title: Selenium- and zinc-deficient cardiomyopathy in human intestinal malabsorption: preliminary results of selenium/zinc infusion.
abstract: OBJECTIVE
  Patients with intestinal malabsorption may develop cardiac dysfunction the origin of which is often unclear. We sought to investigate the pathogenesis of dilated cardiomyopathy in human malabsorption.
  
  
  RESULTS
  Eighteen patients with intestinal bypass as treatment for severe obesity and cardiomyopathy underwent endomyocardial biopsy. Biopsies were processed by histology, electron microscopy, polymerase chain reaction (PCR) for cardiotropic viruses, instrumental neutron activation analysis (INAA) of 33 myocardial trace elements, and assessment of glutathione peroxidase (GPX) activity and LC3-II expression. Histology and electron microscopy showed hypertrophy/degeneration of cardiomyocytes with pronounced cell autophagy and high expression of LC3-II. PCR was negative for viral genomes. INAA showed severe myocardial selenium (Se) and zinc (Zn) deficiency and reduced GPX activity vs. both patients with idiopathic dilated cardiomyopathy and normal controls. Se and Zn were added to antifailing heart therapy in 10 patients (group A1) agreeing to a control biopsy, and the response was compared with that of 8 patients (group A2) on supportive therapy alone. After 6 months, myocardial normalization of Se, Zn, LC3-II, and GPX in group A1 was associated with recovery of cardiomyocyte degeneration and autophagy, and significant improvement in cardiac dimension and function, that remained unchanged in group A2.
  
  
  CONCLUSIONS
  A reversible Se- and Zn-deficient cardiomyopathy may occur in patients with intestinal malabsorption. It is characterized by decline of myocardial antioxidant reserve, oxidative damage of cell membranes, and enhanced cell autophagy.
authors.affiliation: Department of Cardiovascular and Respiratory, Nephrological, and Geriatric Sciences, La Sapienza University, Rome, Italy. biocard@inmi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Frustaci
authors.forename: Enrico
authors.initials: E
authors.lastname: Sabbioni
authors.forename: Salvador
authors.initials: S
authors.lastname: Fortaner
authors.forename: Massimo
authors.initials: M
authors.lastname: Farina
authors.forename: Riccardo
authors.initials: R
authors.lastname: del Torchio
authors.forename: Marco
authors.initials: M
authors.lastname: Tafani
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morgante
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Ciriolo
authors.forename: Matteo A
authors.initials: MA
authors.lastname: Russo
authors.forename: Cristina
authors.initials: C
authors.lastname: Chimenti
mesh_terms: D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000473:pathology*; D002908:Chronic Disease; D003677:Deficiency Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012643:Selenium / Q000008:administration & dosage* / Q000032:analysis / Q000172:deficiency; D015032:Zinc / Q000008:administration & dosage* / Q000032:analysis / Q000172:deficiency
chemical_list: D012643:Selenium; D015032:Zinc