Contemporary insight on myocarditis pathogenesis
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Abstract
Diagnosis and prognosis of myocarditis course remain one of the most complex and unsolved problems of contemporary cardiology, not only in Ukraine but also in the developed countries of the world. It is well known that in order to develop adequate methods of diagnosis, treatment and prevention of complications, fundamental knowledge regarding the pathogenetic mechanisms of the development and progression of a particular disease is necessary. In the pathogenesis of impaired cardiac function and its dilation in both acute and chronic stages of myocarditis, the primary role played by immunopathological reactions manifested by autoimmunization and hyperreactivity against the structural elements of the heart muscle. The pathogenetic mechanisms of viral myocarditis are based on a complex of factors – direct cytotoxic effect of virus on cardiomyocytes, activation of apoptotic processes, as well as reactions of primary and secondary immunity, microvascular lesion, remodeling of the contractile apparatus of the heart muscle. The main proinflammatory cytokines produced by immune cells in the inflammation zone are: γ-interferon, tumor necrosis factor-α, interleukin (IL) 1β, IL-2, IL-6, IL-17A, IL-23. Another mechanism of myocardial contraction is associated with the activation of immunopathological responses of the humoral type with the synthesis of cardiospecific antibodies, in particular to the β1-adrenoceptor, cardiac myosin, actin, laminin, vimentin and other structures of the heart muscle. A significant role in the pathogenesis of myocarditis is now given to stimulation of Toll-like receptors of type 2 and type 4 and activation of matrix metalloproteinases, which has a direct relationship with the production of proinflammatory cytokines. Promising to clarify some of the pathogenetic mechanisms of inflammatory heart damage is currently considered the study of different microRNAs types. Currently, the world cardiology community recognizes the relevance of further study of the various mechanisms of myocarditis pathways in order to identify those pathogenetic links, the impact of which can reduce the pathological effect of inflammatory cardiac damage and the severity of the disease and improve prognosis for patients with myocarditis.
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