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Mone K, Reddy J. The knowns and unknowns of cardiac autoimmunity in viral myocarditis. Rev Med Virol 2023; 33:e2478. [PMID: 37658748 DOI: 10.1002/rmv.2478] [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: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Abstract
Myocarditis can result from various infectious and non-infectious causes that can lead to dilated cardiomyopathy (DCM) and heart failure. Among the infectious causes, viruses are commonly suspected. But the challenge is our inability to demonstrate infectious viral particles during clinical presentations, partly because by that point, the viruses would have damaged the tissues and be cleared by the immune system. Therefore, viral signatures such as viral nucleic acids and virus-reactive antibodies may be the only readouts pointing to viruses as potential primary triggers of DCM. Thus, it becomes hard to explain persistent inflammatory infiltrates that might occur in individuals affected with chronic myocarditis/DCM manifesting myocardial dysfunctions. In these circumstances, autoimmunity is suspected, and antibodies to various autoantigens have been demonstrated, suggesting that immune therapies to suppress the autoimmune responses may be necessary. From this perspective, we endeavoured to determine whether or not the known viral causes are associated with development of autoimmune responses to cardiac antigens that include both cardiotropic and non-cardiotropic viruses. If so, what their nature and significance are in developing chronic myocarditis resulting from viruses as primary triggers.
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Affiliation(s)
- Kiruthiga Mone
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Jay Reddy
- School of Veterinary Medicine and Biomedical Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Krishnan-Sivadoss I, Mijares-Rojas IA, Villarreal-Leal RA, Torre-Amione G, Knowlton AA, Guerrero-Beltrán CE. Heat shock protein 60 and cardiovascular diseases: An intricate love-hate story. Med Res Rev 2020; 41:29-71. [PMID: 32808366 PMCID: PMC9290735 DOI: 10.1002/med.21723] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
Cardiovascular diseases (CVDs) are the result of complex pathophysiological processes in the tissues comprising the heart and blood vessels. Inflammation is the main culprit for the development of cardiovascular dysfunction, and it may be traced to cellular stress events including apoptosis, oxidative and shear stress, and cellular and humoral immune responses, all of which impair the system's structure and function. An intracellular chaperone, heat shock protein 60 (HSP60) is an intriguing example of a protein that may both be an ally and a foe for cardiovascular homeostasis; on one hand providing protection against cellular injury, and on the other triggering damaging responses through innate and adaptive immunity. In this review we will discuss the functions of HSP60 and its effects on cells and the immune system regulation, only to later address its implications in the development and progression of CVD. Lastly, we summarize the outcome of various studies targeting HSP60 as a potential therapeutic strategy for cardiovascular and other diseases.
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Affiliation(s)
- Indumathi Krishnan-Sivadoss
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Medicina Cardiovascular y Metabolómica, Monterrey, Nuevo León, México
| | - Iván A Mijares-Rojas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Medicina Cardiovascular y Metabolómica, Monterrey, Nuevo León, México
| | - Ramiro A Villarreal-Leal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Medicina Cardiovascular y Metabolómica, Monterrey, Nuevo León, México
| | - Guillermo Torre-Amione
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Medicina Cardiovascular y Metabolómica, Monterrey, Nuevo León, México.,Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas
| | - Anne A Knowlton
- Veterans Affairs Medical Center, Sacramento, California, USA.,Department of Internal Medicine, Molecular and Cellular Cardiology, Cardiovascular Division, University of California, Davis, California, USA.,Department of Pharmacology, University of California, Davis, California, USA
| | - C Enrique Guerrero-Beltrán
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Medicina Cardiovascular y Metabolómica, Monterrey, Nuevo León, México.,Tecnologico de Monterrey, Hospital Zambrano Hellion, TecSalud, Centro de Investigación Biomédica, San Pedro Garza García, Nuevo León, México
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Błyszczuk P. Myocarditis in Humans and in Experimental Animal Models. Front Cardiovasc Med 2019; 6:64. [PMID: 31157241 PMCID: PMC6532015 DOI: 10.3389/fcvm.2019.00064] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/30/2019] [Indexed: 12/21/2022] Open
Abstract
Myocarditis is defined as an inflammation of the cardiac muscle. In humans, various infectious and non-infectious triggers induce myocarditis with a broad spectrum of histological presentations and clinical symptoms of the disease. Myocarditis often resolves spontaneously, but some patients develop heart failure and require organ transplantation. The need to understand cellular and molecular mechanisms of inflammatory heart diseases led to the development of mouse models for experimental myocarditis. It has been shown that pathogenic agents inducing myocarditis in humans can often trigger the disease in mice. Due to multiple etiologies of inflammatory heart diseases in humans, a number of different experimental approaches have been developed to induce myocarditis in mice. Accordingly, experimental myocarditis in mice can be induced by infection with cardiotropic agents, such as coxsackievirus B3 and protozoan parasite Trypanosoma cruzi or by activating autoimmune responses against heart-specific antigens. In certain models, myocarditis is followed by the phenotype of dilated cardiomyopathy and the end stage of heart failure. This review describes the most commonly used mouse models of experimental myocarditis with a focus on the role of the innate and adaptive immune systems in induction and progression of the disease. The review discusses also advantages and limitations of individual mouse models in the context of the clinical manifestation and the course of the disease in humans. Finally, animal-free alternatives in myocarditis research are outlined.
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Affiliation(s)
- Przemysław Błyszczuk
- Department of Clinical Immunology, Jagiellonian University Medical College, Cracow, Poland.,Department of Rheumatology, Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Unresolved issues in theories of autoimmune disease using myocarditis as a framework. J Theor Biol 2014; 375:101-123. [PMID: 25484004 DOI: 10.1016/j.jtbi.2014.11.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/10/2014] [Accepted: 11/20/2014] [Indexed: 11/20/2022]
Abstract
Many theories of autoimmune disease have been proposed since the discovery that the immune system can attack the body. These theories include the hidden or cryptic antigen theory, modified antigen theory, T cell bypass, T cell-B cell mismatch, epitope spread or drift, the bystander effect, molecular mimicry, anti-idiotype theory, antigenic complementarity, and dual-affinity T cell receptors. We critically review these theories and relevant mathematical models as they apply to autoimmune myocarditis. All theories share the common assumption that autoimmune diseases are triggered by environmental factors such as infections or chemical exposure. Most, but not all, theories and mathematical models are unifactorial assuming single-agent causation of disease. Experimental and clinical evidence and mathematical models exist to support some aspects of most theories, but evidence/models that support one theory almost invariably supports other theories as well. More importantly, every theory (and every model) lacks the ability to account for some key autoimmune disease phenomena such as the fundamental roles of innate immunity, sex differences in disease susceptibility, the necessity for adjuvants in experimental animal models, and the often paradoxical effect of exposure timing and dose on disease induction. We argue that a more comprehensive and integrated theory of autoimmunity associated with new mathematical models is needed and suggest specific experimental and clinical tests for each major theory that might help to clarify how they relate to clinical disease and reveal how theories are related.
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Abstract
The possible role of infections in driving autoimmune disease (AD) has long been debated. Many theories have emerged including release of hidden antigens, epitope spread, anti-idiotypes, molecular mimicry, the adjuvant effect, antigenic complementarity, or simply that AD could be a direct consequence of activation or subversion of the immune response by microbes. A number of issues are not adequately addressed by current theories, including why animal models of AD require adjuvants containing microbial peptides in addition to self tissue to induce disease, and why ADs occur more often in one sex than the other. Reviews published in the past 3 years have focused on the role of the innate immune response in driving AD and the possible role of persistent infections in altering immune responses. Overall, recent evidence suggests that microbes activating specific innate immune responses are critical, while antigenic cross-reactivity may perpetuate immune responses leading to chronic autoinflammatory disease.
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Abstract
In inflammatory dilated cardiomyopathy and myocarditis there is--apart from heart failure and antiarrhythmic therapies--no alternative to an aetiologically driven specific treatment. Prerequisite are noninvasive and invasive biomarkers including endomyocardial biopsy and PCR on cardiotropic agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy including the genetic background, the predisposition for heart failure and inflammation. It analyses the epidemiologic shift in pathogenetic agents in the last 20 years, the role of innate and aquired immunity including the T- and B-cell driven immune responses. The phases and clinical faces of myocarditis are summarized. Up-to-date information on current treatment options starting with heart failure and antiarrhythmic therapy are provided. Although inflammation can resolve spontaneously, specific treatment directed to the causative aetiology is often required. For fulminant, acute and chronic autoreactive myocarditis immunosuppressive treatment is beneficial, while for viral cardiomyopathy and myocarditis ivIg can resolve inflammation and is as successful as interferon therapy in enteroviral and adenoviral myocarditis. For Parvo B19 and HHV6 myocarditis eradication of the virus is still a problem by any of these treatment options. Finally, the potential of stem cell therapy has to be tested in future trials. In virus-negative, autoreactive perimyocardial disease a locoregional approach with intrapericardial instillation of high local doses of triamcinolone acetate has been shown to be highly efficient and with few systemic side-effects.
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Nakamura H, Kunitsugu I, Fukuda K, Matsuzaki M, Sano M. Diverse stage-dependent effects of glucocorticoids in a murine model of viral myocarditis. J Cardiol 2013; 61:237-42. [DOI: 10.1016/j.jjcc.2012.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/28/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
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Standard and etiology-directed evidence-based therapies in myocarditis: state of the art and future perspectives. Heart Fail Rev 2012; 18:761-95. [DOI: 10.1007/s10741-012-9362-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Yoshizawa A, Nagai S, Baba Y, Yamada T, Matsui M, Tanaka H, Miyoshi SI, Amagai M, Yoshikawa T, Fukuda K, Ogawa S, Koyasu S. Autoimmunity against M2muscarinic acetylcholine receptor induces myocarditis and leads to a dilated cardiomyopathy-like phenotype. Eur J Immunol 2012; 42:1152-63. [DOI: 10.1002/eji.201142104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Akihiro Yoshizawa
- Department of Microbiology and Immunology, Keio University School of Medicine; Tokyo Japan
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
- Tokyo Dental College Ichikawa Hospital; Ichikawa Japan
| | - Shigenori Nagai
- Department of Microbiology and Immunology, Keio University School of Medicine; Tokyo Japan
- Core Research for Evolutional Science and Technology, Japan Science and Technology Agency; Tokyo Japan
| | - Yukiko Baba
- Department of Microbiology and Immunology, Keio University School of Medicine; Tokyo Japan
- Core Research for Evolutional Science and Technology, Japan Science and Technology Agency; Tokyo Japan
| | - Taketo Yamada
- Department of Pathology; Keio University School of Medicine; Tokyo Japan
| | - Minoru Matsui
- Department of Pharmacy; Chiba Institute of Science; Chiba Japan
| | - Hikaru Tanaka
- Department of Pharmacology; Toho University Faculty of Pharmaceutical Sciences; Chiba Japan
| | | | - Masayuki Amagai
- Department of Dermatology; Keio University School of Medicine; Tokyo Japan
| | - Tsutomu Yoshikawa
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Satoshi Ogawa
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - Shigeo Koyasu
- Department of Microbiology and Immunology, Keio University School of Medicine; Tokyo Japan
- Research Center for Science Systems, Japan Society for the Promotion of Science; Tokyo Japan
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Maisch B, Noutsias M, Ruppert V, Richter A, Pankuweit S. Cardiomyopathies: Classification, Diagnosis, and Treatment. Heart Fail Clin 2012; 8:53-78. [DOI: 10.1016/j.hfc.2011.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nishtala K, Phong TQ, Steil L, Sauter M, Salazar MG, Kandolf R, Kroemer HK, Felix SB, Völker U, Klingel K, Hammer E. Virus‐induced dilated cardiomyopathy is characterized by increased levels of fibrotic extracellular matrix proteins and reduced amounts of energy‐producing enzymes. Proteomics 2011; 11:4310-20. [DOI: 10.1002/pmic.201100229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 08/04/2011] [Accepted: 08/10/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Krishnatej Nishtala
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
| | - Truong Q. Phong
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
| | - Leif Steil
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
| | - Martina Sauter
- Abteilung Molekulare Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Manuela G. Salazar
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
| | - Reinhard Kandolf
- Abteilung Molekulare Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Heyo K. Kroemer
- Institut für Pharmakologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stephan B. Felix
- Klinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Uwe Völker
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
| | - Karin Klingel
- Abteilung Molekulare Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Elke Hammer
- Interfakultäres Institut für Genetik und Funktionelle Genomforschung, Ernst‐Moritz‐Arndt‐Universität Greifswald, Greifswald, Germany
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Ono H, Nakamura H, Matsuzaki M. A NADH dehydrogenase ubiquinone flavoprotein is decreased in patients with dilated cardiomyopathy. Intern Med 2010; 49:2039-42. [PMID: 20930427 DOI: 10.2169/internalmedicine.49.3710] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is known that patients with myocarditis of unknown etiology and with dilated cardiomyopathy show a high incidence of serum autoantibodies (M7) directed against mitochondrial flavoproteins. The tissue concentration of mitochondrial flavoproteins in the myocardium obtained from patients with dilated cardiomyopathy (DCM) was examined to further investigate the immunopathological mechanism of cardiomyopathy. METHODS AND RESULTS Myocardial tissue specimens were obtained from patients who underwent cardiac catheterization and a subendomyocardial biopsy for the diagnosis of cardiomyopathy. All samples were analyzed by Western blotting. NADH dehydrogenase ubiquinone flavoprotein (NDUFV1) production in the myocardium decreased significantly with DCM, in comparison to fumarate hydratase and flavoprotein SDHA. There was a significant negative-correlation between the left ventricular end-diastolic dimension and NDUFV1 production (R(2)=0.291, p value<0.05). CONCLUSION NDUFV1 may be involved in the pathogenesis of DCM. A defect of mitochondrial NDUFV1 may reduce complex I, which produces most of the superoxide, which is then scavenged by the mitochondrial enzyme Mn-superoxide dismutase to produce H(2)O(2). Exploring the nature of the candidate protein found in the myocardium in this study will provide further insight into the immunological mechanism of DCM.
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Affiliation(s)
- Hitomi Ono
- Department of Medicine, Yamaguchi University, Ube
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Root-Bernstein R, Vonck J, Podufaly A. Antigenic complementarity between coxsackie virus and streptococcus in the induction of rheumatic heart disease and autoimmune myocarditis. Autoimmunity 2009; 42:1-16. [PMID: 18608177 DOI: 10.1080/08916930802208540] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A variety of clinical, epidemiological, and experimental data suggest that rheumatic heart disease and autoimmune myocarditis are not only similar in their pathogenesis, but may often be due to combined infections with coxsackie virus (CX) and streptococcus A bacteria (SA). This paper reviews the evidence for this hypothesis, provides some new experimental data supporting the hypothesis, and suggests specific experiments for testing it. While, it is well-established that the M protein of SA mimics myosin, we demonstrate using homology search tools that various CX proteins mimic actin. We further demonstrate that antibody against CX recognizes actin as an antigen, and that anti-actin antibodies recognize CX antigen. Thus, anti-CX antibodies may also target muscle. Moreover, since myosin and actin are molecularly complementary, it follows that some SA and CX proteins may be molecularly complementary. Some antibodies against these complementary proteins in SA and CX should therefore act like idiotype-antiidiotype antibodies. We show that, indeed, CX and SA antibodies precipitate each other. Thus, it is possible that combined CX-SA infections produce more severe disease by producing pairs of idiotypic antibodies that act like antiidiotypic antibodies as well, thereby, disregulating immune control and triggering an autoimmune reaction against both myosin and actin simultaneously. We predict that combinations of the appropriate actin- and myosin-like antigens from CX and SA will, therefore, be much more autoimmunogenic than antigens from CX or SA alone, and that the combination will not require use of adjuvants or self-proteins that many current protocols require. It is possible that co-infections involving CX or SA with other infectious agents may produce similarly enhanced disease.
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Castellano G, Affuso F, Di Conza P, Fazio S. Myocarditis and dilated cardiomyopathy: possible connections and treatments. J Cardiovasc Med (Hagerstown) 2008; 9:666-71. [DOI: 10.2459/jcm.0b013e3282f3e9c2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Esfandiarei M, McManus BM. Molecular biology and pathogenesis of viral myocarditis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2008; 3:127-55. [PMID: 18039131 DOI: 10.1146/annurev.pathmechdis.3.121806.151534] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Myocarditis is a cardiac disease associated with inflammation and injury of the myocardium. Several viruses have been associated with myocarditis in humans. However, coxsackievirus B3 is still considered the dominant etiological agent. The observed pathology in viral myocarditis is a result of cooperation or teamwork between viral processes and host immune responses at various stages of disease. Both innate and adaptive immune responses are crucial determinants of the severity of myocardial damage, and contribute to the development of chronic myocarditis and dilated cardiomyopathy following acute viral myocarditis. Advances in genomics and proteomics, and in the use of informatics and biostatistics, are allowing unbiased initial evaluations that can be the basis for testable hypotheses about virus pathogenesis and new therapies.
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Affiliation(s)
- Mitra Esfandiarei
- The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Providence Health Care Research Institute, Vancouver, Canada.
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Dörner A, Kallwellis-Opara A, Pauschinger M, Kühl U, Schultheiss HP. Cardiac autoantibodies in viral myocarditis. Heart Fail Clin 2007; 1:333-43. [PMID: 17386858 DOI: 10.1016/j.hfc.2005.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chen XJ, Bian ZP, Lu S, Xu JD, Gu CR, Yang D, Zhang JN. Cardiac protective effect of Astragalus on viral myocarditis mice: comparison with Perindopril. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2006; 34:493-502. [PMID: 16710898 DOI: 10.1142/s0192415x06004028] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In clinical practice, Astragali Radix (Astragalus), the root of Astragalus membranaceus Bunge, has been widely applied to treat patients with viral diseases, including viral myocarditis in China. The present study was designed to evaluate the protective effects of Astragalus on the function of sarcoplasmic reticulum calcium ATPase (SERCA2) activity and endothelin system at acute and chronic periods of myocarditis mice induced by CVB(3) infection. Astragalus feeding (2.2 mg/kg/day) could significantly increase the survival rate, alleviate pathological alterations and serum cardiac troponin I (cTnI), as well as restore impaired SERCA activity at the acute stage. Low affinity and capacity of ETR were reversed with Astragalus after the first CVB(3) inoculation up to 7 days and after the second virus inoculation up to 150 days. In the meantime, the contents of cardiac ET-1 and ANP were reduced. Comparison the myocarditis mice treated with Perindopril (0.44 mg/kg/day), an ACE inhibitor, shows that Astragalus achieved a similar effect on survival rate, SERCA2 and ET system. These results indicated that the beneficial effects of Astragalus and Perindopril for treating viral myocarditis might be partly mediated by preserving the functions of SERCA 2 activity and ET system.
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Affiliation(s)
- Xiang-Jian Chen
- Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
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