Despite widespread suspicion and human and animal evidence of immunologic alteration in association with tissue-proven primary (idiopathic) myocarditis, the respective roles of cellular and humoral immune dysfunction in the process of myocardial injury are still under active investigation. Several factors have prevented the clear establishment of the immune mechanisms in human myocarditis. The variability in the clinical and histopathologic diagnosis as well as the unlikelihood of investigating human myocarditis in its early course have left the early events enigmatic. The suggestive evidence that immunosuppressive therapy may ameliorate human myocarditis has come despite uncertainty about the precise mechanisms by which immunosuppressive therapy works in immune modulation. Much more work must be done in the application of immunologic, immunopathologic, and molecular biology techniques before the cellular, humoral, and genetic processes of the disease will be clear. Further understanding of the cell-surface receptors on T lymphocytes will allow for eventual immune modulation, perhaps with a significant therapeutic impact on myocarditis. What effect the putative enterovirus-like sequences in human DNA might have on lymphocyte function is a pathway worth exploring. The manner in which immunologic proceses interact with myocyte metabolism and myocyte function in the genesis of myocyte failure is also totally unknown. The use of various immunologic probes in studies of myocardia injury is just beginning. The early events of tissue injury in idiopathic myocarditis may rely on yet-to-be clarified components of the acute inflammatory response including the humoral immune system and metabolites of the lipoxygenase pathway of arachidonic acid. An upcoming multicenter trial of immunosuppressive therapy in biopsy-proven myocarditis in humans will concurrently address the clinical outcome and the role of immunologic and genetic mechanisms in the myocarditic process, and will provide further opportunities for virologic and viral genomic studies of tissues from these patients.
|Original language||English (US)|
|Number of pages||22|
|State||Published - 1988|
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine