New Concepts in Viral Heart Disease: Virology, Immunology and Clinical Management

502 Pages·1988·12.727 MB·English

by  W. H. Abelmann (auth.), PD Dr. med. Heinz-Peter Schultheiß (eds.)

H.-P' SchultheiS (Ed.)
New Concepts in Viral
Heart Disease
Virology, Immunology
and Clinical Management
With 190 Figures and 58 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
PD Dr. med. Heinz-Peter SchultheiB
Med. Klinik I
Klinikum GroBhadern
MarchioninistraBe 15
8000 Miinchen 70
ISBN -13 :978-3-642-73612-4 e-ISBN -13 :978-3-642-7361 0-0
DOl: 10.1007/978-3-642-73610-0
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Preface
The recent rapid advances in our knowledge of immunological and virological
mechanisms involved in the pathogenesis of viral heart disease makes it difficult
for everybody working in this field to keep up with the latest developments. How
ever, much of what we know is still circumstantial and only vaguely substained.
Interdisciplinary understanding and cooperation thus seems necessary to get a
better insight into the mechanisms by which viruses may initiate immunological
organ-specific tissue injury and disease!
This volume evolved out of an international symposium by the same title held
on May 25.-28., 1988 in Tegernsee, near Munich, of which a wide spectrum ofim
munological, virological, diagnostical and clinical problems was covered.
Both review articles and new experimental and clinical data are included in this
volume to give the reader an up-to-date information about current concepts and
future aspects.
Chapter I serves as an excellent introduction to the epidemiology and natural
history of dilated cardiomyopathy / viral heart disease. Although a definite viral
etiology in myocarditis and dilated cardiomyopathy is often difficult to establish,
epidemiological and serological data incriminate a viral etiology underlying many
cases of "dilated cardiomyopathy". Chapters II and III describe the current think
ing on virological and immunological mechanisms involved in the pathogenesis of
viral heart disease. Among others virus topism, virus persistance, possible mecha
nisms and genetic basis of post-infection autoimmunity, and the virus-interaction
with the immune system are discussed. Chapter IV provides an overview on
humoral and cellular cardiac-specific autoimmunity in patients with myocarditis
and dilated cardiomyopathy. Autoantibodies to several membrane proteins -
such as the beta-adrenoreceptor, the calcium channel, the connexon and the
AD P / A TP carrier - are described. The difficulties and future directions in the
diagnosis of virus-myocarditis are reviewed in chapter V. Recent data demon
strating enterovirus RNA in myocardial tissue from patients with myocarditis and
dilated cardiomyopathy and the meaning of this finding for the pathogenesis of
viral heart disease are discussed, furthermore the signification of immunohisto
chemical-, in-situ hybridization-and immunoscintigraphic techniques. In the final
chapters new aspects of the clinical management - specially the hemodynamic and
metabolic effects of ACE-inhibitors and the current status of immunomodulating
therapy - are critically reviewed.
The numerous suggestions and unrestrained support of Professor G. Riecker,
Department of Internal Medicine, University of Munich, is greatly appreciated.
VI Preface
As organizer, it is a pleasure to thank the members of the scientific committee:
Professor P. H. Hofschneider and Professor R. Kandolf, Department of Viro
logy, Max-Planck-Institute for Biochemistry, Martinsried, Professor M. Klingen
berg, Institute of Physical Biochemistry, University of Munich, and Professor G.
Riethmiiller, Institute of Immunology, University of Munich, for the fruitful and
lively discussions, to all those at the Department of Internal Medicine who did so
much to ensure the success of the symposium, and to Dr. C. Osthoff, Springer
Verlag, for publishing the book so rapidly.
Lastly but by no means least, I would like to thank Hoechst for their full support
without which it would not have been possible to organize this meeting.
I hope that the presentations contained in this book convey the excitement and
very productive scientific atmosphere of the conference, led to a better under
standing of the basic aspects of viral heart disease and to a genuine exchange of
concepts and experimental approaches between basic scientists and clinically
oriented researchers.
HEINZ-PETER SCHULTHEISS
Table of Contents
1. Epidemiology and Natural History
The Etiology, Pathogenesis and Pathophysiology of Dilated
Cardiomyopathies
W. H. ABELMANN ..................................... 3
Virological, Immunological and Clinical Features of Myocarditis
and Dilated Cardiomyopathy
J. F. GOODWIN ...................................... 22
Epidemiology and Pathogenicity of Coxsackieviruses
N. R. GRIST ......................................... 26
Natural History of Acute Viral or Idiopathic Myocarditis:
A Clinical and Endomycardial Biopsy Follow-up
M. SEKIGUCHI, M. HIROE, S. HIRAMITSU, T. IZUMI ............. 33
Myocarditis in Patients with Dilated Cardiomyopathy -
Correlation with Clinical, Hemodynamic and Biochemical Findings
V. REGITZ, R. STRASSER, G. CHMIELEWSKI, S. BLUMCKE, E. FLECK . 51
Coxsackievirus Cardiomyopathy in Animal Models,
Including the Augmenting Effect of Exercise During the Acute Phase
M. P. REYES, A. M. LERNER, R. KHATIB ................... " 61
II. Concepts in Viral Pathogenesis
Replication, Molecular Biology, and Pathogenesis of Coxsackieviruses
N. K. CHATTERJEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 73
A Murine Model for Coxsackievirus B3-Induced Acute Myocardial
Necrosis for Study of Cellular Receptors as Determinants of Viral Tropism
R. L. CROWELL, S. D. FINKELSTEIN, K.-H. L. HSU, B. J. LANDAU,
P. STALHANDSKE, P. S. WHITTIER ......................... 79
VIII Table of Contents
Induction of Soluble Mediators During Coxsackievirus B3 Replication
In Vitro and In Vivo
C. J. GAUNTT, C. W. LUTTON, G. E. REVTYAK, A. J. VALENTE,
A. N. FERNANDES, H. M. ARIZPE, M. M. ROZEK ... . . . . . . . . . . .. 93
Persistence of Echovirus Type 6 in Cultured Cells
V. F. RIGHTLAND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 105
Detection and Typing of Enteroviruses by Nucleic Acid Probes
and Monoclonal Antibodies
T. HYYPIA, M. KALLAJOKI, P. AUVINEN . . . . . . . . . . . . . . . . . . .. 115
Generation of Enterovirus Group-Specific Antisera Using Bacterially
Synthesized Coxsackievirus B3 Proteins
S. WERNER, H. SCHONKE, W. KLUMP, P.-H. HOFSCHNEIDER,
R. KANDOLF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 125
III. Virus and Immunity
Myocarditis: A Post-infectious Autoimmune Disease
N. R. ROSE, N. NEU, D. A. NEUMANN, A. HERSKOWITZ 139
Viral Myocarditis: Immunogenetic and Autoimmune Aspects
K. W. BEISEL, M. D. TRAYSTMAN ........................ 148
Is Coxsackievirus B3-Induced Myocarditis in A/J Mice Mediated
by an Autoimmune Response to Cardiac Myosin?
N. NEU, G. KROMER, B. PLOIER, N. R. ROSE. . . . . . . . . . . . . . . .. 160
Virus-Induced Autoimmunity: Cross-Reactivity of Antiviral Antibodies
with Self-Components
B. S. PRABHAKER, J. SRINIVASAPPA, K. W. BEISEL, A. L. NNOTKINS. 168
Immunopathogenic Mechanisms in Experimental Myocarditis:
Evidence for Autoimmunity to the Virus Receptor and Antigenic Mimicry
Between the Virus and Cardiocyte
S. A. HUBER, K. SIMPSON, A. WELLER, M. HERZUM ........... 179
Coxsackie B3 Myocarditis: Genetic Aspects of Different
Immunopathogenetic Mechanisms in BALB/c and DBA/2 Mice. Antigenic
Specificity of Heart-Reactive Antibodies in DBA/2 Mice
M. HERZUM, S. A. HUBER, B. MAISCH ., . . . . . . . . . . . . . . . . . . .. 188
Interactions of Group B Coxsackieviruses with Immunocytes
P. G. CONALDI, D. MATTEUCCI, E. SOLDAINI,
M. GUIDI, M. BENDINELLI .............................. 195
Table of Contents IX
Early Cellular Infiltrates in Coxsackievirus B3 Murine Myocarditis
L. H. CHOW, C. J. GAUNTT, B. M. McMANUS. . . . . . . . . . . . . . . .. 205
IV. Characterization of Autoimmunological Mechanisms
Beta-Adrenoceptor Autoantibodies in Idiopathic Dilated Cardiomyopathy
C. J. LIMAS, C. LIMAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 217
Antibodies Against the ADPIA TP Carrier Crossreact with
the Ca-Channel-Functional and Biochemical Data
G. UULRICH, U. KOHL, B. MELZNER, I. JANDA, B. SCHAFER,
H.-P. SCHULTHEISS .................................. 225
Antibodies and Autoantibodies against ADP/ATP Carrier
Enhance Calcium Current in Isolated Ventricular Myocytes
M. MORAD, M. NABAUER, H.-P. SCHULTHEISS ............... 236
Antibodies Against the ADP/ATP Carrier Alter Myocardial Function
by Disturbing Cellular Energy Metabolism
H.-P. SCHULTHEISS, U. KOHL, R. SCHAUER, K. SCHULZE,
B. KEMKES, B. F. BECKER. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 243
The Importance of Humoral and Cellular Immunological Parameters
for the Pathogenesis of Viral Myocarditis
B. MAISCH, M. HERZUM, T. IZUMI, S. NUNODA . . . . . . . . . . . . . .. 259
Characterization ofT-Lymphocytes Cultured from
Human Endomyocardial Biopsies
J. T. FALLON, I. STAMENKOVIC, D. M. FRISMAN, C. LEARY,
1. PALACIOS, J. T. KURNICK . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 274
V. Diagnostic Criteria
The Role of Biopsy in the Diagnosis and Follow-up of Myocarditis.
A Critical Review
E. G. J. OLSEN, B. T. MEANY, P. J. RICHARDSON. . . . . . . . . . . . .. 285
Impaired Myocardial Ultra-Structure and Cytoskeleton in
Cardiomyopathic Human Myocardium
J. SCHAPER, R. FROEDE, A. BUCK, N. BLEESE ................ 295
Immunofluorescence Microscopy in the Diagnosis and Follow-up
of Patients Suspected of Having Inflammatory Heart Disease
E. H. HAMMOND, R. L. MENLOVE, J. L. ANDERSON. . . . . . . . . . .. 303
x Table of Contents
Introduction of Major Histocompatibility (MHC) Antigens on Myocardial
Cells in Patients with Active Myocarditis and Idiopathic Cardiomyopathy
A. HERSKOWITZ, K. L. BAUGHMAN, N. R. ROSE, D. A. NEUMANN,
W. E. BESCHORNER, K. W. SELL, A. AHMED-ANSARI . . . . . . . . . .. 312
Evalution of Immunohistological Data for the Diagnosis of Myocarditis
U. KOHL, M. TOUSSAINT, G. UULRICH, D. WAGNER, P. WOLFF,
H.-P. SCHULTHEISS .................................. 325
Enteroviral Heart Disease: Diagnosis by In Situ Hybridization
R. KANDOLF, P. KIRSCHNER, D. AMEIS, A. CANU, E. ERDMANN,
H.-P. SCHULTHEISS, B. KEMKES, P. H. HOFSCHNEIDER . . . . . . . . .. 337
Persistence of Enterovirus RNA in Dilated Cardiomyopathy:
A Progression from Myocarditis
L. ARCHARD, C. FREEKE, P. RICHARDSON, B. MEANY, E. OLSEN,
P. MORGAN-CAPNER, M. ROSE, P. TAYLOR, N. BANNER,
M. YACOUB, N. BOWLES ............................... 349
Diagnosis of Acute Myocarditis with Radiolabeled Monoclonal
Antimyosin Antibody: Immunoscintigraphic Evaluation
B. A. KHAW, T. YASUDA, I. F. PALACIOS, J. T. FALLON, G. W. DEC, '
P. D. NICOL, A. J. FISCHMAN, H. W. STRAUSS, E. HABER ........ 363
VI. Immuno-Modulating Therapy:
Experimental and Clinical Approaches
Animal Models for Therapeutic Trials of Viral Myocarditis:
Effect of Ribavirin and Alpha Interferon on Coxsackievirus B3
and Encephalomyocarditis Virus Myocarditis
A. MATSUMORI, I. OKADA, C. KAWAI, C. S. CRUMPACKER,
W. H. ABELMANN ................................... 377
Antiviral Activity of Human Fibroblast Interferon in Coxsackievirus
B3-Infected Cultured Human Heart Cells
P. KIRSCHNER, R. KANDOLF, A. CANU, A. HElM, P. H. HOFSCHNEIDER. 385
Immunosuppressive Therapy in Myocarditis:
Acute Viral Versus Chronic Idiopathic Myocarditis
J. D. HOSENPUD .................................... 393
Immunosuppressive Treatment in Myocarditis
F. CAMERINI, A. SALVI, R. BUSSANI, L. DREAS, A. D. LENARDA,
E. HROVATIN, G. SINAGRA, F. SILVESTRI ................... 402
The Role of Cardiac Transplantation in Patients with Active Myocarditis
J. B. O'CONNELL, G. W. DEC, J. W. MASON. . . . . . . . . . . . . . . . .. 426
Table of Contents XI
Clinical and Experimental Aspects of Treatment for Viral Myocarditis
C. KAWAI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 433
VII. New Aspects of Clinical Management
Alterations of Receptors and of Agonist Effectiveness in Myocardial Failure
E. ERDMANN, M. BOHM ... . . . . . . . . . . . . . . . . . . . . . . . . . ... 441
Positive Inotropic Drugs in the Treatment of Chronic Congestive
Heart Failure: A Critical Up-date
w. MOTZ, B. E. STRAUER . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 449
Effect of ACE-Inhibitors on Myocardial Perfusion
G. ERTL .......................................... 456
Experimental Evidence for Cardioprotection Afforded by Ramipril,
an Inhibitor of Angiotensin Converting Enzyme
B. F. BECKER, M. HEIER, E. GERLACH . . . . . . . . . . . . . . . . . . . .. 465
Energetic Consequences of Pharmacological Therapy in Patients
with Myocardial Failure
G. HASENFUSS, C. HOLUBARSCH, H. W. HEISS, H. JUST ......... 475
The Effect of ACE Inhibitors on Energy Metabolism in Chronic Heart
Failure - Enzymatic Studies of Myocardial Biopsies
K. SCHULZE, M. SCHINDLER, H.-P. SCHULTHEISS. . . . . . . . . . . . .. 485
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 495