.jproteome.3c00691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Determination of the prognosis and treatment outcomes of dilated cardiomyopathy is a serious problem due to the lack of valid specific protein markers. Using in-depth proteome discovery analysis, we compared 49 plasma samples from patients suffering from dilated cardiomyopathy with plasma samples from their healthy counterparts. In total, we identified 97 proteins exhibiting statistically significant dysregulation in diseased plasma samples. The functional enrichment analysis of differentially expressed proteins uncovered dysregulation in biological processes like inflammatory response, wound healing, complement cascade, blood coagulation, and lipid metabolism in dilated cardiomyopathy patients. The same proteome approach was employed in order to find protein markers whose expression differs between the patients well-responding to therapy and nonresponders. In this case, 45 plasma proteins revealed statistically significant different expression between these two groups. Of them, fructose-1,6-bisphosphate aldolase seems to be a promising biomarker candidate because it accumulates in plasma samples obtained from patients with insufficient treatment response and with worse or fatal outcome. Data are available via ProteomeXchange with the identifier PXD046288.
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Affiliation(s)
- Jana Klimentova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Pavel Rehulka
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
| | - Jiri Stulik
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- Charles
University, Faculty of Medicine in Hradec Kralove, Simkova 870, Hradec Kralove 50003, Czech Republic
| | - Vera Vozandychova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Helena Rehulkova
- Faculty
of Military Health Sciences, Department of Molecular Pathology and
Biology, University of Defence, Trebesska 1575, Hradec Kralove 50001, Czech Republic
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Ivana Jurcova
- Institute
for Clinical and Experimental Medicine (IKEM), Videnska 1958/9, Prague 14021, Czech Republic
| | - Marie Lazarova
- Department
of Internal Medicine I − Cardiology, Faculty of Medicine and
Dentistry, Palacky University and University
Hospital Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Renata Aiglova
- Department
of Internal Medicine I − Cardiology, Faculty of Medicine and
Dentistry, Palacky University and University
Hospital Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Jiri Dokoupil
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Juraj Hrecko
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
| | - Radek Pudil
- The
first Department of Internal Medicine − Cardioangiology, Medical Faculty of Charles University in Hradec Kralove
and University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove 50005, Czech Republic
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7
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Xu S, Wu Z, Chen H. Construction and evaluation of immune-related diagnostic model in patients with heart failure caused by idiopathic dilated cardiomyopathy. BMC Cardiovasc Disord 2024; 24:92. [PMID: 38321374 PMCID: PMC10845749 DOI: 10.1186/s12872-023-03666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/09/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE The purpose of the study was to construct the potential diagnostic model of immune-related genes during the development of heart failure caused by idiopathic dilated cardiomyopathy. METHOD GSE5406 and GSE57338 were downloaded from the GEO website ( https://www.ncbi.nlm.nih.gov/geo/ ). CIBERSORT was used for the evaluation of immune infiltration in idiopathic dilated cardiomyopathy (DCM) of GSE5406. Differently expressed genes were calculated by the limma R package and visualized by the volcano plot. The immune-related genes were downloaded from Immport, TISIDB, and InnateDB. Then the immune-related differential genes (IRDGs) were acquired from the intersection. Protein-protein interaction network (PPI) and Cytoscape were used to visualize the hub genes. Three machine learning methods such as random forest, logical regression, and elastic network regression model were adopted to construct the prediction model. The diagnostic value was also validated in GSE57338. RESULTS Our study demonstrated the obvious different ratio of T cell CD4 memory activated, T cell regulatory Tregs, and neutrophils between DCM and control donors. As many as 2139 differential genes and 274 immune-related different genes were identified. These genes were mainly enriched in lipid and atherosclerosis, human cytomegalovirus infection, and cytokine-cytokine receptor interaction. At the same time, as many as fifteen hub genes were identified as the IRDGs (IFITM3, IFITM2, IFITM1, IFIT3, IFIT1, HLA-A, HLA-B, HLA-C, ADAR, STAT1, SAMHD1, RSAD2, MX1, ISG20, IRF2). Moreover, we also discovered that the elastic network and logistic regression models had a higher diagnostic value than that of random forest models based on these hub genes. CONCLUSION Our study demonstrated the pivotal role of immune function during the development of heart failure caused by DCM. This study may offer new opportunities for the detection and intervention of immune-related DCM.
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Affiliation(s)
- Sichi Xu
- Department of Cardiology, The Central Hospital of Wuhan, Tong Ji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tong Ji Medica College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Zhaogui Wu
- Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China
| | - Haihua Chen
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
- Hubei Clinical Research Center for Emergency and Resuscitation, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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8
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Zhang J, Cheng L, Li Z, Li H, Liu Y, Zhan H, Xu H, Huang Y, Feng F, Li Y. Immune cells and related cytokines in dilated cardiomyopathy. Biomed Pharmacother 2024; 171:116159. [PMID: 38242041 DOI: 10.1016/j.biopha.2024.116159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024] Open
Abstract
Dilated cardiomyopathy (DCM) is a non-ischemic cardiomyopathy involving one or more underlying etiologies. It is characterized by structural and functional dysfunction of the myocardium, potentially leading to fibrosis and ventricular remodeling, and an elevated risk of heart failure (HF). Although the pathogenesis of DCM remains unknown, compelling evidence suggests that DCM-triggered immune cells and inflammatory cascades play a crucial role in the occurrence and development of DCM. Various factors are linked to myocardial damage, inducing aberrant activation of the immune system and sustained inflammatory responses in DCM. The investigation of the immunopathogenesis of DCM also contributes to discovering new biomarkers and therapeutic targets. This review examines the roles of immune cells and related cytokines in DCM pathogenesis and explores immunotherapy strategies in DCM.
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Affiliation(s)
- Jingdi Zhang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Linlin Cheng
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haolong Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongmei Liu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haoting Zhan
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Honglin Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuan Huang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Futai Feng
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongzhe Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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9
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Watany MM, Elhosary MM. Clinical utility of circulating TWEAK and CD163 as biomarkers of iron-induced cardiac decompensation in transfusion dependent thalassemia major. Cytokine 2024; 173:156443. [PMID: 38000169 DOI: 10.1016/j.cyto.2023.156443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIM Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) affects most of the cells involved in cardiac fibrosis like inflammatory cells, cardiomyocytes and fibroblasts. CD163, the receptor of TWEAK on the surface of type 2 macrophages, is shed into plasma upon macrophages activation. This work aimed to evaluate serum TWEAK and its decoy receptor CD163 as probable biomarkers to monitor myocardial iron overload (MIO) in transfusion dependent thalassemia major (TDTM) patients and to predict iron-induced cardiac decompensation (IICD). METHODS A total of 140 TDTM patients were enrolled. Patients were categorized into two groups; group I (n = 70) diagnosed with IICD while group II (n = 70) had no evidence of IICD. sTWEAK and sCD163 were quantitated utilizing Enzyme-linked-immunosorbent- assay. RESULTS sTWEAK was evidently lower in group I than group II (medians, 412 and 1052 pg/mL respectively). sCD163 was higher in group I than group II (medians, 615.5 and 323.5 ng/mL respectively). sTWEAK positively correlated with cardiac MRI-T2 mapping and ventricular ejection fractions and negatively correlated with B-Natriuretic peptide and cardiac troponin. An inverse relationship between TWEAK and CD163 was documented throughout the study. sTWEAK, sCD163 and TWEAK/CD163 ratio proved to be significant predictors of IICD in TDTM patients. TWEAK/CD163 ratio < 1.04 discriminated IICD in TDTM patients with 100 % clinical sensitivity and specificity. CONCLUSION Circulating TWEAK and CD163 appears to be promising biomarkers for monitoring MIO and predicting IICD in TDTM patients.
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Affiliation(s)
- Mona M Watany
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
| | - Marwa M Elhosary
- Msc Immunology from Tanta University, Faculty of Science, Tanta 31527, Egypt
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10
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Uccello G, Bonacchi G, Rossi VA, Montrasio G, Beltrami M. Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis. J Clin Med 2023; 13:150. [PMID: 38202158 PMCID: PMC10780032 DOI: 10.3390/jcm13010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term "chronic inflammatory cardiomyopathy" describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype-phenotype association is suspected, as this has significant implications for patients' and their family members' prognoses. Recognition of the pathophysiological pathway and clinical "red flags" and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes.
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Affiliation(s)
- Giuseppe Uccello
- Division of Cardiology, Alessandro Manzoni Hospital—ASST Lecco, 23900 Lecco, Italy;
| | - Giacomo Bonacchi
- Division of Cardiology, Tor Vergata University Hospital, 00133 Rome, Italy;
| | | | - Giulia Montrasio
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BS, UK;
| | - Matteo Beltrami
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy
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11
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Jeyalan V, Austin D, Loh SX, Wangsaputra VK, Spyridopoulos I. Fractalkine/CX 3CR1 in Dilated Cardiomyopathy: A Potential Future Target for Immunomodulatory Therapy? Cells 2023; 12:2377. [PMID: 37830591 PMCID: PMC10571889 DOI: 10.3390/cells12192377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is a cardiac condition with structural and functional impairment, where either the left ventricle or both ventricular chambers are enlarged, coinciding with reduced systolic pump function (reduced ejection fraction, rEF). The prevalence of DCM is more than 1:250 individuals, and mortality largely due to heart failure in two-third of cases, and sudden cardiac death in one-third of patients. Damage to the myocardium, whether from a genetic or environmental cause such as viruses, triggers inflammation and recruits immune cells to the heart to repair the myocardium. Examination of myocardial biopsy tissue often reveals an inflammatory cell infiltrate, T lymphocyte (T cell) infiltration, or other activated immune cells. Despite medical therapy, adverse outcomes for DCM remain. The evidence base and existing literature suggest that upregulation of CX3CR1, migration of immune cells, together with cytomegalovirus (CMV) seropositivity is associated with worse outcomes in patients with dilated cardiomyopathy. We hypothesise that this potentially occurs through cardiac inflammation and fibrosis, resulting in adverse remodelling. Immune modulators to target this pathway may potentially improve outcomes above and beyond current guideline-recommended therapy.
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Affiliation(s)
- Visvesh Jeyalan
- Academic Cardiovascular Unit, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (V.J.); (D.A.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
| | - David Austin
- Academic Cardiovascular Unit, The James Cook University Hospital, Middlesbrough TS4 3BW, UK; (V.J.); (D.A.)
- Population Health Science Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Shu Xian Loh
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
| | - Vincent Kharisma Wangsaputra
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
- Faculty of Medicine, Universitas Indonesia, Central Jakarta 10430, Indonesia
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK;
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
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12
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Baumeier C, Harms D, Aleshcheva G, Gross U, Escher F, Schultheiss HP. Advancing Precision Medicine in Myocarditis: Current Status and Future Perspectives in Endomyocardial Biopsy-Based Diagnostics and Therapeutic Approaches. J Clin Med 2023; 12:5050. [PMID: 37568452 PMCID: PMC10419903 DOI: 10.3390/jcm12155050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
The diagnosis and specific and causal treatment of myocarditis and inflammatory cardiomyopathy remain a major clinical challenge. Despite the rapid development of new imaging techniques, endomyocardial biopsies remain the gold standard for accurate diagnosis of inflammatory myocardial disease. With the introduction and continued development of immunohistochemical inflammation diagnostics in combination with viral nucleic acid testing, myocarditis diagnostics have improved significantly since their introduction. Together with new technologies such as miRNA and gene expression profiling, quantification of specific immune cell markers, and determination of viral activity, diagnostic accuracy and patient prognosis will continue to improve in the future. In this review, we summarize the current knowledge on the pathogenesis and diagnosis of myocarditis and inflammatory cardiomyopathies and highlight future perspectives for more in-depth and specialized biopsy diagnostics and precision, personalized medicine approaches.
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Affiliation(s)
- Christian Baumeier
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Dominik Harms
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
- Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Ganna Aleshcheva
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Ulrich Gross
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
| | - Felicitas Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, 13353 Berlin, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
| | - Heinz-Peter Schultheiss
- Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany; (D.H.); (G.A.); (U.G.); (H.-P.S.)
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13
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Wang E, Zhou R, Li T, Hua Y, Zhou K, Li Y, Luo S, An Q. The Molecular Role of Immune Cells in Dilated Cardiomyopathy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1246. [PMID: 37512058 PMCID: PMC10385992 DOI: 10.3390/medicina59071246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Dilated cardiomyopathy (DCM) is a rare and severe condition characterized by chamber dilation and impaired contraction of the left ventricle. It constitutes a fundamental etiology for profound heart failure and abrupt cardiac demise, rendering it a prominent clinical indication for heart transplantation (HTx) among both adult and pediatric populations. DCM arises from various etiologies, including genetic variants, epigenetic disorders, infectious insults, autoimmune diseases, and cardiac conduction abnormalities. The maintenance of cardiac function involves two distinct types of immune cells: resident immune cells and recruited immune cells. Resident immune cells play a crucial role in establishing a harmonious microenvironment within the cardiac tissue. Nevertheless, in response to injury, cardiomyocytes initiate a cytokine cascade that attracts peripheral immune cells, thus perturbing this intricate equilibrium and actively participating in the initiation and pathological remodeling of dilated cardiomyopathy (DCM), particularly during the progression of myocardial fibrosis. Additionally, immune cells assume a pivotal role in orchestrating the inflammatory processes, which are intimately linked to the prognosis of DCM. Consequently, understanding the molecular role of various immune cells and their regulation mechanisms would provide an emerging era for managing DCM. In this review, we provide a summary of the most recent advancements in our understanding of the molecular mechanisms of immune cells in DCM. Additionally, we evaluate the effectiveness and limitations of immunotherapy approaches for the treatment of DCM, with the aim of optimizing future immunotherapeutic strategies for this condition.
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Affiliation(s)
- Enping Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Ruofan Zhou
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Tiange Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Yimin Hua
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Kaiyu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Yifei Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shuhua Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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14
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Taylor J, Yeung ACY, Ashton A, Faiz A, Guryev V, Fang B, Lal S, Grosser M, Dos Remedios CG, Braet F, McLachlan CS, Li A. Transcriptomic Comparison of Human Peripartum and Dilated Cardiomyopathy Identifies Differences in Key Disease Pathways. J Cardiovasc Dev Dis 2023; 10:jcdd10050188. [PMID: 37233155 DOI: 10.3390/jcdd10050188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare form of acute onset heart failure that presents in otherwise healthy pregnant women around the time of delivery. While most of these women respond to early intervention, about 20% progress to end-stage heart failure that symptomatically resembles dilated cardiomyopathy (DCM). In this study, we examined two independent RNAseq datasets from the left ventricle of end-stage PPCM patients and compared gene expression profiles to female DCM and non-failing donors. Differential gene expression, enrichment analysis and cellular deconvolution were performed to identify key processes in disease pathology. PPCM and DCM display similar enrichment in metabolic pathways and extracellular matrix remodeling suggesting these are similar processes across end-stage systolic heart failure. Genes involved in golgi vesicles biogenesis and budding were enriched in PPCM left ventricles compared to healthy donors but were not found in DCM. Furthermore, changes in immune cell populations are evident in PPCM but to a lesser extent compared to DCM, where the latter is associated with pronounced pro-inflammatory and cytotoxic T cell activity. This study reveals several pathways that are common to end-stage heart failure but also identifies potential targets of disease that may be unique to PPCM and DCM.
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Affiliation(s)
- Jude Taylor
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
| | - Anna C Y Yeung
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, The University of Technology Sydney (UTS), Sydney, NSW 2007, Australia
| | - Anthony Ashton
- Division of Cardiovascular Medicine, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Alen Faiz
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, The University of Technology Sydney (UTS), Sydney, NSW 2007, Australia
- Groningen Research Institute for Asthma and COPD (GRIAC), The University of Groningen, 9700 Groningen, The Netherlands
| | - Victor Guryev
- Groningen Research Institute for Asthma and COPD (GRIAC), The University of Groningen, 9700 Groningen, The Netherlands
- Laboratory of Genome Structure and Ageing, European Research Institute for the Biology of Ageing (ERIBA), University Medical Centre Groningen, The University of Groningen, 9713 Groningen, The Netherlands
| | - Bernard Fang
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sean Lal
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, The Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
| | | | - Cristobal G Dos Remedios
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Filip Braet
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Australian Centre for Microscopy & Microanalysis, The University of Sydney, Sydney, NSW 2006, Australia
| | - Craig S McLachlan
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
| | - Amy Li
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Pharmacy & Biomedical Sciences, La Trobe University, Bendigo, VIC 3550, Australia
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15
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Giannotta G, Murrone A, Giannotta N. COVID-19 mRNA Vaccines: The Molecular Basis of Some Adverse Events. Vaccines (Basel) 2023; 11:747. [PMID: 37112659 PMCID: PMC10145134 DOI: 10.3390/vaccines11040747] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Each injection of any known vaccine results in a strong expression of pro-inflammatory cytokines. This is the result of the innate immune system activation, without which no adaptive response to the injection of vaccines is possible. Unfortunately, the degree of inflammation produced by COVID-19 mRNA vaccines is variable, probably depending on genetic background and previous immune experiences, which through epigenetic modifications could have made the innate immune system of each individual tolerant or reactive to subsequent immune stimulations.We hypothesize that we can move from a limited pro-inflammatory condition to conditions of increasing expression of pro-inflammatory cytokines that can culminate in multisystem hyperinflammatory syndromes following COVID-19 mRNA vaccines (MIS-V). We have graphically represented this idea in a hypothetical inflammatory pyramid (IP) and we have correlated the time factor to the degree of inflammation produced after the injection of vaccines. Furthermore, we have placed the clinical manifestations within this hypothetical IP, correlating them to the degree of inflammation produced. Surprisingly, excluding the possible presence of an early MIS-V, the time factor and the complexity of clinical manifestations are correlated to the increasing degree of inflammation: symptoms, heart disease and syndromes (MIS-V).
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Affiliation(s)
| | - Antonio Murrone
- Oncologia Territoriale, Hospice Cure Palliative ASUFC, 33030 Udine, Italy;
| | - Nicola Giannotta
- Medical and Surgery Sciences, Faculty of Medicine, Magna Græcia University, 88100 Catanzaro, Italy;
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16
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Al-U'datt DGF, Tranchant CC, Alu'datt M, Abusara S, Al-Dwairi A, AlQudah M, Al-Shboul O, Hiram R, Altuntas Y, Jaradat S, Alzoubi KH. Inhibition of transglutaminase 2 (TG2) ameliorates ventricular fibrosis in isoproterenol-induced heart failure in rats. Life Sci 2023; 321:121564. [PMID: 36931499 DOI: 10.1016/j.lfs.2023.121564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
AIMS Transglutaminase (TG) inhibitors represent promising therapeutic interventions in cardiac fibrosis and related dysfunctions. However, it remains unknown how TG inhibition, TG2 in particular, affects the signaling systems that drive pathological fibrosis. This study aimed to examine the effect TG inhibition by cystamine on the progression of isoproterenol (ISO)-induced cardiac fibrosis and dysfunction in rats. MATERIALS AND METHODS Cardiac fibrosis was established by intraperitoneal injection of ISO to rats (ISO group), followed by 6 weeks of cystamine injection (ISO + Cys group). The control groups were administered normal saline alone or with cystamine. Hemodynamics, lipid profile, liver enzymes, urea, and creatinine were assessed in conjunction with heart failure markers (serum NT-proANP and cTnI). Left ventricular (LV) and atrial (LA) fibrosis, total collagen content, and mRNA expression of profibrotic markers including TG2 were quantified by Masson's trichrome staining, LC-MS/MS and quantitative PCR, respectively. KEY FINDINGS Cystamine administration to ISO rats significantly decreased diastolic and mean arterial pressures, total cholesterol, triglycerides, LDL, liver enzymes, urea, and creatinine levels, while increasing HDL. NT-proANP and cTnI serum levels remained unchanged. In LV tissues, significant reductions in ISO-induced fibrosis and elevated total collagen content were achieved after cystamine treatment, together with a reduction in TG2 concentration. Reduced mRNA expression of several profibrotic genes (COL1A1, FN1, MMP-2, CTGF, periostin, CX43) was also evidenced in LV tissues of ISO rats upon cystamine administration, whereas TGF-β1 expression was depressed in LA tissues. Cystamine decreased TG2 mRNA expression in the LV of control rats, while LV expression of TG2 was relatively low in ISO rats irrespective of cystamine treatment. SIGNIFICANCE TG2 inhibition by cystamine in vivo exerted cardioprotective effects against ISO-induced cardiac fibrosis in rats decreasing the LV abundance of several profibrotic markers and the content of TG2 and collagen, suggesting that TG2 pharmacological inhibition could be beneficial to alleviate cardiac fibrosis.
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Affiliation(s)
- Doa'a G F Al-U'datt
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Carole C Tranchant
- School of Food Science, Nutrition and Family Studies, Faculty of Health Sciences and Community Services, Université de Moncton, New Brunswick, Canada
| | - Muhammad Alu'datt
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Sara Abusara
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahmed Al-Dwairi
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad AlQudah
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; Physiology Department, Arabian Gulf University, Manama, Bahrain
| | - Othman Al-Shboul
- Department of Physiology and Biochemistry, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Roddy Hiram
- Montreal Heart Institute and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Yasemin Altuntas
- Montreal Heart Institute and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Saied Jaradat
- Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates; Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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17
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Zhang C, Wang XY, Zuo JL, Wang XF, Feng XW, Zhang B, Li YT, Yi CH, Zhang P, Ma XC, Chen ZM, Ma Y, Han JH, Tao BR, Zhang R, Wang TQ, Tong L, Gu W, Wang SY, Zheng XF, Yuan WK, Kan ZJ, Fan J, Hu XY, Li J, Zhang C, Chen JH. Localization and density of tertiary lymphoid structures associate with molecular subtype and clinical outcome in colorectal cancer liver metastases. J Immunother Cancer 2023; 11:jitc-2022-006425. [PMID: 36759015 PMCID: PMC9923349 DOI: 10.1136/jitc-2022-006425] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Tertiary lymphoid structures (TLSs) have been proposed to assess the prognosis of patients with cancer. Here, we investigated the prognostic value and relevant mechanisms of TLSs in colorectal cancer liver metastases (CRCLM). METHODS 603 patients with CRCLM treated by surgical resection from three cancer centers were included. The TLSs were categorized according to their anatomic subregions and quantified, and a TLS scoring system was established for intratumor region (T score) and peritumor region (P score). Differences in relapse-free survival (RFS) and overall survival (OS) between groups were determined. Multiplex immunohistochemical staining (mIHC) was used to determine the cellular composition of TLSs in 40 CRCLM patients. RESULTS T score positively correlated with superior prognosis, while P score negatively associated with poor survival (all p<0.05). Meanwhile, T score was positively associated with specific mutation subtype of KRAS. Furthermore, TLSs enrichment gene expression was significantly associated with survival and transcriptomic subtypes of CRCLM. Subsequently, mIHC showed that the densities of Treg cells, M2 macrophages and Tfh cells were significantly higher in intratumor TLSs than in peritumor TLSs (p=0.029, p=0.047 and p=0.041, respectively), and the frequencies of Treg cells and M2 macrophages were positively correlated with P score, while the frequencies of Tfh cells were positively associated with T scores in intratumor TLSs (all p<0.05). Next, based on the distribution and abundance of TLSs, an Immune Score combining T score and P score was established which categorized CRCLM patients into four immune classes with different prognosis (all p<0.05). Among them, patients with higher immune class have more favorable prognoses. The C-index of Immune Class for RFS and OS was higher than Clinical Risk Score statistically. These results were also confirmed by the other two validation cohorts. CONCLUSIONS The distribution and abundance of TLSs is significantly associated with RFS and OS of CRCLM patients, and a novel immune class was proposed for predicting the prognosis of CRCLM patients.
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Affiliation(s)
- Chong Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiang-Yu Wang
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Jie-Liang Zuo
- Department of General Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Xue-Fu Wang
- School of Pharmacy, Anhui Medical University, Hefei, China,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Wen Feng
- School of Pharmacy, Anhui Medical University, Hefei, China,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Bo Zhang
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Yi-Tong Li
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Chen-He Yi
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Peng Zhang
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Xiao-Chen Ma
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Zhen-Mei Chen
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Yue Ma
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Jia-Hao Han
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Bao-Rui Tao
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Rui Zhang
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
| | - Tian-Qi Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Li Tong
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wang Gu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Si-Yu Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Fei Zheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Kang Yuan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zi-Jie Kan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jie Fan
- Department of Pathology, Huashan Hospital Fudan University, Shanghai, China
| | - Xiang-Yang Hu
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jun Li
- Department of General Surgery, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China
| | - Chao Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin-Hong Chen
- Department of General Surgery, Huashan Hospital Fudan University, Shanghai, China
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18
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Identification of key immune-related genes in dilated cardiomyopathy using bioinformatics analysis. Sci Rep 2023; 13:1820. [PMID: 36725968 PMCID: PMC9892583 DOI: 10.1038/s41598-022-26277-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is characterized by the left ventricular dilatation and impaired myocardial systolic dysfunction with high mortality and morbidity. However, the underlying mechanisms remain elusive. We first identified the differentially expressed genes (DEGs) between the DCM and control group using two expression profiles from GSE3585 and GSE84796. Enrichment analysis was conducted to explore the potential mechanisms underlying DCM. A total of four algorithms, including key module of MCODE, degree, maximum neighborhood component (MNC), and maximal clique centrality (MCC), were used to identify the hub genes within Cytoscape. The correlation between hub genes and infiltrated immune cells was evaluated to determine potential immune-related genes. The expression analysis and diagnosis value analysis of potential immune-related genes were performed. Finally, the expression analysis with GSE57338 and relationship analysis with the comparative toxicogenomics database (CTD) were performed to identify the key immune-related genes in DCM. A total of 80 DEGs were screened for DCM. Enrichment analysis revealed that DEGs were involved in the immune-related pathological process. Immune infiltration analysis indicated a potentially abnormal immune response in DCM. Four up-regulated genes (COL1A2, COL3A1, CD53, and POSTN) were identified as potential immune-related genes. Finally, three genes (COL1A2, COL3A1, and POSTN) were determined as the key immune-related genes in DCM via expression analysis with a validation set (GSE57338) and relationship analysis with CTD. Our study suggested that the upregulated COL1A2, COL3A1, and POSTN might be the key immune-related genes for DCM. Further studies are needed to validate the underlying mechanisms.
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19
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Harding D, Chong MHA, Lahoti N, Bigogno CM, Prema R, Mohiddin SA, Marelli-Berg F. Dilated cardiomyopathy and chronic cardiac inflammation: Pathogenesis, diagnosis and therapy. J Intern Med 2023; 293:23-47. [PMID: 36030368 DOI: 10.1111/joim.13556] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dilated cardiomyopathy (DCM) is typically defined by left ventricular dilation and systolic dysfunction in the absence of a clear precipitant. Idiopathic disease is common; up to 50% of patients with DCM have no cause found despite imaging, genetic and biopsy assessments. Treatment remains focused on managing symptoms, reducing the risk of sudden cardiac death and ameliorating the structural and electrical complications of disease progression. In the absence of aetiology-specific treatments, the condition remains associated with a poor prognosis; mortality is approximately 40% at 10 years. The role of immune-mediated inflammatory injury in the development and progression of DCM was first proposed over 30 years ago. Despite the subsequent failures of three large clinical trials of immunosuppressive treatment (ATTACH, RENEWAL and the Myocarditis Treatment Trial), evidence for an abnormal adaptive immune response in DCM remains significant. In this review, we summarise and discuss available evidence supporting immune dysfunction in DCM, with a specific focus on cellular immunity. We also highlight current clinical and experimental treatments. We propose that the success of future immunosuppressive treatment trials in DCM will be dependent on the deep immunophenotyping of patients, to identify those with active inflammation and/or an abnormal immune response who are most likely to respond to therapy.
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Affiliation(s)
- Daniel Harding
- Centre for Biochemical Pharmacology, William Harvey Research Institute, London, UK
| | - Ming H A Chong
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Nishant Lahoti
- Conquest Hospital, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, UK
| | - Carola M Bigogno
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Roshni Prema
- University Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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20
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Exploring the Role of Obesity in Dilated Cardiomyopathy Based on Bio-informatics Analysis. J Cardiovasc Dev Dis 2022; 9:jcdd9120462. [PMID: 36547458 PMCID: PMC9783214 DOI: 10.3390/jcdd9120462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Obesity is a major risk factor for cardiovascular disease (CVD), contributing to increasing global disease burdens. Apart from heart failure, coronary artery disease, and arrhythmia, recent research has found that obesity also elevates the risk of dilated cardiomyopathy (DCM). The main purpose of this study was to investigate the underlying biological role of obesity in increasing the risk of DCM. (2) Methods: The datasets GSE120895, GSE19303, and GSE2508 were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were analyzed using GSE120895 for DCM and GSE2508 for obesity, and the findings were compiled to discover the common genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted for the common genes in RStudio. In addition, CIBERSORT was used to obtain the immune cellular composition from DEGs. The key genes were identified in the set of common genes by the least absolute shrinkage and selection operator (LASSO) algorithm, the prognostic risk models of which were verified by receiver operator characteristic (ROC) curves in GSE19303. Finally, Spearman's correlation was used to explore the connections between key genes and immune cells. (3) Results: GO and KEGG pathway enrichment analyses showed that the main enriched terms of the common genes were transforming growth factor-beta (TGF-β), fibrillar collagen, NADPH oxidase activity, and multiple hormone-related signaling pathways. Both obesity and DCM had a disordered immune environment, especially obesity. The key genes NOX4, CCDC80, COL1A2, HTRA1, and KLHL29 may be primarily responsible for the changes. Spearman's correlation analysis performed for key genes and immune cells indicated that KLHL29 closely correlated to T cells and M2 macrophages, and HTRA1 very tightly correlated to plasma cells. (4) Conclusions: Bio-informatics analyses performed for DCM and obesity in our study suggested that obesity disturbed the immune micro-environment, promoted oxidative stress, and increased myocardial fibrosis, resulting in ventricular remodeling and an increased risk of DCM. The key genes KLHL29 and HTRA1 may play critical roles in obesity-related DCM.
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21
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Shintani Y, Nakayama T, Masaki A, Yokoi M, Wakami K, Ito T, Goto T, Sugiura T, Inagaki H, Seo Y. Clinical impact of the pathological quantification of myocardial fibrosis and infiltrating T lymphocytes using an endomyocardial biopsy in patients with hypertrophic cardiomyopathy. Int J Cardiol 2022; 362:110-117. [PMID: 35662562 DOI: 10.1016/j.ijcard.2022.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of quantitative pathological findings derived from endomyocardial biopsies (EMB) on clinical prognosis in patients with hypertrophic cardiomyopathy (HCM) remains unclear. METHODS We retrospectively studied 55 consecutive HCM patients who underwent EMB. We quantified the collagen area fraction (CAF), the cardiomyocyte diameter, the nuclear area and circularity, and the number of myocardial infiltrating CD3+ cells using EMB samples by image analyzing software. The primary clinical endpoint was defined as a composite including cardiovascular death, admission due to heart failure and ventricular arrhythmia. RESULTS During the median follow-up of 37.2 months, the primary endpoint was found in 12 patients. No significant difference in the risk score of 5-year sudden cardiac death was observed between the event-occurrence group and the event-free group. In the multivariable Cox proportional-hazard analysis, CAF [hazard ratio (HR) per 10% increase: 1.555, 95% CI: 1.014-2.367, p = 0.044] and the number of infiltrating CD3+ cells (HR per 10% increase: 1.231, 95% CI: 1.011-1.453, p = 0.041) were the independent predictors of the primary endpoint, while the myocardial diameter and the nuclear irregularity had no significant prognostic impact. Kaplan-Meier survival curves demonstrated that patients with both higher CAF and higher number of CD3+ cells had the worst prognosis (log-rank, P < 0.001). CONCLUSIONS The higher CAF and the higher number of infiltrating CD3+ cells quantified using EMB samples were the independent predictors of poor clinical outcomes in patients with HCM. Cardiomyocyte diameter and nuclear irregularity did not significantly impact the clinical prognosis.
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Affiliation(s)
- Yasuhiro Shintani
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
| | - Ayako Masaki
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hiroshi Inagaki
- Department of Pathology and Molecular Diagnostics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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22
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Rasquinha MT, Lasrado N, Petro-Turnquist E, Weaver E, Venkataraman T, Anderson D, Laserson U, Larman HB, Reddy J. PhIP-Seq Reveals Autoantibodies for Ubiquitously Expressed Antigens in Viral Myocarditis. BIOLOGY 2022; 11:biology11071055. [PMID: 36101433 PMCID: PMC9312229 DOI: 10.3390/biology11071055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
Simple Summary Myocarditis is the inflammation of the heart muscle, and viral infections are a common cause of this disease. Myocarditis in some patients can progress to dilated cardiomyopathy (DCM). The mouse model of coxsackievirus B3 (CVB3) is commonly used to understand this disease progression in DCM patients. In this paper, we have attempted to analyze antibodies for heart antigens that could be produced as a result of heart damage in animals infected with CVB3 using a technique called Phage ImmunoPrecipitation Sequencing (PhIP-Seq). The analyses led us to identify antibodies for several proteins that were not previously reported that may have relevance to human disease. Abstract Enteroviruses such as group B coxsackieviruses (CVB) are commonly suspected as causes of myocarditis that can lead to dilated cardiomyopathy (DCM), and the mouse model of CVB3 myocarditis is routinely used to understand DCM pathogenesis. Mechanistically, autoimmunity is suspected due to the presence of autoantibodies for select antigens. However, their role continues to be enigmatic, which also raises the question of whether the breadth of autoantibodies is sufficiently characterized. Here, we attempted to comprehensively analyze the autoantibody repertoire using Phage ImmunoPrecipitation Sequencing (PhIP-Seq), a versatile and high-throughput platform, in the mouse model of CVB3 myocarditis. First, PhIP-Seq analysis using the VirScan library revealed antibody reactivity only to CVB3 in the infected group but not in controls, thus validating the technique in this model. Second, using the mouse peptide library, we detected autoantibodies to 32 peptides from 25 proteins in infected animals that are ubiquitously expressed and have not been previously reported. Third, by using ELISA as a secondary assay, we confirmed antibody reactivity in sera from CVB3-infected animals to cytochrome c oxidase assembly factor 4 homolog (COA4) and phosphoinositide-3-kinase adaptor protein 1 (PIK3AP1), indicating the specificity of antibody detection by PhIP-Seq technology. Fourth, we noted similar antibody reactivity patterns in CVB3 and CVB4 infections, suggesting that the COA4- and PIK3AP1-reactive antibodies could be common to multiple CVB infections. The specificity of the autoantibodies was affirmed with influenza-infected animals that showed no reactivity to any of the antigens tested. Taken together, our data suggest that the autoantibodies identified by PhIP-Seq may have relevance to CVB pathogenesis, with a possibility that similar reactivity could be expected in human DCM patients.
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Affiliation(s)
- Mahima T. Rasquinha
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.T.R.); (N.L.)
| | - Ninaad Lasrado
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.T.R.); (N.L.)
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Erika Petro-Turnquist
- Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (E.P.-T.); (E.W.)
| | - Eric Weaver
- Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (E.P.-T.); (E.W.)
| | - Thiagarajan Venkataraman
- Division of Immunology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA;
| | - Daniel Anderson
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Uri Laserson
- Department of Genetics and Genomic Sciences and Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - H. Benjamin Larman
- Division of Immunology, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA;
- Correspondence: (H.B.L.); (J.R.); Tel.: +1-(410)-614-6525 (H.B.L); +1-(402)-472-8541 (J.R.)
| | - Jay Reddy
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583, USA; (M.T.R.); (N.L.)
- Correspondence: (H.B.L.); (J.R.); Tel.: +1-(410)-614-6525 (H.B.L); +1-(402)-472-8541 (J.R.)
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23
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Ultrasmall Superparamagnetic Particles of Iron Oxide and Cardiac Magnetic Resonance: Novel Imaging in Everyday Conditions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myocardial inflammation has been hypothesised to be the common underlying mechanism through which several cardiovascular diseases develop and progress. Cardiac magnetic resonance (CMR) has become a powerful non-invasive tool that enables the direct visualisation of the myocardium. The emerging use of ultrasmall superparamagnetic particles of iron oxide (USPIO) and their magnetic properties is gaining a lot of research interest. USPIO-enhanced CMR can provide valuable information, as it allows for the identification of active inflammation in the myocardium, a process that has been hypothesised to be the substrate for adverse remodelling and, eventually, heart failure. In this review, we summarise the properties of USPIO and their role in cardiac magnetic resonance imaging as well as their clinical applications.
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24
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Ohta-Ogo K, Sugano Y, Ogata S, Nakayama T, Komori T, Eguchi K, Dohi K, Yokokawa T, Kanamori H, Nishimura S, Nakamura K, Ikeda Y, Nishimura K, Takemura G, Anzai T, Hiroe M, Hatakeyama K, Ishibashi-Ueda H, Imanaka-Yoshida K. Myocardial T-Lymphocytes as a Prognostic Risk-Stratifying Marker of Dilated Cardiomyopathy - Results of the Multicenter Registry to Investigate Inflammatory Cell Infiltration in Dilated Cardiomyopathy in Tissues of Endomyocardial Biopsy (INDICATE Study). Circ J 2022; 86:1092-1101. [PMID: 35264513 DOI: 10.1253/circj.cj-21-0529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) associated with inflammation is diagnosed by endomyocardial biopsy; patients with this have a poorer prognosis than patients without inflammation. To date, standard diagnostic criteria have not been established. METHODS AND RESULTS This study analyzed clinical records and endomyocardial biopsy samples of 261 patients with DCM (201 males, median left ventricular ejection fraction; 28%) from 8 institutions in a multicenter retrospective study. Based on the European Society of Cardiology criteria and CD3 (T-lymphocytes) and CD68 (macrophages) immunohistochemistry, 48% of patients were categorized as having inflammatory DCM. For risk-stratification, we divided patients into 3 groups using Akaike Information Criterion/log-rank tests, which can determine multiple cut-off points: CD3+-Low, <13/mm2(n=178, 68%); CD3+-Moderate, 13-24/mm2(n=58, 22%); and CD3+-High, ≥24/mm2(n=25, 10%). The survival curves for cardiac death or left ventricular assist device implantation differed significantly among the 3 groups (10-year survival rates: CD3+-Low: 83.4%; CD3+-Moderate: 68.4%; CD3+-High: 21.1%; Log-rank P<0.001). Multivariate Cox analysis revealed CD3+count as a potent independent predictive factor for survival (fully adjusted hazard ratio: CD3+-High: 5.70, P<0.001; CD3+-Moderate: 2.64, P<0.01). CD3+-High was also associated with poor left ventricular functional and morphological recovery at short-term follow up. CONCLUSIONS Myocardial CD3+T-lymphocyte infiltration has a significant prognostic impact in DCM and a 3-tiered risk-stratification model could be helpful to refine patient categorization.
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Affiliation(s)
- Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center
| | | | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Takahiro Komori
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | - Kazuo Eguchi
- Department of General Internal Medicine, Saitama Red Cross Hospital
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Shigeyuki Nishimura
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceuticals
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Genzou Takemura
- Department of Internal Medicine, Asahi University School of Dentistry
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Michiaki Hiroe
- Department of Cardiology, National Center for Global Health and Medicine
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center
| | | | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine
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25
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Development and verification of the nomogram for dilated cardiomyopathy gene diagnosis. Sci Rep 2022; 12:8908. [PMID: 35618744 PMCID: PMC9135684 DOI: 10.1038/s41598-022-13135-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a primary myocardial disease of unclear mechanism and poor prevention. The purpose of this study is to explore the potential molecular mechanisms and targets of DCM via bioinformatics methods and try to diagnose and prevent disease progression early. We screened 333 genes differentially expressed between DCM and normal heart samples from GSE141910, and further used Weighted correlation network analysis to identify 197 DCM-related genes. By identifying the key modules in the protein–protein interaction network and Least Absolute Shrinkage and Selection Operator regression analysis, seven hub DCM genes (CX3CR1, AGTR2, ADORA3, CXCL10, CXCL11, CXCL9, SAA1) were identified. Calculating the area under the receiver’s operating curve revealed that these 7 genes have an excellent ability to diagnose and predict DCM. Based on this, we built a logistic regression model and drew a nomogram. The calibration curve showed that the actual incidence is basically the same as the predicted incidence; while the C-index values of the nomogram and the four external validation data sets are 0.95, 0.90, 0.96, and 0.737, respectively, showing excellent diagnostic and predictive ability; while the decision curve indicated the wide applicability of the nomogram is helpful for clinicians to make accurate decisions.
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26
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Zhu T, Wang M, Quan J, Du Z, Li Q, Xie Y, Lin M, Xu C, Xie Y. Identification and Verification of Feature Biomarkers Associated With Immune Cells in Dilated Cardiomyopathy by Bioinformatics Analysis. Front Genet 2022; 13:874544. [PMID: 35646094 PMCID: PMC9133742 DOI: 10.3389/fgene.2022.874544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: To explore immune-related feature genes in patients with dilated cardiomyopathy (DCM). Methods: Expression profiles from three datasets (GSE1145, GSE21610 and GSE21819) of human cardiac tissues of DCM and healthy controls were downloaded from the GEO database. After data preprocessing, differentially expressed genes (DEGs) were identified by the ‘limma’ package in R software. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were then performed to identify biological functions of the DEGs. The compositional patterns of stromal and immune cells were estimated using xCell. Hub genes and functional modules were identified based on protein-protein interaction (PPI) network analysis by STRING webtool and Cytoscape application. Correlation analysis was performed between immune cell subtypes and hub genes. Hub genes with |correlation coefficient| > 0.5 and p value <0.05 were selected as feature biomarkers. A logistic regression model was constructed based on the selected biomarkers and validated in datasets GSE5406 and GSE57338. Results: A total of 1,005 DEGs were identified. Functional enrichment analyses indicated that extracellular matrix remodeling and immune and inflammation disorder played important roles in the pathogenesis of DCM. Immune cells, including CD8+ T-cells, macrophages M1 and Th1 cells, were proved to be significantly changed in DCM patients by immune cell infiltration analysis. In the PPI network analysis, STAT3, IL6, CCL2, PIK3R1, ESR1, CCL5, IL17A, TLR2, BUB1B and MYC were identified as hub genes, among which CCL2, CCL5 and TLR2 were further screened as feature biomarkers by using hub genes and immune cells correlation analysis. A diagnosis model was successfully constructed by using the three biomarkers with area under the curve (AUC) scores 0.981, 0.867 and 0.946 in merged dataset, GSE5406 and GSE57338, respectively. Conclusion: The present study identified three immune-related genes as diagnostic biomarkers for DCM, providing a novel perspective of immune and inflammatory response for the exploration of DCM molecular mechanisms.
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Affiliation(s)
- Tingfang Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingjie Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinwei Quan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zunhui Du
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiheng Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Xie
- Johns Hopkins University, Baltimore, MD, United States
| | - Menglu Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cathy Xu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yucai Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yucai Xie,
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27
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Feldtmann R, Kümmel A, Chamling B, Strohbach A, Lehnert K, Gross S, Loerzer L, Riad A, Lindner D, Westermann D, Fielitz J, Dörr M, Felix SB. Myeloid differentiation factor-2 activates monocytes in patients with dilated cardiomyopathy. Immunology 2022; 167:40-53. [PMID: 35502635 DOI: 10.1111/imm.13490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/21/2022] [Indexed: 11/27/2022] Open
Abstract
Plasma levels of myeloid differentiation factor-2 (MD-2), a co-receptor of toll-like-receptor 4 (TLR4), independently predict mortality in patients with dilated cardiomyopathy (DCM). We tested whether monocyte-activation by MD-2 contributes to immune activation and inflammatory status in DCM patients. We found increased MD-2 plasma-levels in 25 patients with recent-onset DCM (1,250±80.7 ng/ml) compared to 25 age- and gender-matched healthy controls (793.4±52.0 ng/ml; p<0.001). Monocytes isolated from DCM-patients showed a higher expression (141.7±12.4 %; p=0.006 vs. controls) of the MD-2 encoding gene, LY96, and an increased NF-κB-activation. Further, the TLR4-activator lipopolysaccharide (LPS) caused a higher increase in interleukin (IL)-6 in monocytes from DCM-patients compared to controls (mean fluorescence intensity: 938.7±151.0 vs. 466.9±51.1; p=0.005). MD-2 increased IL-6 secretion in a TLR4/NF-κB-dependent manner in monocyte-like THP-1-cells as demonstrated by TLR4-siRNA and NF-κB-inhibition. Since endothelial cells (ECs) are responsible for recruiting monocytes to the site of inflammation, ECs were treated with MD-2 leading to an activation of Akt and increased secretion of monocyte-chemoattractant-protein-1 (MCP-1). Activation of ECs by MD-2 was accompanied by an increased expression of the adhesion-molecules CD54, CD106, and CD62E, resulting in an increased monocyte-recruitment, which was attenuated by CD54-inhibition. In addition, in murine WT but not LY96-KO bone marrow-derived macrophages LPS increased the amount of CD54 and CD49d/CD29. MD-2 facilitates a pro-inflammatory status of monocytes and EC-mediated monocyte-recruitment via TLR4/NF-κB. Elevated MD-2 plasma-levels are possibly involved in monocyte-related inflammation promoting disease-progression in DCM. Our results suggest that MD-2 contributes to increasing monocytic inflammatory activity and triggers recruitment of monocytes to ECs in DCM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rico Feldtmann
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Andreas Kümmel
- 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
| | - Anne Strohbach
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Kristin Lehnert
- 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
| | - Lisa Loerzer
- Department of Internal Medicine B, Cardiology, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Germany
| | - Alexander Riad
- DRK-Krankenhaus Teterow gGMBH, Internal Medicine, Teterow, Germany
| | - Diana Lindner
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, 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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28
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Koga-Ikuta A, Fukushima S, Ishibashi-Ueda H, Tadokoro N, Kakuta T, Watanabe T, Fukushima N, Suzuki K, Fukui T, Fujita T. Immunocompetent cells in durable ventricular assist device-implanted non-ischaemic dilated cardiomyopathy. Gen Thorac Cardiovasc Surg 2022; 70:685-693. [PMID: 35229229 PMCID: PMC9300518 DOI: 10.1007/s11748-022-01773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Objective Because the presence of immunocompetent cells in the myocardium is associated with the pathological stage and/or myocardial viability, we explored relationships between functional recovery after left ventricular assist device implantation and the distribution of immunocompetent cells in non-ischaemic dilated cardiomyopathy patients. Methods We reviewed 50 consecutive dilated cardiomyopathy patients implanted with HeartMate II at our institute between April 2013 and December 2018 who were treated with optimal medical therapy during left ventricular assist device support. Patients were stratified by improvement of the left ventricular ejection fraction at 6 months after implantation: ≥ 10% increase (Gr ≥ 10%), 5–10% (Gr 5–10%), and ≤ 5% (Gr ≤ 5%). T cells and macrophages were evaluated in the apical myocardium after left ventricular assist device implantation. Results During left ventricular assist device support, 12 patients underwent heart transplantation and 2 patients died. Four patients with Gr ≤ 5% were readmitted because of congestive heart failure, but none with Gr ≥ 10%. Macrophages and T cells in the left ventricular myocardium with Gr ≥ 10% were significantly more present compared to those in other groups. Conclusions The distribution of immunocompetent cells in the left ventricular myocardium might predict myocardial viability of this pathology after implantation.
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Affiliation(s)
- Ayumi Koga-Ikuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | | | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takurya Watanabe
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Norihide Fukushima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ken Suzuki
- Translational Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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29
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Ammirati E, Buono A, Moroni F, Gigli L, Power JR, Ciabatti M, Garascia A, Adler ED, Pieroni M. State-of-the-Art of Endomyocardial Biopsy on Acute Myocarditis and Chronic Inflammatory Cardiomyopathy. Curr Cardiol Rep 2022; 24:597-609. [PMID: 35201561 PMCID: PMC8866555 DOI: 10.1007/s11886-022-01680-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 12/11/2022]
Abstract
Purpose of Review Histologic evidence of myocardial inflammatory infiltrate not secondary to an ischemic injury is required by current diagnostic criteria to reach a definite diagnosis of myocarditis. Endomyocardial biopsy (EMB) is therefore often indicated for the diagnosis of myocarditis, although it may lack sufficient sensitivity considering the limited possibility of myocardial sampling. Improving the diagnostic yield and utility of EMB is of high priority in the fields of heart failure cardiology and myocarditis in particular. The aim of the present review is to highlight indications, strengths, and shortcomings of current EMB techniques, and discuss innovations currently being tested in ongoing clinical studies, especially in the setting of acute myocarditis and chronic inflammatory cardiomyopathy. Recent Findings EMB provides unique diagnostic elements and prognostic information which can effectively guide the treatment of myocarditis. Issues affecting the diagnostic performance in the setting of acute myocarditis and chronic inflammatory cardiomyopathies will be discussed in this review in the light of recent expert consensus documents on the management of these conditions and on indication to EMB. Recent innovations using electroanatomic mapping (EAM)-guided EMB and fluoroscopic-guided EMB during temporary mechanical circulatory support have improved the utility of the procedure. Summary EMB remains an important diagnostic test whose results need to be interpreted in the context of (1) clinical pre-test probability, (2) timing of sampling, (3) quality of sampling (4) site of sampling, (5) histologic type of myocarditis, and (6) analytic methods that are applied. Herein we will review these caveats as well as perspectives and innovations related to the use of this diagnostic tool.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis" Cardio Center and Transplant Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza, Brescia, Italy
| | | | - Lorenzo Gigli
- De Gasperis" Cardio Center and Transplant Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - John R Power
- Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Michele Ciabatti
- Cardiovascular Department, ASL8 Arezzo San Donato Hospital, Arezzo, Italy
| | - Andrea Garascia
- De Gasperis" Cardio Center and Transplant Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Maurizio Pieroni
- Cardiovascular Department, ASL8 Arezzo San Donato Hospital, Arezzo, Italy
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30
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Zhang W, Chen Z, Qiao S, Chen S, Zheng H, Wei X, Li Q, Xu B, Huang W. The effects of extracellular vesicles derived from Krüppel-Like Factor 2 overexpressing endothelial cells on the regulation of cardiac inflammation in the dilated cardiomyopathy. J Nanobiotechnology 2022; 20:76. [PMID: 35139878 PMCID: PMC8827179 DOI: 10.1186/s12951-022-01284-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/23/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is one of the common causes of heart failure. Myocardial injury triggers an inflammatory response and recruits immune cells into the heart. High expression of Krüppel-like factor 2 (KLF2) in endothelial cells (ECs) potentially exerts an anti-inflammatory effect. However, the role of extracellular vesicles (EVs) from KLF2-overexpressing ECs (KLF2-EVs) in DCM remains unclear. METHODS AND RESULTS EVs were separated from the supernatant of KLF2-overexpressing ECs by gradient centrifugation. Mice were repeatedly administered low-dose doxorubicin (DOX) and then received KLF2-EVs through an intravenous injection. Treatment with KLF2-EVs prevented doxorubicin-induced left ventricular dysfunction and reduced the recruitment of Ly6high Mo/Mø in the myocardium. We used flow cytometry to detect Ly6high monocytes in bone marrow and spleen tissues and to elucidate the mechanisms underlying this beneficial effect. KLF2-EVs increased the retention of Ly6Chigh monocytes in the bone marrow but not in the spleen tissue. KLF2-EVs also significantly downregulated C-C chemokine receptor 2 (CCR2) protein expression in cells from the bone marrow. CONCLUSIONS EVs derived from KLF2-overexpressing ECs reduced cardiac inflammation and ameliorated left ventricular dysfunction in DCM mice by targeting the CCR2 protein to inhibit Ly6Chigh monocyte mobilization from the bone marrow.
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Affiliation(s)
- Wenfeng Zhang
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Ziwei Chen
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Shuaihua Qiao
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Siyuan Chen
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Hongyan Zheng
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Xuan Wei
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Qiaoling Li
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
| | - Biao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China. .,Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
| | - Wei Huang
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
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31
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Vander Heide RS. Diffuse mononuclear inflammatory response to COVID-19: Friendly fire or smoldering enemy? Cardiovasc Pathol 2022; 58:107416. [PMID: 35134567 PMCID: PMC8817453 DOI: 10.1016/j.carpath.2022.107416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Richard S Vander Heide
- Service Line Medical Director of Pathology and Laboratory Medicine, Marshfield Clinic Health System, Marshfield, Wisconsin, United States.
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32
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Yokouchi-Konishi T, Ohta-Ogo K, Kamiya CA, Shionoiri T, Nakanishi A, Iwanaga N, Ohuchi H, Kurosaki K, Ichikawa H, Noguchi T, Ishibashi-Ueda H, Yoshimatsu J. Clinicopathologic Study of Placentas From Women With a Fontan Circulation. Circ J 2021; 86:138-146. [PMID: 34497162 DOI: 10.1253/circj.cj-21-0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pregnant women with a Fontan circulation have a high risk of obstetric complications, such as preterm delivery and small for gestational age (SGA), which may be affected by low blood flow to the placenta and hypoxia. This study investigated placental pathology in a Fontan circulation. METHODS AND RESULTS Eighteen pregnancies in 11 women with a Fontan circulation were reviewed. Pregnancy outcomes showed 9 miscarriages and 9 live births, with 4 preterm deliveries. Five neonates were SGA (<5th percentile). Eight placentas from live births in 7 women were available for the study. Five placentas had low weight placenta for gestational age, and 7 grossly showed a chronic subchorionic hematoma. Histological examination revealed all placentas had some form of histological hypoxic lesions: maternal vascular malperfusion in 7, fetal vascular malperfusion in 1, and other hypoxia-related lesions in 8. Quantitative analyses, including immunohistochemistry (CD31, CD68, and hypoxia inducible factor-1α antibodies) and Masson's trichrome staining, were also performed and compared with 5 control placentas. Capillary density and the area of fibrosis were significantly greater in placentas from women with a Fontan circulation than in control placentas. CONCLUSIONS Placentas in a Fontan circulation were characterized by a high frequency of low placental weight, chronic subchorionic hematoma, and constant histological hypoxic changes, which could reflect altered maternal cardiac conditions and lead to poor pregnancy outcomes.
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Affiliation(s)
- Tae Yokouchi-Konishi
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center
| | - Chizuko A Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Tadasu Shionoiri
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Atsushi Nakanishi
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Naoko Iwanaga
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Hideo Ohuchi
- Department of Pediatrics Cardiology, National Cerebral and Cardiovascular Center
| | - Kenichi Kurosaki
- Department of Pediatrics Cardiology, National Cerebral and Cardiovascular Center
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center
- NCVC Biobank, National Cerebral and Cardiovascular Center
| | - Jun Yoshimatsu
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
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33
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Pereira JDJ, Ikegami RN, Kawakami JT, Garavelo SM, Reis MM, Palomino SAP, Mangini S, Moreno CR, de Barros SF, Souza AR, Higuchi MDL. Distinct Microbial Communities in Dilated Cardiomyopathy Explanted Hearts Are Associated With Different Myocardial Rejection Outcomes. Front Cell Infect Microbiol 2021; 11:732276. [PMID: 34912727 PMCID: PMC8668412 DOI: 10.3389/fcimb.2021.732276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Background Idiopathic dilated cardiomyopathy (IDCM) myocardial inflammation may be associated with external triggering factors such as infectious agents. Here, we searched if moderate/severe heart transplantation rejection is related to the presence of myocardial inflammation in IDCM explanted hearts, associated with microbial communities. Method Receptor myocardial samples from 18 explanted hearts were separated into groups according to post-transplant outcome: persistent moderate rejection (PMR; n = 6), moderate rejection (MR; n = 7) that regressed after pulse therapy, and no rejection (NR; n = 5)/light intensity rejection. Inflammation was quantified through immunohistochemistry (IHC), and infectious agents were evaluated by IHC, molecular biology, in situ hybridization technique, and transmission electron microscopy (TEM). Results NR presented lower numbers of macrophages, as well as B cells (p = 0.0001), and higher HLA class II expression (p ≤ 0.0001). PMR and MR showed higher levels of Mycoplasma pneumoniae (p = 0.003) and hepatitis B core (p = 0.0009) antigens. NR presented higher levels of parvovirus B19 (PVB19) and human herpes virus 6 (HHV6) and a positive correlation between Borrelia burgdorferi (Bb) and enterovirus genes. Molecular biology demonstrated the presence of M. pneumoniae, Bb, HHV6, and PVB19 genes in all studied groups. TEM revealed structures compatible with the cited microorganisms. Conclusions This initial study investigating on infectious agents and inflammation in the IDCM explanted hearts showed that the association between M. pneumoniae and hepatitis B core was associated with a worse outcome after HT, represented by MR and PMR, suggesting that different IDCM microbial communities may be contributing to post-transplant myocardial rejection.
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Affiliation(s)
- Jaqueline de Jesus Pereira
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Renata Nishiyama Ikegami
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Joyce Tiyeko Kawakami
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Shérrira Menezes Garavelo
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Martins Reis
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Suely Aparecida Pinheiro Palomino
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Sandrigo Mangini
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila Rodrigues Moreno
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Samar Freschi de Barros
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Aline Rodrigues Souza
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Maria de Lourdes Higuchi
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Patologia Cardíaca, Departamento de Patologia, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
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34
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Affiliation(s)
- Melina Müller
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Leslie T Cooper
- Department of Cardiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bettina Heidecker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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35
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Goldman BI, Choung HY, Sainvil M, Miller CW. The spectrum of macrophage-predominant inflammatory myocardial disease presenting as fulminant heart failure. Cardiovasc Pathol 2021; 57:107393. [PMID: 34699976 DOI: 10.1016/j.carpath.2021.107393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endomyocardial biopsy results are integral for diagnosis and management of myocarditis. Current diagnostic classifications of myocarditis are based on the microscopic and immunochemical characterization of inflammation do not include monocyte/macrophage-predominant (i.e. "histiocytic") myocarditis as a histologic subtype. METHODS Endomyocardial biopsies from 6 patients with sudden heart failure were reviewed by 3 cardiac pathologists. Routine stains and immunostains to identify T cells and monocytes/macrophages, complement C4d, and endothelium were applied. Electron microscopy was performed in 2 cases. RESULTS The 6 patients included 2 with diagnoses of systemic lupus erythematosus (SLE) and 4 without known disease. Microscopy showed space-occupying inflammation in 2 cases and interstitial inflammation in 4. No giant cell myocarditis or eosinophilic myocarditis was found. Immunostains showed infiltration predominantly by macrophages and/or monocytes with markedly fewer T cells. In 4 of 6 cases necrotic cells were immunopositive for complement C4d. Monocytes we identified immunochemically within the microvasculature in 5 cases and by electron microscopy in 2. Patients with SLE had microvascular C4d positivity or interstitial/sarcolemmal staining. Clinical outcomes ranged from spontaneous resolution to persistent heart failure requiring an internal cardioverter/defibrillator. CONCLUSIONS (1) Heart failure with CD68 predominant inflammation ("histiocytic" myocardial inflammatory disease, HMID) occurs with variable clinical presentation and outcome; (2) HMID may be primary or secondary; (3) some cases of HMID show features suggestive of antibody and/or complement mediated myocardial injury, and (4) HMID is a diagnosis distinct from those in classification systems currently in use.
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36
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Inflammation-Related Biomarkers Are Associated with Heart Failure Severity and Poor Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy. Life (Basel) 2021; 11:life11101006. [PMID: 34685378 PMCID: PMC8540264 DOI: 10.3390/life11101006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Inflammation-related biomarkers are associated with clinical outcomes in mixed-etiology chronic heart failure populations. Inflammation-related markers tend to be higher in ischemic than in non-ischemic dilated cardiomyopathy (NI-DCM) patients, which might impact their prognostic performance in NI-DCM patients. Therefore, we aimed to assess the association of inflammation-related biomarkers with heart failure severity parameters and adverse cardiac events in a pure NI-DCM patient cohort. Fifty-seven patients with NI-DCM underwent endomyocardial biopsy. Biopsies were evaluated by immunohistochemistry for CD3+, CD45ro+, CD68+, CD4+, CD54+, and HLA-DR+ cells. Blood samples were tested for high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-α (TNF-α), soluble urokinase-type plasminogen activator receptor and adiponectin. During a five-year follow-up, twenty-seven patients experienced at least one composite adverse cardiac event: left ventricle assist device implantation, heart transplantation or death. Interleukin-6, TNF-α and adiponectin correlated with heart failure severity parameters. Patients with higher levels of interleukin-6, TNF-α, adiponectin or hs-CRP, or a higher number of CD3+ or CD45ro+ cells, had lower survival rates. Interleukin-6, adiponectin, and CD45ro+ cells were independently associated with poor clinical outcomes. All patients who had interleukin-6, TNF-α and adiponectin concentrations above the threshold experienced an adverse cardiac event. Therefore, a combination of these cytokines can identify high-risk NI-DCM patients.
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37
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Hirono K, Takarada S, Okabe M, Miyao N, Nakaoka H, Ibuki K, Ozawa S, Origasa H, Ichida F, Imanaka-Yoshida K. Clinical significance of chronic myocarditis: systematic review and meta-analysis. Heart Vessels 2021; 37:300-314. [PMID: 34365565 DOI: 10.1007/s00380-021-01914-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Chronic myocarditis is a prolonged inflammatory condition in the myocardium and its histological manifestation is defined by the presence of an inflammatory infiltrate. Chronic myocarditis has not been well known and its treatment of chronic myocarditis has not been established. Primary outcome of this study was to assess the efficacy of immunomodulatory treatment in addition to conventional treatment, and secondary outcomes were to clarity the prognosis of natural history of chronic myocarditis and incidence of chronic myocarditis in patients with dilated cardiomyopathy (DCM). We searched for studies in Medline, Embase, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi published between January 1946 and June 2020. Sixteen studies met the inclusion criteria. A meta-analysis revealed that patients receiving immunomodulatory treatment showed an improvement in left ventricular ejection fraction after immunomodulatory treatment compared to the control group (hazard ratio, 16.65; confidence interval, 4.55-28.74; p = 0.007). Five-year survival rate of the patients with inflammatory DCM (iDCM) and DCM was 52.7-70.3% and 51.9-91.1%, respectively. Moreover, 51.5%-62.7% of patients with DCM met the criteria of iDCM. Our systematic review revealed that patients with chronic myocarditis had poor prognosis and immunomodulatory treatment was significantly effective in addition to conventional treatment.
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Affiliation(s)
- Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Shinya Takarada
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Mako Okabe
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Nariaki Miyao
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Hideyuki Nakaoka
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Keijiro Ibuki
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Sayaka Ozawa
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Hideki Origasa
- Biostatistics and Clinical Epidemiology, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health&Welfare, Tokyo, Japan
| | - Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Mie, Japan
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Cellular pathology of the human heart in Duchenne muscular dystrophy (DMD): lessons learned from in vitro modeling. Pflugers Arch 2021; 473:1099-1115. [DOI: 10.1007/s00424-021-02589-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023]
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Imanaka-Yoshida K. Tenascin-C in Heart Diseases-The Role of Inflammation. Int J Mol Sci 2021; 22:ijms22115828. [PMID: 34072423 PMCID: PMC8198581 DOI: 10.3390/ijms22115828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022] Open
Abstract
Tenascin-C (TNC) is a large extracellular matrix (ECM) glycoprotein and an original member of the matricellular protein family. TNC is transiently expressed in the heart during embryonic development, but is rarely detected in normal adults; however, its expression is strongly up-regulated with inflammation. Although neither TNC-knockout nor -overexpressing mice show a distinct phenotype, disease models using genetically engineered mice combined with in vitro experiments have revealed multiple significant roles for TNC in responses to injury and myocardial repair, particularly in the regulation of inflammation. In most cases, TNC appears to deteriorate adverse ventricular remodeling by aggravating inflammation/fibrosis. Furthermore, accumulating clinical evidence has shown that high TNC levels predict adverse ventricular remodeling and a poor prognosis in patients with various heart diseases. Since the importance of inflammation has attracted attention in the pathophysiology of heart diseases, this review will focus on the roles of TNC in various types of inflammatory reactions, such as myocardial infarction, hypertensive fibrosis, myocarditis caused by viral infection or autoimmunity, and dilated cardiomyopathy. The utility of TNC as a biomarker for the stratification of myocardial disease conditions and the selection of appropriate therapies will also be discussed from a clinical viewpoint.
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Affiliation(s)
- Kyoko Imanaka-Yoshida
- Department of Pathology and Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan;
- Mie University Research Center for Matrix Biology, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan
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40
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Seferović PM, Tsutsui H, McNamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy. Eur J Heart Fail 2021; 23:854-871. [PMID: 34010472 DOI: 10.1002/ejhf.2190] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M McNamara
- Heart and Vascur Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin, Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy.,Cardiology Clinical Academic Group, St George's Hospitals NHS Trust, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
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Seferović PM, Tsutsui H, Mcnamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association, Heart Failure Society of America, and Japanese Heart Failure Society Position Statement on Endomyocardial Biopsy. J Card Fail 2021; 27:727-743. [PMID: 34022400 DOI: 10.1016/j.cardfail.2021.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumors. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples has significantly improved the diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (1) an overview of the practical approach to EMB, (2) an update on indications for EMB, (3) a revised plan for heart transplant rejection surveillance, (4) the impact of multimodality imaging on EMB, and (5) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M Mcnamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy, and Cardiology Clinical Academic Group, St George's Hospitals NHS Trust
| | - Andrew J S Coats
- Monash University, Australia, and University of Warwick, Coventry, UK
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Reichman-Warmusz E, Nowak J, Kaczmarek K, Nowalany-Kozielska E, Wojnicz R. Impact of cellular myocardial infiltration on clinical outcome in non-ischaemic heart failure. J Clin Pathol 2021; 75:30-33. [PMID: 33785545 DOI: 10.1136/jclinpath-2020-206964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
AIMS So far, little has been known on whether myocardial inflammatory infiltration influences heart failure (HF) progression. Thus, the aim of this study was to test the impact of intramyocardial infiltration on clinical outcomes. METHODS Biopsy samples from 358 patients with stable HF secondary to dilated cardiomyopathy were studied. Immunohistochemistry for lymphocyte (CD3) and macrophage (CD68) markers was performed and counted. After a 1-year follow-up, patients were classified as improved based on the predefined definition of improvement. The clinical data were collected from 324 patients (90.5%). RESULTS According to the predefined definition of improvement, 133 patients improved (41.0%) but 191 remained unchanged or deteriorated (58.9%). After a 12-month follow-up, the OR with 95% CI of counts of myocardial inflammatory CD68-positive ≥4 cell/high power field (HPF) compared with CD68-positive <4 cell/HPF for lack of improvement was 1.91 (1.65-2.54). However, the number of CD3 positive cell infiltration had no impact on clinical outcome after a 1-year follow-up. In the baseline study, a reasonably negative correlation was found between the number of CD68 positive cells and troponin T (r=-0.39; p<0.001 by Spearman's r). This was corroborated with a low negative correlation between these cells and myocardial form of creatine kinase (CK-MB) fraction (r=-0.27; p=0.006). There was no correlation between CD3 and CD68 positive cells (Spearman's r; r=-0.17, p=0.16). CONCLUSIONS The current results provide evidence that high macrophage counts may be a predisposing factor for HF progression.
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Affiliation(s)
- Edyta Reichman-Warmusz
- Department of Histology and Cell Pathology in Zabrze, Medical University of Silesia, Katowice, Slaskie, Poland
| | - Jolanta Nowak
- 3rd Department of Cardiology in Zabrze, Medical University of Silesia, Katowice, Slaskie, Poland
| | - Krzysztof Kaczmarek
- Department of Electrocardiology, Medical University of Lodz, Lodz, Lodzkie, Poland
| | | | - Romuald Wojnicz
- Department of Histology and Cell Pathology in Zabrze, Medical University of Silesia, Katowice, Slaskie, Poland
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Lin KB, Chen KK, Li S, Cai MQ, Yuan MJ, Wang YP, Zhang X, Wei M, Yan ML, Ma XX, Zheng DY, Wu QH, Li JB, Huang D. Impaired Left Atrial Performance Resulting From Age-Related Arial Fibrillation Is Associated With Increased Fibrosis Burden: Insights From a Clinical Study Combining With an in vivo Experiment. Front Cardiovasc Med 2021; 7:615065. [PMID: 33634168 PMCID: PMC7901954 DOI: 10.3389/fcvm.2020.615065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Atrial fibrillation (AF) is increasingly considered an age-related degenerative disease, whose process is associated with the development of impaired left atrial (LA) performance. However, the subtle dynamic changes of LA performance in AF during aging have yet to be fully elucidated. Atrial fibrosis is a key substrate for the development of AF, but the progression of fibrosis during aging and its relationship with LA dysfunction need to be further explored. Methods: A total of 132 control individuals and 117 persistent AF patients were prospectively studied. Subjects were further stratified into three age groups (age group 1: younger than 65 years, age group 2: between 65 and 79 years old, and age group 3: older than 80 years). The two-dimensional speckle tracking imaging was carried out for analyzing the alterations in LA function underlying LA remodeling, whereas electroanatomic mapping was performed to investigate LA fibrosis burden. In animal study, aged mice and young mice served as research subjects. Echocardiography and histological staining were used to assess LA performance and fibrosis burden, respectively. Results: Echocardiography showed progressive increases in LA dimension and LA stiffness index, and progressive decreases in LA global longitudinal strain and LA strain rates with advancing age in both AF and control cohorts, which was more prominent in AF cohort. Electroanatomic mapping showed progressive decrease in mean LA voltage and progressive increases in LA surface area, low-voltage area %, and LA volume with advancing age, whereas more significant alterations were observed in AF patients. Moreover, left atrial global longitudinal strain was positively correlated with mean LA voltage, whereas LA stiffness index was negatively related to mean LA voltage. In animal experiment, increased LA size and pulmonary artery dimension as well as longer P-wave duration and more prominent LA fibrosis were found in aged mice. Conclusions: This study provides new evidence of subtle changes in structure and performance of left atrium and their association with atrial fibrosis in both AF and non-AF subjects during physiological aging. In addition, our study also provides normal values for LA structure and performance in both AF and non-AF conditions during aging. These measurements may provide an early marker for onset of AF and LA adverse remodeling.
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Affiliation(s)
- Kai-Bin Lin
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Kan-Kai Chen
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuai Li
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ming-Qi Cai
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min-Jie Yuan
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan-Peng Wang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xue Zhang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Meng Wei
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mei-Ling Yan
- Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Xin-Xin Ma
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dong-Yan Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qi-Han Wu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Jing-Bo Li
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dong Huang
- Heart Center, Shanghai Jiaotong University Affiliated Sixth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Weckbach LT, Curta A, Bieber S, Kraechan A, Brado J, Hellmuth JC, Muenchhoff M, Scherer C, Schroeder I, Irlbeck M, Maurus S, Ricke J, Klingel K, Kääb S, Orban M, Massberg S, Hausleiter J, Grabmaier U. Myocardial Inflammation and Dysfunction in COVID-19-Associated Myocardial Injury. Circ Cardiovasc Imaging 2021; 14:e012220. [PMID: 33463366 DOI: 10.1161/circimaging.120.011713] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Myocardial injury, defined by elevated troponin levels, is associated with adverse outcome in patients with coronavirus disease 2019 (COVID-19). The frequency of cardiac injury remains highly uncertain and confounded in current publications; myocarditis is one of several mechanisms that have been proposed. METHODS We prospectively assessed patients with myocardial injury hospitalized for COVID-19 using transthoracic echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy. RESULTS Eighteen patients with COVID-19 and myocardial injury were included in this study. Echocardiography revealed normal to mildly reduced left ventricular ejection fraction of 52.5% (46.5%-60.5%) but moderately to severely reduced left ventricular global longitudinal strain of -11.2% (-7.6% to -15.1%). Cardiac magnetic resonance showed any myocardial tissue injury defined by elevated T1, extracellular volume, or late gadolinium enhancement with a nonischemic pattern in 16 patients (83.3%). Seven patients (38.9%) demonstrated myocardial edema in addition to tissue injury fulfilling the Lake-Louise criteria for myocarditis. Combining cardiac magnetic resonance with speckle tracking echocardiography demonstrated functional or morphological cardiac changes in 100% of investigated patients. Endomyocardial biopsy was conducted in 5 patients and revealed enhanced macrophage numbers in all 5 patients in addition to lymphocytic myocarditis in 1 patient. SARS-CoV-2 RNA was not detected in any biopsy by quantitative real-time polymerase chain reaction. Finally, follow-up measurements of left ventricular global longitudinal strain revealed significant improvement after a median of 52.0 days (-11.2% [-9.2% to -14.7%] versus -15.6% [-12.5% to -19.6%] at follow-up; P=0.041). CONCLUSIONS In this small cohort of COVID-19 patients with elevated troponin levels, myocardial injury was evidenced by reduced echocardiographic left ventricular strain, myocarditis patterns on cardiac magnetic resonance, and enhanced macrophage numbers but not predominantly lymphocytic myocarditis in endomyocardial biopsies.
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Affiliation(s)
- Ludwig T Weckbach
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, Ludwig-Maximilians-University, Planegg-Martinsried, Germany (L.T.W.).,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Adrian Curta
- Department of Radiology (A.C., S. Maurus, J.R.), Ludwig-Maximilians-University, Munich, Germany
| | - Stephanie Bieber
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Angelina Kraechan
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Johannes Brado
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany
| | - Johannes C Hellmuth
- Medical Department III (J.C.H.), Ludwig-Maximilians-University, Munich, Germany.,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Maximilian Muenchhoff
- COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.).,Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Faculty of Medicine, LMU München, Munich, Germany (M.M.)
| | - Clemens Scherer
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Ines Schroeder
- Department of Anaesthesiology (I.S., M.I.), Ludwig-Maximilians-University, Munich, Germany
| | - Michael Irlbeck
- Department of Anaesthesiology (I.S., M.I.), Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Maurus
- Department of Radiology (A.C., S. Maurus, J.R.), Ludwig-Maximilians-University, Munich, Germany
| | - Jens Ricke
- Department of Radiology (A.C., S. Maurus, J.R.), Ludwig-Maximilians-University, Munich, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Germany (K.K.)
| | - Stefan Kääb
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
| | - Mathias Orban
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.)
| | - Steffen Massberg
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.)
| | - Jörg Hausleiter
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.)
| | - Ulrich Grabmaier
- Medical Department I (L.T.W., S.B., A.K., J.B., C.S., S.K., M.O., S. Massberg, J.H., U.G.), Ludwig-Maximilians-University, Munich, Germany.,German Centre for Cardiovascular Research, Partner Site Munich, Germany (L.T.W., C.S., S.K., M.O., S. Massberg, J.H., U.G.).,COVID-19 Registry of the LMU Munich, University Hospital, LMU Munich, Germany (L.T.W., S.B., A.K., J.C.H., M.M., C.S., S.K., U.G.)
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High-Density Lipoprotein-Targeted Therapies for Heart Failure. Biomedicines 2020; 8:biomedicines8120620. [PMID: 33339429 PMCID: PMC7767106 DOI: 10.3390/biomedicines8120620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023] Open
Abstract
The main and common constituents of high-density lipoproteins (HDLs) are apolipoprotein A-I, cholesterol, and phospholipids. Biochemical heterogeneity of HDL particles is based on the variable presence of one or more representatives of at least 180 proteins, 200 lipid species, and 20 micro RNAs. HDLs are circulating multimolecular platforms that perform divergent functions whereby the potential of HDL-targeted interventions for treatment of heart failure can be postulated based on its pleiotropic effects. Several murine studies have shown that HDLs exert effects on the myocardium, which are completely independent of any impact on coronary arteries. Overall, HDL-targeted therapies exert a direct positive lusitropic effect on the myocardium, inhibit the development of cardiac hypertrophy, suppress interstitial and perivascular myocardial fibrosis, increase capillary density in the myocardium, and prevent the occurrence of heart failure. In four distinct murine models, HDL-targeted interventions were shown to be a successful treatment for both pre-existing heart failure with reduced ejection fraction (HFrEF) and pre-existing heart failure with preserved ejection fraction (HFrEF). Until now, the effect of HDL-targeted interventions has not been evaluated in randomized clinical trials in heart failure patients. As HFpEF represents an important unmet therapeutic need, this is likely the preferred therapeutic domain for clinical translation.
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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: 361] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [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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Cha MJ, Seo JW, Oh S, Park EA, Lee SH, Kim MY, Park JY. Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy. J Pathol Transl Med 2020; 54:396-410. [PMID: 32717775 PMCID: PMC7483025 DOI: 10.4132/jptm.2020.06.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The definitive pathologic diagnosis of cardiac sarcoidosis requires observation of a granuloma in the myocardial tissue. It is common, however, to receive a "negative" report for a clinically probable case. We would like to advise pathologists and clinicians on how to interpret "negative" biopsies. METHODS Our study samples were 27 endomyocardial biopsies from 25 patients, three cardiac transplantation and an autopsied heart with suspected cardiac sarcoidosis. Pathologic, radiologic, and clinical features were compared. RESULTS The presence of micro-granulomas or increased histiocytic infiltration was always (6/6 or 100%) associated with fatty infiltration and confluent fibrosis, and they showed radiological features of sarcoidosis. Three of five cases (60%) with fatty change and confluent fibrosis were probable for cardiac sarcoidosis on radiology. When either confluent fibrosis or fatty change was present, one-third (3/9) were radiologically probable for cardiac sarcoidosis. We interpreted cases with micro-granuloma as positive for cardiac sarcoidosis (five of 25, 20%). Cases with both confluent fibrosis and fatty change were interpreted as probable for cardiac sarcoidosis (seven of 25, 28%). Another 13 cases, including eight cases with either confluent fibrosis or fatty change, were interpreted as low probability based on endomyocardial biopsy. CONCLUSIONS The presence of micro-granuloma could be an evidence for positive diagnosis of cardiac sarcoidosis. Presence of both confluent fibrosis and fatty change is necessary for probable cardiac sarcoidosis in the absence of granuloma. Either of confluent fibrosis or fatty change may be an indirect pathological evidence but they are interpreted as nonspecific findings.
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Affiliation(s)
- Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Wook Seo
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine and Interdisciplinary Program for Bioengineering, Seoul National University College of Medicine, Seoul, Korea.,Cardiology Division, Cardiovascular Center, and Cardiac Electrophysiology Lab, Seoul National University Hospital, Seoul, Korea
| | - Eun-Ah Park
- Division of Cardiovascular Imaging, Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sang-Han Lee
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Pathology, Kyungpook National University Hospital, Daegu, Korea
| | - Moon Young Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Young Park
- Department of Pathology, Sejong Hospital, Bucheon, Korea
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Yoshizawa S, Uto K, Nishikawa T, Hagiwara N, Oda H. Histological features of endomyocardial biopsies in patients undergoing hemodialysis: Comparison with dilated cardiomyopathy and hypertensive heart disease. Cardiovasc Pathol 2020; 49:107256. [PMID: 32721819 DOI: 10.1016/j.carpath.2020.107256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Heart failure is a frequently occurring complication in patients on maintenance hemodialysis (HD). However, the histological features of right ventricular endomyocardial biopsy (RVEMB) samples remain unclear. METHODS The clinical characteristics and histological findings of consecutive patients undergoing HD with available RVEMB samples (HD group; n=28) were retrospectively compared with those of patients with dilated cardiomyopathy (n=56) and hypertensive heart disease (n=15). RESULTS The mean myocyte diameter was significantly larger in the HD group than in the other groups (P<.001), whereas the mean percent area of fibrosis did not differ among the three groups. Immunohistochemical analysis revealed that the capillary density was significantly lower in the HD group compared with the other groups (P<.001), and it was positively associated with left ventricular ejection fraction (P=.014). The number of CD68-positive macrophages, which was significantly higher in the HD group compared with the other two groups (P<.001), was associated with cardiovascular mortality (P=.020; log-rank test). CONCLUSIONS Myocyte hypertrophy, macrophage infiltration, and reduced capillary density were characteristic histological features of the RVEMB samples in patients undergoing HD, which may be related to the pathogenesis of cardiac dysfunction.
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Affiliation(s)
- Saeko Yoshizawa
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Nishikawa
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideaki Oda
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
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Zhang H, Xu A, Sun X, Yang Y, Zhang L, Bai H, Ben J, Zhu X, Li X, Yang Q, Wang Z, Wu W, Yang D, Zhang Y, Xu Y, Chen Q. Self-Maintenance of Cardiac Resident Reparative Macrophages Attenuates Doxorubicin-Induced Cardiomyopathy Through the SR-A1-c-Myc Axis. Circ Res 2020; 127:610-627. [PMID: 32466726 DOI: 10.1161/circresaha.119.316428] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
RATIONALE Doxorubicin-induced cardiomyopathy (DiCM) is a primary cause of heart failure and mortality in cancer patients, in which macrophage-orchestrated inflammation serves as an essential pathological mechanism. However, the specific roles of tissue-resident and monocyte-derived macrophages in DiCM remain poorly understood. OBJECTIVE Uncovering the origins, phenotypes, and functions of proliferative cardiac resident macrophages and mechanistic insights into the self-maintenance of cardiac macrophage during DiCM progression. METHODS AND RESULTS Mice were administrated with doxorubicin to induce cardiomyopathy. Dynamic changes of resident and monocyte-derived macrophages were examined by lineage tracing, parabiosis, and bone marrow transplantation. We found that the monocyte-derived macrophages primarily exhibited a proinflammatory phenotype that dominated the whole DiCM pathological process and impaired cardiac function. In contrast, cardiac resident macrophages were vulnerable to doxorubicin insult. The survived resident macrophages exhibited enhanced proliferation and conferred a reparative role. Global or myeloid specifically ablation of SR-A1 (class A1 scavenger receptor) inhibited proliferation of cardiac resident reparative macrophages and, therefore, exacerbated cardiomyopathy in DiCM mice. Importantly, the detrimental effect of macrophage SR-A1 deficiency was confirmed by transplantation of bone marrow. At the mechanistic level, we show that c-Myc (Avian myelocytomatosis virus oncogene cellular homolog), a key transcriptional factor for the SR-A1-P38-SIRT1 (Sirtuin 1) pathway, mediated the effect of SR-A1 in reparative macrophage proliferation in DiCM. CONCLUSIONS The SR-A1-c-Myc axis may represent a promising target to treat DiCM through augmentation of cardiac resident reparative macrophage proliferation.
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MESH Headings
- Animals
- CX3C Chemokine Receptor 1/genetics
- CX3C Chemokine Receptor 1/metabolism
- Cardiomyopathy, Dilated/chemically induced
- Cardiomyopathy, Dilated/enzymology
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/prevention & control
- Cell Proliferation
- Cell Self Renewal
- Cells, Cultured
- Disease Models, Animal
- Doxorubicin
- Female
- Green Fluorescent Proteins/genetics
- Green Fluorescent Proteins/metabolism
- Humans
- Macrophages/enzymology
- Macrophages/pathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Myocardium/enzymology
- Myocardium/pathology
- Phenotype
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- Scavenger Receptors, Class A/deficiency
- Scavenger Receptors, Class A/genetics
- Scavenger Receptors, Class A/metabolism
- Signal Transduction
- Ventricular Remodeling
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Affiliation(s)
- Hanwen Zhang
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Andi Xu
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Xuan Sun
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Department of Cardiology, Nanjing Drum Tower Hospital, China (X.S.)
| | - Yaqing Yang
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Lai Zhang
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Hui Bai
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Jingjing Ben
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Xudong Zhu
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Xiaoyu Li
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Qing Yang
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Zidun Wang
- Department of Cardiology, First Affiliated Hospital with Nanjing Medical University, China (Z.W., D.Y.)
| | - Wei Wu
- Bioinformatics (W.W.), Nanjing Medical University, China
| | - Di Yang
- Department of Cardiology, First Affiliated Hospital with Nanjing Medical University, China (Z.W., D.Y.)
| | | | - Yong Xu
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
| | - Qi Chen
- From the Department of Pathophysiology (H.Z., A.X., X.S., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.), Nanjing Medical University, China
- Key Laboratory of Targeted Intervention of Cardiovascular Diseases, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Jiangsu Province, China (H.Z., A.X., Y.Y., L.Z., H.B., J.B., X.Z., X.L., Q.Y., Y.X., Q.C.)
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Substrate for the Myocardial Inflammation-Heart Failure Hypothesis Identified Using Novel USPIO Methodology. JACC Cardiovasc Imaging 2020; 14:365-376. [PMID: 32305466 PMCID: PMC7854561 DOI: 10.1016/j.jcmg.2020.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The purpose of this study was to identify where ultrasmall superparamagnetic particles of iron oxide (USPIO) locate to in myocardium, develop a methodology that differentiates active macrophage uptake of USPIO from passive tissue distribution; and investigate myocardial inflammation in cardiovascular diseases. BACKGROUND Myocardial inflammation is hypothesized to be a key pathophysiological mechanism of heart failure (HF), but human evidence is limited, partly because evaluation is challenging. USPIO-magnetic resonance imaging (MRI) potentially allows specific identification of myocardial inflammation but it remains unclear what the USPIO-MRI signal represents. METHODS Histological validation was performed using a murine acute myocardial infarction (MI) model. A multiparametric, multi-time-point MRI methodology was developed, which was applied in patients with acute MI (n = 12), chronic ischemic cardiomyopathy (n = 7), myocarditis (n = 6), dilated cardiomyopathy (n = 5), and chronic sarcoidosis (n = 5). RESULTS USPIO were identified in myocardial macrophages and myocardial interstitium. R1 time-course reflected passive interstitial distribution whereas multi-time-point R2* was also sensitive to active macrophage uptake. R2*/R1 ratio provided a quantitative measurement of myocardial macrophage infiltration. R2* behavior and R2*/R1 ratio were higher in infarcted (p = 0.001) and remote (p = 0.033) myocardium in acute MI and in chronic ischemic cardiomyopathy (infarct: p = 0.008; remote p = 0.010), and were borderline higher in DCM (p = 0.096), in comparison to healthy controls, but were no different in myocarditis or sarcoidosis. An R2*/R1 threshold of 25 had a sensitivity and specificity of 90% and 83%, respectively, for detecting active USPIO uptake. CONCLUSIONS USPIO are phagocytized by cardiac macrophages but are also passively present in myocardial interstitium. A multiparametric multi-time-point MRI methodology specifically identifies active myocardial macrophage infiltration. Persistent active macrophage infiltration is present in infarcted and remote myocardium in chronic ischemic cardiomyopathy, providing a substrate for HF.
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