Naslov
Immunomodulation in children with cardiomyopathies

Autori
Malčić, Ivan ; Kniewald, Hrvoje ; Šarić, Dalibor ; Ugljen, Ranko ; Mustapić, Željka ; Dorner, Sanja ; Gaurina-Srček, Višnja ; Jelušić, Marija ; Radošević, Kristina

Vrsta, podvrsta i kategorija rada
Poglavlja u knjigama, znanstveni

Knjiga
Immuno-Modulatory Drugs

Urednik/ci
Kniewald, Zlatko

Izdavač
Hrvatsko Društvo za Biotehnologiju ; Medicinska naklada

Grad
Zagreb

Godina
2005

Raspon stranica
67-76

ISBN
953-176-315-1

Ključne riječi
immunomodulation, cardiomyopathy, heart disease, children

Sažetak
The awarness that immune-mediated mechanism may play a pathogenetic role in many disorders in pediatric cardiology makes immunomodulatory therapy increasingly important. The greatest reason for that congestive heart disease caused by myocarditis. Myocarditis is very often overcome without clinical symptoms, but it can appear as fulminant form or as a chronic dilated cardiomyopathy. Both of forms are potentially life threatening to patients, especially the fulminant form which is lethal within a few days. Dilated cardiomyopathyies caused by viral agents are possible to treat today by different immunomodulatory mechanisms. It is considered that immunodeficiency lie behind all complicated forms of myocarditis. The course of disease is most likely caused by disturbed balance between pro- and anti- inflammatory cytokines. Considerably increased levels of TNF-α and IL1-β in comparison to IL-6 and IL-10 is found in the group of patients with dilated cardiomyopathy after myocarditis who develops decreasing of systolic function of the left ventricle. Intravenous immunoglobuline as immunomodulatory agent considerably increases the level of anti-inflammatory interleukins, especially IL-10 and anti-IL-1. It seems that because of this the contractility of the left ventricle increase considerably in some patients. Therefore, besides the conventional medicament therapy (ACE-inhibitors, angiotensin-II-blockers, diuretics, beta-blockers, digoxine), immunoglobuline should be applied intravenously, without any fear of doing harm to the patients that otherwise we cannot cure. The application of other immunomodulatory drugs depends exclusively on the final outcome of the diagnostic algorithm in which the dilated cardiomyopathy, as a unique hemodynamic entity, can be caused by different intramyocardial processes: chronic persistent myocarditis with finding of viral RNA (which can be persistent or replicating viral RNA), chronic immunological myocarditis with deposition of immune complexes and without viral RNA (positive immunofluorescency with deposition of immune complexes) and chronic viral heart disease (live virus exists in the heart). Differential diagnosis between the presence and absence of replicated RNA is made using molecular-genetic analysis by RT-PCR (reverse-transcriptase polymerase chain reaction). Every algorithm of diagnostic flow in processing heart muscle bioptate should end with that analysis, but technical (and financial) difficulties exist on this field.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Biotehnologija

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