IMMUNOSUPPRESSIVE TREATMENT FOR MYOCARDITIS AND DILATED CARDIOMYOPATHY

This overview examines the immunological rationale for immunosuppressi ve and immunomodulating therapy in man and experimental animals. The c ontroversy of whether immunosuppressive treatment is beneficial in myo carditis will continue even after the Myocarditis Treatment Trial has been published. It is known that in viral heart disease immunosuppress ive drugs should be avoided, but in autoreactive forms of myocarditis with proven humoral and cellular effector mechanisms they may be used in controlled randomized trials to validate or refute their benefit. I mmunomodulating factors, e.g. immunostimulatory or antiviral substance s such as ribaverin, the interleukins and interferons have demonstrate d some effect in experimental animal myocarditis but proof of their be nefit in man is still lacking Hyperimmunoglobulin therapy appears to b e of particular interest because it incurs few side effects and has po sitive results in cytomegalovirus-associated myopericarditis in man an d suspected myocarditis in children.