DIAGNOSTIC RELEVANCE OF HUMORAL AND CELL-MEDIATED IMMUNE-REACTIONS IN PATIENTS WITH ACUTE VIRAL MYOCARDITIS

  • 1 January 1982
    • journal article
    • research article
    • Vol. 48  (3) , 533-545
Abstract
Sera of 177 patients with acute myocarditis (10 coxsackie B 3/4, 4 influenza, 4 mumps, 15 cytomegalovirus, 144 undefined) were tested by indirect immunofluorescence for autoantibodies against heart and skeletal muscle and vital or air-dried adult cardiocytes. Antibody-dependent cytolysis, lymphocytotoxicity and antibody-dependent cellular lymphocytotoxicity were assessed using vital adult rat cardiocytes as target cells. Muscle-specific anti-sarcolemmal antibodies [ASA] of the anti-myolemmal type, often associated with non-organ-specific anti-endothelial antibodies, were demonstrated in nine of 10 patients with coxsackievirus B, in all patients with influenza and mumps and in 65 of 144 patients with undefined myocarditis. Of 15 patients with cytomegalovirus myocarditis, 13 lacked ASA but had low titer anti-interfibrillary antibodies instead. In the presence of complement, anti-myolemmal antibodies induced cytolysis of vital cardiocytes; hepatocytes remained unaffected. Titers of anti-myolemmal antibodies correlated with the degree of cardiocytolysis. The anti-myolemmal immunofluorescent pattern and the cytolytic serum activity could be absorbed with the respective viral antigens, suggesting that these antibodies cross-react with moieties of the virus itself and may be both diagnostic and etiological markers in acute viral myocarditis. Lymphocyte-mediated cytotoxicity against heterologous cardiac target cells could not be observed in patients with myocarditis of proven viral etiology. Lymphocyte-mediated cytotoxicity was demonstrated in 10 ASA-positive and 1 ASA-negative patient with myocarditis of unknown origin. ASA-positive sera blocked lymphocytotoxicity in 3 of these patients.