title: Infectious agents and inflammation in donated hearts and dilated cardiomyopathies related to cardiovascular diseases, Chagas' heart disease, primary and secondary dilated cardiomyopathies.
abstract: BACKGROUND
  Clinical and experimental conflicting data have questioned the relationship between infectious agents, inflammation and dilated cardiomyopathy (DCM).
  
  
  OBJECTIVE
  The aim of this study was to determine the frequency of infectious agents and inflammation in endomyocardial biopsy (EMB) specimens from patients with idiopathic DCM, explanted hearts from different etiologies, including Chagas' disease, compared to donated hearts.
  
  
  METHODS
  From 2008 to 2011, myocardial samples from 29 heart donors and 55 patients with DCMs from different etiologies were studied (32 idiopathic, 9 chagasic, 6 ischemic and 8 other specific etiologies). Inflammation was investigated by immunohistochemistry and infectious agents by immunohistochemistry, molecular biology, in situ hybridization and electron microscopy.
  
  
  RESULTS
  There were no differences regarding the presence of macrophages, expression of HLA class II and ICAM-I in donors and DCM. Inflammation in Chagas' disease was predominant. By immunohistochemistry, in donors, there was a higher expression of antigens of enterovirus and Borrelia, hepatitis B and C in DCMs. By molecular biology, in all groups, the positivity was elevated to microorganisms, including co-infections, with a higher positivity to adenovirus and HHV6 in donors towards DCMs. This study was the first to demonstrate the presence of virus in the heart tissue of chagasic DCM.
  
  
  CONCLUSIONS
  The presence of inflammation and infectious agents is frequent in donated hearts, in the myocardium of patients with idiopathic DCM, myocardial dysfunction related to cardiovascular diseases, and primary and secondary cardiomyopathies, including Chagas' disease. The role of co-infection in Chagas' heart disease physiopathology deserves to be investigated in future studies.
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. Electronic address: sanmangini@ig.com.br.
authors.forename: Sandrigo
authors.initials: S
authors.lastname: Mangini
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Higuchi
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Joyce Tiyeko
authors.initials: JT
authors.lastname: Kawakami
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Marcia Martins
authors.initials: MM
authors.lastname: Reis
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Renata Nishiyama
authors.initials: RN
authors.lastname: Ikegami
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Suely Aparecida Pinheiro
authors.initials: SA
authors.lastname: Palomino
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Pablo Maria Alberto
authors.initials: PM
authors.lastname: Pomerantzeff
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Alfredo Inácio
authors.initials: AI
authors.lastname: Fiorelli
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Fabiana Goulart
authors.initials: FG
authors.lastname: Marcondes-Braga
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Sílvia Moreira Ayub
authors.initials: SM
authors.lastname: Ferreira
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Victor Sarli
authors.initials: VS
authors.lastname: Issa
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Germano Emílio Conceição
authors.initials: GE
authors.lastname: Souza
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Chizzola
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000382:microbiology; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000382:microbiology*; D014355:Chagas Disease / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006321:Heart / Q000382:microbiology*; D016027:Heart Transplantation / Q000592:standards; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors; D055815:Young Adult
keywords: Chagas' heart disease; Dilated cardiomyopathy; Endomyocardial biopsy; Heart donors; Heart failure; Myocarditis