title: Enterovirus heart disease of adults: a persistent, limited organ infection in the presence of neutralizing antibodies.
abstract: Detection of enterovirus RNA in endomyocardial biopsies (EMB) by reverse transcription/polymerase chain reaction (RT-PCR) is currently the preferred diagnostic procedure in suspected enterovirus heart disease (EHD), which can present clinically as myocarditis, dilated cardiomyopathy (DCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). EMB and peripheral blood mononuclear cells (PBMC) of 44 patients with suspected EHD were examined by nested RT-PCR to investigate whether the myocardial enterovirus infection is limited to the heart or is generalized. Enterovirus RNA was detected in EMB, but not in PBMC, of 8 patients (3 of these suffered from ARVC), whereas EMB of 16 controls and PBMC of 45 controls were negative. In addition, enterovirus RNA was demonstrated in PBMC, but not in EMB, of a single patient with suspected EHD. A high sequence homology of the amplicons to coxsackievirus B3 was demonstrated in 7 patients, and to coxsackievirus B2 in two patients. In order to evaluate whether the myocardial enterovirus infection was acute or persistent, neutralization and complement fixation tests were performed for antibodies against the serotypes indicated by the nucleic acid sequences. Neutralizing antibodies were detected in the sera of all 9 patients, but complement fixing antibodies were demonstrated only in one EHD patient and in the patient positive for enterovirus RNA in PBMC. In conclusion, the molecular and serological data demonstrate that CVB3 predominates as cardiotropic enterovirus, and that the enterovirus replication is limited to the heart in EHD. Serological results support the hypothesis of myocardial enterovirus RNA persistence in spite of neutralizing antibodies.
authors.affiliation: Institut für Virologie und Seuchenhygiene, Medizinische Hochschule, Hannover, Germany. Albert.Heim@T-Online.de
authors.forename: A
authors.initials: A
authors.lastname: Heim
authors.forename: I
authors.initials: I
authors.lastname: Grumbach
authors.forename: S
authors.initials: S
authors.lastname: Hake
authors.forename: G
authors.initials: G
authors.lastname: Müller
authors.forename: P
authors.initials: P
authors.lastname: Pring-Akerblom
authors.forename: G
authors.initials: G
authors.lastname: Mall
authors.forename: H R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000914:Antibodies, Viral / Q000276:immunology*; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000821:virology; D001483:Base Sequence; D009202:Cardiomyopathies / Q000276:immunology / Q000821:virology*; D016022:Case-Control Studies; D002460:Cell Line; D002522:Chlorocebus aethiops; D004770:Enterovirus / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000276:immunology / Q000821:virology*; D005260:Female; D006367:HeLa Cells; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009205:Myocarditis / Q000276:immunology / Q000821:virology*; D009500:Neutralization Tests; D011446:Prospective Studies; D012367:RNA, Viral; D016415:Sequence Alignment; D017423:Sequence Analysis, RNA; D014407:Tumor Cells, Cultured; D014709:Vero Cells
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral