© 1999 American Heart Association, Inc.
Editorials |
The Immune System in Viral Myocarditis
Maintaining the Balance
From the Department of Medicine, University of California, San Diego, Calif.
Correspondence to Kirk U. Knowlton, MD, Department of Medicine, University of California, 9500 Gilman Dr, San Diego, CA 92093-0613C. E-mail kknowlton@ucsd.edu
Key Words: Coxsackievirus • myocarditis • cardiomyopathy • lymphocyte
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Introduction |
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"Nature has provided in the white corpuscles as you call them—or the phagocytes as we call them—a natural means of devouring and destroying all disease germs. [However,] ...the inoculation that ought to cure sometimes kills."
Bernard Shaw, The Doctor's Dilemma, 1906
Dilated cardiomyopathy, one of the leading causes of heart failure in the United States, is a multifactorial disease that includes both hereditary and acquired forms.1 In patients, it has been shown that dilated cardiomyopathy can be a sequela of viral myocarditis.2 Although many different infectious agents have been attributed as the cause of viral myocarditis, enteroviruses, in particular Coxsackie B viruses, are consistently among the most common.2 The concept that enteroviruses contribute to the pathogenesis of a subset of human dilated cardiomyopathy has been strengthened by the detection of enteroviral genome in the hearts of patients with dilated cardiomyopathy. Since the first description by Bowles et al in 1986,3 many articles have addressed this issue (reviewed in Baboonian et al4 ). Although the results of individual studies vary, the data overall indicate that enteroviral genome is present in the heart of 15% to 25% of patients with dilated cardiomyopathy.4
Analogous to many other viral illnesses, both direct viral injury and
the immune response of the host play an important role in the
pathogenesis of viral heart disease. Furthermore, results from
experiments in murine models of viral myocarditis indicate that
although the immune response has an important protective role, it may
also have deleterious effects on the host. The
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