1
|
Costa C, Moniati F. The Epidemiology of COVID-19 Vaccine-Induced Myocarditis. Adv Med 2024; 2024:4470326. [PMID: 38681683 PMCID: PMC11045291 DOI: 10.1155/2024/4470326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background In December 2019, the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) led to the COVID-19 pandemic, with millions of deaths worldwide. Vaccine breakthroughs in late 2020 resulted in the authorization of COVID-19 vaccines. While these vaccines have demonstrated efficacy, evidence from vaccine safety monitoring systems around the globe supported a causal association between COVID-19 vaccines, in particular those using mRNA technology, i.e., Moderna's mRNA-1273 and Pfizer-BioNTech's BNT162b2, and myocarditis. Objective This paper aims to investigate the epidemiology of mRNA COVID-19 vaccine-induced myocarditis, including age, ethnicity, and gender associations with these vaccines. It also discusses the immunopathophysiological mechanisms of mRNA COVID-19 vaccine-associated myocarditis and outlines principles of diagnosis, clinical presentation, and management. Methods A literature review was conducted using PubMed, Embase, and Queen Mary University of London Library Services databases. Search terms included "myocarditis," "coronavirus disease 2019," "SARS-CoV-2," "mRNA Covid-19 vaccines," "Covid vaccine-associated myocarditis," "epidemiology," "potential mechanisms," "myocarditis diagnosis," and "myocarditis management." Results While the definite mechanism of mRNA COVID-19 vaccine-associated myocarditis remains ambiguous, potential mechanisms include molecular mimicry of spike proteins and activation of the adaptive immune response with dysregulated cytokine expression. Male predominance in COVID-19 vaccine-induced myocarditis may be attributed to sex hormones, variations in inflammatory reactions, coagulation states based on gender, and female-specific protective factors. Moreover, an analysis of diagnostic and management strategies reveals a lack of consensus on acute patient presentation management. Conclusion In contrast to viral infections that stand as the predominant etiological factor for myocarditis with more severe consequences, the mRNA COVID-19 vaccination elicits a mild and self-limiting manifestation of the condition. There is currently insufficient evidence to confirm the definite underlying mechanism of COVID-19 vaccine-associated myocarditis. Further research is needed to develop preventive and therapeutic solutions in this context.
Collapse
Affiliation(s)
| | - Foteini Moniati
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
| |
Collapse
|
2
|
Barcena ML, Tonini G, Haritonow N, Breiter P, Milting H, Baczko I, Müller‐Werdan U, Ladilov Y, Regitz‐Zagrosek V. Sex and age differences in AMPK phosphorylation, mitochondrial homeostasis, and inflammation in hearts from inflammatory cardiomyopathy patients. Aging Cell 2023; 22:e13894. [PMID: 37365150 PMCID: PMC10410062 DOI: 10.1111/acel.13894] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/28/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Linked to exacerbated inflammation, myocarditis is a cardiovascular disease, which may lead to dilated cardiomyopathy. Although sex and age differences in the development of chronic myocarditis have been postulated, underlying cellular mechanisms remain poorly understood. In the current study, we aimed to investigate sex and age differences in mitochondrial homeostasis, inflammation, and cellular senescence. Cardiac tissue samples from younger and older patients with inflammatory dilated cardiomyopathy (DCMI) were used. The expression of Sirt1, phosphorylated AMPK, PGC-1α, Sirt3, acetylated SOD2, catalase, and several mitochondrial genes was analyzed to assess mitochondrial homeostasis. The expression of NF-κB, TLR4, and interleukins was used to examine the inflammatory state in the heart. Finally, several senescence markers and telomere length were investigated. Cardiac AMPK expression and phosphorylation were significantly elevated in male DCMI patients, whereas Sirt1 expression remained unchanged in all groups investigated. AMPK upregulation was accompanied by a preserved expression of all mitochondrial proteins/genes investigated in older male DCMI patients, whereas the expression of TOM40, TIM23, and the mitochondrial oxidative phosphorylation genes was significantly reduced in older female patients. Mitochondrial homeostasis in older male patients was further supported by the reduced acetylation of mitochondrial proteins as indicated by acetylated SOD2. The inflammatory markers NF-κB and TLR4 were downregulated in older male DCMI patients, whereas the expression of IL-18 was increased in older female patients. This was accompanied by progressed senescence in older DCMI hearts. In conclusion, older women experience more dramatic immunometabolic disorders on the cellular level than older men.
Collapse
Affiliation(s)
- Maria Luisa Barcena
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
| | - Greta Tonini
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
| | - Natalie Haritonow
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
| | - Pavelas Breiter
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
| | - Hendrik Milting
- Erich and Hanna Klessmann InstituteHeart and Diabetes Centre NRW, University Hospital of the Ruhr‐University BochumBad OeynhausenGermany
| | - Istvan Baczko
- Department of Pharmacology and Pharmacotherapy, Albert Szent‐Györgyi Medical SchoolUniversity of SzegedSzegedHungary
| | - Ursula Müller‐Werdan
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
| | - Yury Ladilov
- Department of Geriatrics and Medical GerontologyCharité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin and Berlin Institute of HealthBerlinGermany
- Department of Cardiovascular Surgery, Heart Center BrandenburgBrandenburg Medical SchoolBernau bei BerlinGermany
| | - Vera Regitz‐Zagrosek
- DZHK (German Centre for Cardiovascular Research)BerlinGermany
- Institute for Gender in Medicine, Center for Cardiovascular Research, Charité University HospitalBerlinGermany
- Department of CardiologyUniversity Hospital Zürich, University of ZürichZürichSwitzerland
| |
Collapse
|
3
|
Interdonato L, Impellizzeri D, D’Amico R, Cordaro M, Siracusa R, D’Agostino M, Genovese T, Gugliandolo E, Crupi R, Fusco R, Cuzzocrea S, Di Paola R. Modulation of TLR4/NFκB Pathways in Autoimmune Myocarditis. Antioxidants (Basel) 2023; 12:1507. [PMID: 37627502 PMCID: PMC10451772 DOI: 10.3390/antiox12081507] [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: 06/26/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Myocarditis is an inflammatory and oxidative disorder characterized by immune cell recruitment in the damaged tissue and organ dysfunction. In this paper, we evaluated the molecular pathways involved in myocarditis using a natural compound, Coriolus versicolor, in an experimental model of autoimmune myocarditis (EAM). Animals were immunized with an emulsion of pig cardiac myosin and complete Freund's adjuvant supplemented with mycobacterium tuberculosis; thereafter, Coriolus versicolor (200 mg/Kg) was orally administered for 21 days. At the end of the experiment, blood pressure and heart rate measurements were recorded and the body and heart weights as well. From the molecular point of view, the Coriolus versicolor administration reduced the activation of the TLR4/NF-κB pathway and the levels of pro-inflammatory cytokines (INF-γ, TNF-α, IL-6, IL-17, and IL-2) and restored the levels of anti-inflammatory cytokines (IL-10). These anti-inflammatory effects were accompanied with a reduced lipid peroxidation and nitrite levels and restored the antioxidant enzyme activities (SOD and CAT) and GSH levels. Additionally, it reduced the histological injury and the immune cell recruitment (CD4+ and CD68+ cells). Moreover, we observed an antiapoptotic activity in both intrinsic (Fas/FasL/caspase-3) and extrinsic (Bax/Bcl-2) pathways. Overall, our data showed that Coriolus versicolor administration modulates the TLR4/NF-κB signaling in EAM.
Collapse
Affiliation(s)
- Livia Interdonato
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Daniela Impellizzeri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Ramona D’Amico
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Marika Cordaro
- Department of Biomedical, Dental and Morphological and Functional Imaging, University of Messina, Consolare Valeria, 98100 Messina, Italy
| | - Rosalba Siracusa
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Melissa D’Agostino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Tiziana Genovese
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Enrico Gugliandolo
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| | - Rosalia Crupi
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| | - Roberta Fusco
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Rosanna Di Paola
- Department of Veterinary Sciences, University of Messina, 98168 Messina, Italy
| |
Collapse
|
4
|
Melissa officinalis L. Supplementation Provides Cardioprotection in a Rat Model of Experimental Autoimmune Myocarditis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1344946. [PMID: 35265259 PMCID: PMC8901324 DOI: 10.1155/2022/1344946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/09/2022] [Indexed: 12/03/2022]
Abstract
Due to existing evidence regarding antioxidant and anti-inflammatory effects of Melissa officinalis extracts (MOEs), this study was aimed at investigating the potential of ethanolic MOE to prevent the development of myocarditis and its ability to ameliorate the severity of experimental autoimmune myocarditis (EAM) by investigating MOE effects on in vivo cardiac function, structure, morphology, and oxidative stress parameters. A total of 50 7-week-old male Dark Agouti rats were enrolled in the study and randomly allocated into the following groups: CTRL, nontreated healthy rats; EAM, nontreated rats with EAM; MOE50, MOE100, and MOE200, rats with EAM treated with either 50, 100, or 200 mg/kg of MOE for 3 weeks per os. Myocarditis was induced by immunization of the rats with porcine myocardial myosin (0.5 mg) emulsion on day 0. Cardiac function and dimensions of the left ventricle (LV) were assessed via echocardiography. Additionally, the blood pressure and heart rate were measured. On day 21, rats were sacrificed and the hearts were isolated for further histopathological analyses (H/E and Picrosirius red staining). The blood samples were collected to determine oxidative stress parameters. The EAM group characteristically showed greater LV wall thickness and lower ejection fraction (50.33 ± 7.94% vs. 84.81 ± 7.74%) and fractional shortening compared to CTRL (p < 0.05). MOE significantly improved echocardiographic parameters (EF in MOE200 81.44 ± 5.51%) and also reduced inflammatory infiltrate (by 88.46%; p < 0.001) and collagen content (by 76.39%; p < 0.001) in the heart tissues, especially in the MOE200 group compared to the EAM group. In addition, MOEs induced a significant decrease of prooxidants production (O2−, H2O2, and TBARS) and improved antioxidant defense system via increase in GSH, SOD, and CAT compared to EAM, with medium and high dose being more effective than low dose (p < 0.05). The present study suggests that ethanolic MOEs, especially in a 200 mg/kg dose, improve cardiac function and myocardial architecture, possibly via oxidative stress mitigation, thus preventing heart remodeling, development of dilated cardiomyopathy, and subsequent heart failure connected with EAM. MOEs might be considered as a potentially helpful adjuvant therapy in patients with autoimmune myocarditis.
Collapse
|
5
|
Barcena ML, Jeuthe S, Niehues MH, Pozdniakova S, Haritonow N, Kühl AA, Messroghli DR, Regitz-Zagrosek V. Sex-Specific Differences of the Inflammatory State in Experimental Autoimmune Myocarditis. Front Immunol 2021; 12:686384. [PMID: 34122450 PMCID: PMC8195335 DOI: 10.3389/fimmu.2021.686384] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Increasing evidence suggests male sex as a potential risk factor for a higher incidence of cardiac fibrosis, stronger cardiac inflammation, and dilated cardiomyopathy (DCM) in human myocarditis. Chronic activation of the immune response in myocarditis may trigger autoimmunity. The experimental autoimmune myocarditis (EAM) model has been well established for the study of autoimmune myocarditis, however the role of sex in this pathology has not been fully explored. In this study, we investigated sex differences in the inflammatory response in the EAM model. We analyzed the cardiac function, as well as the inflammatory stage and fibrosis formation in the heart of EAM male and female rats. 21 days after induction of EAM, male EAM rats showed a decreased ejection fraction, stroke volume and cardiac output, while females did not. A significantly elevated number of infiltrates was detected in myocardium in both sexes, indicating the activation of macrophages following EAM induction. The level of anti-inflammatory macrophages (CD68+ ArgI+) was only significantly increased in female hearts. The expression of Col3A1 and fibrosis formation were more prominent in males. Furthermore, prominent pro-inflammatory factors were increased only in male rats. These findings indicate sex-specific alterations in the inflammatory stage of EAM, with a pro-inflammatory phenotype appearing in males and an anti-inflammatory phenotype in females, which both significantly affect cardiac function in autoimmune myocarditis.
Collapse
Affiliation(s)
- Maria Luisa Barcena
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany
| | - Sarah Jeuthe
- DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany.,Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian H Niehues
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sofya Pozdniakova
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Climate and Health Program (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Natalie Haritonow
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja A Kühl
- iPATH Berlin-Immunopathology for Experimental Models, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany.,Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Center for Cardiovascular Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Cardiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| |
Collapse
|
6
|
Werner RA, Wakabayashi H, Bauer J, Schütz C, Zechmeister C, Hayakawa N, Javadi MS, Lapa C, Jahns R, Ergün S, Jahns V, Higuchi T. Longitudinal 18F-FDG PET imaging in a rat model of autoimmune myocarditis. Eur Heart J Cardiovasc Imaging 2019; 20:467-474. [PMID: 30102319 PMCID: PMC6429237 DOI: 10.1093/ehjci/jey119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/25/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Although mortality rate is very high, diagnosis of acute myocarditis remains challenging with conventional tests. We aimed to elucidate the potential role of longitudinal 2-Deoxy-2-18F-fluoro-D-glucose (18F-FDG) positron emission tomography (PET) inflammation monitoring in a rat model of experimental autoimmune myocarditis. METHODS AND RESULTS Autoimmune myocarditis was induced in Lewis rats by immunizing with porcine cardiac myosin emulsified in complete Freund's adjuvant. Time course of disease was assessed by longitudinal 18F-FDG PET imaging. A correlative analysis between in- and ex vivo18F-FDG signalling and macrophage infiltration using CD68 staining was conducted. Finally, immunohistochemistry analysis of the cell-adhesion markers CD34 and CD44 was performed at different disease stages determined by longitudinal 18F-FDG PET imaging. After immunization, myocarditis rats revealed a temporal increase in 18F-FDG uptake (peaked at week 3), which was followed by a rapid decline thereafter. Localization of CD68 positive cells was well correlated with in vivo18F-FDG PET signalling (R2 = 0.92) as well as with ex vivo18F-FDG autoradiography (R2 = 0.9, P < 0.001, respectively). CD44 positivity was primarily observed at tissue samples obtained at acute phase (i.e. at peak 18F-FDG uptake), while CD34-positive staining areas were predominantly identified in samples harvested at both sub-acute and chronic phases (i.e. at 18F-FDG decrease). CONCLUSION 18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.
Collapse
Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research (IZKF), University of Würzburg, Josef-Schneider-Str. 2, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Jochen Bauer
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Claudia Schütz
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Christina Zechmeister
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Nobuyuki Hayakawa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University Hospital Würzburg, Straubmühlweg 2a, Würzburg, Germany
| | - Süleyman Ergün
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Valerie Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
- Department of Biomedical Imaging, National Cerebral and Cardiovascular Research Center, 5 Chome-7-1 Fujishirodai, Suita, Osaka Prefecture, Japan
| |
Collapse
|
7
|
Nana-Leventaki E, Nana M, Poulianitis N, Sampaziotis D, Perrea D, Sanoudou D, Rontogianni D, Malliaras K. Cardiosphere-Derived Cells Attenuate Inflammation, Preserve Systolic Function, and Prevent Adverse Remodeling in Rat Hearts With Experimental Autoimmune Myocarditis. J Cardiovasc Pharmacol Ther 2018; 24:70-77. [DOI: 10.1177/1074248418784287] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Cardiosphere-derived cells (CDCs) have yielded promising efficacy signals in early-phase clinical trials of ischemic and nonischemic cardiomyopathy. The potential efficacy of CDCs in acute myocarditis, an inflammatory cardiomyopathy without effective therapy, remains unexplored. Given that CDCs produce regenerative, cardioprotective, anti-inflammatory, and anti-fibrotic effects (all of which could be beneficial in acute myocarditis), we investigated the efficacy of intracoronary delivery of CDCs in a rat model of experimental autoimmune myocarditis. Methods: Lewis rats underwent induction of experimental autoimmune myocarditis by subcutaneous footpad injection of purified porcine cardiac myosin supplemented with Mycobacterium tuberculosis on days 1 and 7. On day 10, rats were randomly assigned to receive global intracoronary delivery of 500 000 CDCs or vehicle. Global intracoronary delivery was performed by injection of cells or vehicle into the left ventricular (LV) cavity during transient occlusion of the aortic root. Rats were euthanized 18 days after infusion. Cardiac volumes and systolic function were assessed by serial echocardiography, performed on days 1, 10, and 28. Myocardial inflammation, T-cell infiltration, and cardiac fibrosis were evaluated by histology. Results: Experimental autoimmune myocarditis was successfully induced in 14/14 rats that completed follow-up. Left ventricular ejection fraction (LVEF) and volumes were comparable on days 1 and 10 between groups. CDC infusion resulted in increased LVEF (81.5% ± 3% vs 65.4% ± 8%, P < .001) and decreased LV end-systolic volume (43 ± 15 vs 100 ± 24 μL, P < .001) compared to placebo administration at 18 days post-infusion. Cardiosphere-derived cell infusion decreased myocardial inflammation (7.4% ± 7% vs 20.7% ± 4% of myocardium, P = .007), cardiac fibrosis (16.6% ± 13% vs 38.1% ± 3% of myocardium, P = .008), and myocardial T-cell infiltration (30.4 ± 29 vs 125.8 ± 49 cells per field, P = .005) at 18 days post-infusion compared to placebo administration. Conclusion: Intracoronary delivery of CDCs attenuates myocardial inflammation, T-cell infiltration, and fibrosis while preventing myocarditis-induced systolic dysfunction and adverse remodeling in rats with experimental autoimmune myocarditis.
Collapse
Affiliation(s)
- E. Nana-Leventaki
- Third Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - M. Nana
- Third Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - N. Poulianitis
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - D. Sampaziotis
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - D. Perrea
- Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas”, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - D. Sanoudou
- Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - D. Rontogianni
- Department of Pathology, Evangelismos Hospital, Athens, Greece
| | - K. Malliaras
- Third Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| |
Collapse
|
8
|
Assessment of TSPO in a Rat Experimental Autoimmune Myocarditis Model: A Comparison Study between [ 18F]Fluoromethyl-PBR28 and [ 18F]CB251. Int J Mol Sci 2018; 19:ijms19010276. [PMID: 29342117 PMCID: PMC5796222 DOI: 10.3390/ijms19010276] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 01/03/2023] Open
Abstract
Overexpression of the 18-kDa translocator protein (TSPO) is closely linked to inflammatory responses in the heart, including myocarditis, which can lead to myocardial necrosis. In vivo assessment of inflammatory responses has enabled the precise diagnosis of myocarditis to improve clinical outcomes. Here, we evaluated TSPO overexpression in a rat model of experimental autoimmune myocarditis (EAM) compared to healthy rats using two TSPO radiotracers, [18F]fluoromethyl-PBR28 ([18F]1) and [18F]CB251 ([18F]2). All radiolabeling methods were successfully applied to an automated module for the reproducible preparation of TSPO radiotracers. Both radiotracers were directly compared in an EAM rat model, as well as in healthy rats to determine whether either radiotracer provides a more promising assessment of in vivo TSPO overexpression. [18F]2 provided more specific TSPO-uptake in the heart of the EAM rats (1.32-fold that of the heart-to-lung uptake ratio versus healthy controls), while [18F]1 did not show a significant difference between the two groups. Histopathological characterization revealed that a prominent positron emission tomography (PET) signal of [18F]2 in the EAM rats corresponded to the presence of a higher density of TSPO compared to the healthy controls. These results suggest that the imidazole[1,2-a]pyridine-based radiotracer [18F]2 is a sensitive tool for noninvasively diagnosing myocarditis related to inflammation of the heart muscle by assessing abnormal TSPO expression.
Collapse
|
9
|
Chen QQ, Chen M, Zhang LH, Zeng Y, Qi-Cai L, Yang XL, Lin XC. Costimulation blockade by combining CTLA4Ig with anti-CD40L mAb markedly inhibits the inflammatory response of experimental autoimmune myocarditis. EUR J INFLAMM 2017. [DOI: 10.1177/1721727x16686980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to investigate the effect of costimulation blockade with cytotoxic T-lymphocyte-associated-antigen 4-immunoglobulin (CTLA4Ig) and anti-CD40L monoclonal antibody (anti-CD40L mAb) on an experimental autoimmune myocarditis (EAM) mouse model. Characteristics of myocardial tissue were observed by hematoxylin and eosin (H&E) staining. The messenger RNA (mRNA) levels of CTLA4, CD40L, IFN-γ, and IL-4 were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR). Serum concentrations of IFN-γ and IL-4 were determined by ELISA. After immune intervention, the inflammatory score, mRNA levels of CTLA4 and CD40L, and IFN-γ level were decreased. Furthermore, these parameters in the combinational intervention group (blockade by CTLA4Ig and anti-CD40L mAb) were significantly decreased, compared to the single intervention group (blockade by CTLA4Ig or anti-CD40L mAb). However, after costimulation, blockade serum IL-4 levels were increased. Therefore, costimulation blockade by combination CTLA4Ig and anti-CD40L mAb could more effectively inhibit the inflammatory response of EAM than single use of CTLA4Ig or anti-CD40L mAb.
Collapse
Affiliation(s)
- Qing-Quan Chen
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Min Chen
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Li-Hua Zhang
- Department of Laboratory Medicine, the Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Yu Zeng
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Liu Qi-Cai
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
- Department of Laboratory Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xiu-Lin Yang
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xu-Chen Lin
- Department of Laboratory Medicine, Medical Technology and Engineering College, Fujian Medical University, Fuzhou, Fujian, PR China
| |
Collapse
|
10
|
Maya Y, Werner RA, Schütz C, Wakabayashi H, Samnick S, Lapa C, Zechmeister C, Jahns R, Jahns V, Higuchi T. 11C-Methionine PET of Myocardial Inflammation in a Rat Model of Experimental Autoimmune Myocarditis. J Nucl Med 2016; 57:1985-1990. [PMID: 27390159 DOI: 10.2967/jnumed.116.174045] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022] Open
Abstract
Myocarditis represents a major cause of dilated cardiomyopathy and sudden cardiac death in younger adults. Currently, definitive diagnosis of myocarditis requires endomyocardial biopsy, which is highly invasive and has the drawback of variable sensitivity due to inherent sampling error. Therefore, reliable noninvasive methods to detect and monitor cardiac inflammation are clinically relevant. In this study, we explored the potential of radiolabeled methionine to assess myocardial inflammatory activity in a rat model of experimental autoimmune myocarditis (EAM). METHODS Autoimmune myocarditis was induced by immunizing Lewis rats twice with porcine cardiac myosin and Freund complete adjuvant. Control animals were treated with adjuvant alone. Dual-tracer autoradiography was performed to assess 14C-methionine uptake and to compare the distributions of 14C-methionine versus 18F-FDG. Hematoxylin and eosin staining and anti-CD68 macrophage staining were performed for histologic analysis. Additionally, cardiac 11C-methionine PET was performed to evaluate the feasibility of in vivo imaging. 18F-FDG PET was also conducted to compare the in vivo uptake of 11C-methionine and 18F-FDG. RESULTS Multiple focal cardiac inflammatory lesions were histologically identified in myosin-immunized rats, whereas no cardiac lesions were observed in the controls. Autoradiographic images clearly showed a high-density accumulation of 14C-methionine in inflammatory lesions of EAM rats, whereas no significant uptake was observed in the control animals. 14C-methionine uptake was significantly higher in inflammatory lesions than in remote noninflammatory areas and control rat hearts. The distribution of 14C-methionine correlated well with that of 18F-FDG and with macrophage density. The contrast between inflammatory and noninflammatory areas was higher for 18F-FDG than for 14C-methionine (3.45 ± 0.68 vs. 2.07 ± 0.21, respectively; P < 0.05). In the PET imaging study, the regional 11C-methionine uptake (percentage injected dose per cubic centimeter) observed in EAM rats was significantly higher than the values obtained for control animals (0.64 ± 0.09 vs. 0.28 ± 0.02, respectively; P < 0.001). A good positive correlation between 11C-methionine and 18F-FDG uptake was found. CONCLUSION In a rat model of autoimmune myocarditis, we demonstrated the colocalization of radiolabeled methionine accumulation with 18F-FDG uptake in histologically proven inflammatory lesions. These data suggest that 11C-methionine might represent a promising candidate for the noninvasive detection and monitoring of myocarditis.
Collapse
Affiliation(s)
- Yoshifumi Maya
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Research Centre, Nihon Medi-Physics Co., Ltd., Chiba, Japan
| | - Rudolf A Werner
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research, University of Würzburg,Würzburg, Germany
| | - Claudia Schütz
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | | | - Samuel Samnick
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Christina Zechmeister
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | - Roland Jahns
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University of Würzburg, Würzburg, Germany
| | - Valérie Jahns
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| |
Collapse
|
11
|
Jeuthe S, Wassilew K, O h-Ici D, da Silva TF, Münch F, Berger F, Kuehne T, Pieske B, Messroghli DR. Myocardial T1 maps reflect histological findings in acute and chronic stages of myocarditis in a rat model. J Cardiovasc Magn Reson 2016; 18:19. [PMID: 27084492 PMCID: PMC4833926 DOI: 10.1186/s12968-016-0241-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance offers both diagnostic and prognostic information in myocarditis. Using an established animal model of myocarditis, the aim of this study was to measure myocardial T1 before the onset, in the acute and in the chronic phases of the disease and to compare its course with histological and immunohistochemistry findings. METHODS Male young Lewis rats were immunized with 0.25 mg porcine myocardial myosin into the rear footpads on day 0. Native and contrast-enhanced ECG-triggered cardiac MRI examinations were performed before immunization on day 0 and on days 14, 21 and 35. Left ventricular function, pre- and post- contrast T1 parameters and LGE images were assessed using Small animal look-locker inversion recovery (SALLI). For each of the indicated time points a minimum of 4 rats were randomly sacrificed for pathological investigations including conventional histology (HE and Sirius-Red staining) and immunohistochemistry (CD 68) investigations. RESULTS All immunized rats developed myocarditis (morbidity 100%). Histologically we observed increased wall thickness with biventricular macrophage-rich mixed inflammatory infiltrates. All rats with a histologically severe myocarditis showed increased native T1 and decreased post-contrast T1 of the myocardium. CONCLUSIONS The assessment of native T1 and post-contrast T1 allows accurate differentiation between healthy myocardium and myocardium with inflammation and also between the acute and chronic phases of the disease.
Collapse
MESH Headings
- Acute Disease
- Animals
- Antigens, CD/immunology
- Antigens, Differentiation, Myelomonocytic/immunology
- Autoimmune Diseases/chemically induced
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Autoimmune Diseases/physiopathology
- Cardiomyopathy, Dilated/chemically induced
- Cardiomyopathy, Dilated/immunology
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/physiopathology
- Chronic Disease
- Disease Models, Animal
- Immunohistochemistry
- Magnetic Resonance Imaging
- Male
- Myocarditis/chemically induced
- Myocarditis/immunology
- Myocarditis/pathology
- Myocarditis/physiopathology
- Myocardium/immunology
- Myocardium/pathology
- Myosins
- Predictive Value of Tests
- Rats, Inbred Lew
- Time Factors
- Ventricular Function, Left
Collapse
Affiliation(s)
- Sarah Jeuthe
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Wassilew
- />Cardiovascular Pathology, Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Darach O h-Ici
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Tiago Ferreira da Silva
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Frédéric Münch
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Felix Berger
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- />Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Daniel R. Messroghli
- />Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| |
Collapse
|
12
|
Muench F, Retel J, Jeuthe S, O h-Ici D, van Rossum B, Wassilew K, Schmerler P, Kuehne T, Berger F, Oschkinat H, Messroghli DR. Alterations in creatine metabolism observed in experimental autoimmune myocarditis using ex vivo proton magic angle spinning MRS. NMR IN BIOMEDICINE 2015; 28:1625-1633. [PMID: 26768489 DOI: 10.1002/nbm.3415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 06/05/2023]
Abstract
Experimental autoimmune myocarditis (EAM) in rodents is an accepted model of myocarditis and dilated cardiomyopathy (DCM). Altered metabolism is thought to play an important role in the pathogenesis of DCM and heart failure (HF). Study of the metabolism may provide new diagnostic information and insights into the mechanisms of myocarditis and HF. Proton MRS ((1)H-MRS) has not yet been used to study the changes occurring in myocarditis and subsequent HF. We aimed to explore the changes in creatine metabolism using this model and compare them with the findings in healthy animals. Myocardial function of male young Lewis rats with EAM was quantified by performing left ventricular ejection fraction (LVEF) analysis in short-axis cine images throughout the whole heart. Inflammatory cellular infiltrate was assessed by immunohistochemistry. Myocardial tissue was analyzed using ex vivo proton magic angle spinning MRS ((1)H-MAS-MRS). Myocarditis was confirmed histologically by the presence of an inflammatory cellular infiltrate and CD68 positive staining. A significant increase in the metabolic ratio of Tau/tCr (taurine/total creatine) obtained by (1)H-MAS-MRS was observed in myocarditis compared with healthy controls (21 d acute EAM, 4.38 (±0.23); 21 d control, 2.84 (±0.08); 35 d chronic EAM, 4.47 (±0.83); 35 d control, 2.59 (±0.38); P < 0.001). LVEF was reduced in diseased animals (EAM, 55.2% (±11.3%); control, 72.6% (±3.8%); P < 0.01) and correlated with Tau/tCr ratio (R = 0.937, P < 0.001). Metabolic alterations occur acutely with the development of myocarditis. Myocardial Tau/tCr ratio as detected by (1)H-MRS correlates with LVEF and is able to differentiate between healthy myocardium and myocardium from rats with EAM.
Collapse
Affiliation(s)
- Frédéric Muench
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
| | - Joren Retel
- Leibniz Institute for Molecular Pharmacology, Department of NMR-Supported Structural Biology, Berlin, Germany
| | - Sarah Jeuthe
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
| | - Darach O h-Ici
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
| | - Barth van Rossum
- Leibniz Institute for Molecular Pharmacology, Department of NMR-Supported Structural Biology, Berlin, Germany
| | - Katharina Wassilew
- German Heart Institute Berlin, Cardiovascular Pathology, Berlin, Germany
| | - Patrick Schmerler
- Charité-University Medicine, Center for Cardiovascular Research, Berlin, Germany
| | - Titus Kuehne
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
| | - Felix Berger
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
| | - Hartmut Oschkinat
- Leibniz Institute for Molecular Pharmacology, Department of NMR-Supported Structural Biology, Berlin, Germany
| | - Daniel R Messroghli
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany
- German Heart Institute Berlin, Department of Internal Medicine - Cardiology, Berlin, Germany
| |
Collapse
|