Intramyocyte detection of Epstein-Barr virus genome by laser capture microdissection in patients with inflammatory cardiomyopathy.
BACKGROUND
The causal role of Epstein-Barr virus (EBV) in inflammatory cardiomyopathy (IC) is still unclear, because this virus is present in latently infected circulating B lymphocytes in 90% of adults. Laser capture microdissection (LCM) has been applied on endomyocardial biopsy samples from patients with IC to assess the presence of EBV genome in separately dissected lymphocytes and myocytes.


RESULTS
Among 142 patients with cardiac dilation and dysfunction and a histological and immunohistochemical diagnosis of myocarditis, 44 had a myocardial viral infection detected by polymerase chain reaction on frozen endomyocardial biopsy samples. In 9 of them, the virus detected was EBV. LCM was performed on 5-microm-thick paraffin sections of EBV-infected hearts. Lymphocytes and myocytes were microdissected and analyzed separately by polymerase chain reaction analysis on DNA extracted from the collected cells. Blood and myocardial samples from patients with positive and negative serology for EBV were used as controls. EBV genome was detected in myocytes but not in infiltrating lymphocytes of patients, nor in myocardial samples from controls. Despite full conventional antifailure therapy, a progressive cardiac dilation and dysfunction was documented in patients with EBV-related IC at a mean of 31+/-14 months of follow-up.


CONCLUSIONS
Intramyocyte detection of EBV can be obtained by LCM in up to 6.3% of patients with IC. This supports a cytopathic EBV role and suggests the opportunity for an antiviral/immunomodulatory therapy.
Chimenti
Cristina
C
Cardiothoracic and Vascular Department, Vita e Salute University, Milan, Italy.
Russo
Andrea
A
Pieroni
Maurizio
M
Calabrese
Fiorella
F
Verardo
Romina
R
Thiene
Gaetano
G
Russo
Matteo A
MA
Maseri
Attilio
A
Frustaci
Andrea
A
D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000473:pathology / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000821:virology*; D019309:Epstein-Barr Virus Nuclear Antigens / Q000235:genetics; D005260:Female; D016679:Genome, Viral; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D007150:Immunohistochemistry; D007834:Lasers; D008214:Lymphocytes / Q000821:virology; D008297:Male; D042282:Microdissection; D008875:Middle Aged; D009205:Myocarditis / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D032383:Myocytes, Cardiac / Q000821:virology*; D017354:Point Mutation; D020133:Reverse Transcriptase Polymerase Chain Reaction
D019309:Epstein-Barr Virus Nuclear Antigens; C417029:EBV-encoded nuclear antigen 1