THE ROLE OF SENSITIZED T-CELLS IN MYOCARDITIS AND DILATED CARDIOMYOPATHY

Enteroviruses like coxsackie are known to cause myocarditis both in an imals and humans and enteroviral genom was found in endomyocardial bio psies of patients with myocarditis and dilated cardiomyopathy. However , subsequent to the initial viral infection, immune mechanisms seem to play an important role in the pathogenesis of both diseases. Using sy nthetic peptides, it was possible to identify T-cell epitopes of coxsa ckie B3 virus and to test their significance in the pathogenesis of my ocarditis in the animal model. The T-cell response against coxsackie v irus and autoantigens like the adenine nucleotide translocator is also present in the human disease, since sensitized T-cells can be culture d from about 50% of endomyocardial biopsies of patients with myocardit is and dilated cardiomyopathy. The significance of the cellular immune responses in the human disease can be demonstrated by the transfer of peripheral blood leukocytes of patients with chronic myocarditis into severe combined immune deficiency mice that develop human cellular in filtrates of the myocardium and an impairment of the left ventricular function within 60 days. Thus, these results show the presence and imp ortance of cellular immune responses in the pathogenesis of myocarditi s and dilated cardiomyopathy.