Autoimmune myocarditis: past, present and future.
Heart failure has become an increasingly prevalent disorder with considerable morbidity and mortality. While many causal mechanisms such as inherited cardiomyopathies, ischemic cardiomyopathy or muscular overload are easily identified in clinical practice, the molecular mechanisms that determine the progression of heart failure or ventricular remodelling are largely unknown. Autoimmune responses and inflammation are involved in the pathogenesis of many cardiovascular diseases. There is compelling evidence that inflammatory mechanisms may contribute to progressive heart failure. Thus, myocardial infiltration of lymphocytes and mononuclear cells, increased expression of pro-inflammatory chemokines and cytokines and circulating autoantibodies are frequently observed in myocarditis and dilated cardiomyopathy. In this review we give an overview on myocarditis and describe why diagnosis and treatment of myocarditis in the clinic can be difficult. We present current animal models and describe possible experimental approaches to improve diagnosis. Finally, we give an outlook on possible drug targets by describing the latest findings in the animal models focussing on chemokines and cytokines, T cell responses and interactions, tolerance induction and the development of autoantibodies.
Leuschner
Florian
F
Department of Cardiology, University of Heidelberg, 69120 Heidelberg, Germany.
Katus
Hugo A
HA
Kaya
Ziya
Z
D000818:Animals; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D024722:Cardiac Myosins / Q000276:immunology; D016207:Cytokines / Q000276:immunology; D004195:Disease Models, Animal; D006801:Humans; D009000:Monocytes / Q000276:immunology; D009205:Myocarditis / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D009206:Myocardium / Q000276:immunology* / Q000473:pathology; D032383:Myocytes, Cardiac / Q000276:immunology; D013601:T-Lymphocytes / Q000276:immunology; D051193:Toll-Like Receptors / Q000378:metabolism; D014336:Troponin / Q000276:immunology / Q000378:metabolism
D001323:Autoantibodies; D016207:Cytokines; D051193:Toll-Like Receptors; D014336:Troponin; D024722:Cardiac Myosins