Skip to main content
SpringerLink
Log in

Autoantibodies and serum inhibition factors (SIF) in patients with myocarditis

Autoantikörper und Seruminhibitionsfaktoren bei Patienten mit Myokarditis

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

54 Patienten mit akuter und chronischer Myokarditis wurden auf Antikörper und Seruminhibitionsfaktoren untersucht. Bei 11 Patienten konnte eine Virusätiologie gesichert werden, bei 17 Patienten bestand der Verdacht auf eine „chronische“ Myokarditis. Aus dem Vergleich der Antikörpermuster zwischen Patienten mit bekannter Virusätiologie und ätiologisch nicht definierter Myokarditis konnte gefolgert werden, daß vor allem Antikörper gegen Sarkolemm und Gefäßendothel Marker eines virusinduzierten Prozesses am Myokard sind. 10 der 11 Patienten mit Influenza, Coxsackie B3-und Coxsackie B4-Myokarditis hatten diese Konstellation. 15 der 26 Patienten mit ätiologisch unklarer Myokarditis wiesen dasselbe Antikörpermuster auf, während bei 17 Patienten mit Verdacht auf chronische Myokarditis antiendotheliale Antikörper und antisarkolemmale Antikörper seltener nachweisbar waren. 65% der Patienten mit „chronischer“ Myokarditis wiesen Antikörper gegen Kerne mit einem Titer bis zu 1:40 auf.

Während Seruminhibitionsfaktoren (SIF) bei allen Patienten mit akuter Virusmyokarditis und bei 11 von 26 Patienten mit akuter, ätiologisch nicht definierter Myokarditis nachweisbar waren, persistierten sie nur bei 3 Patienten mit chronischer Myokarditis, bei denen aufgrund des Auftretens von antinukleären Faktoren und der fehlenden antiendothelialen und antisarkolemmalen Antikörper ein autoimmuner Prozeß angenommen werden könnte.

Die Untersuchungen zeigen, daß eine ätiologische Klassifizierung unklarer Myokarditiden mit serologischen Markern möglich ist und daß Seruminhibitionsfaktoren bei akuten Myokarditiden passager und bei autoimmunen Myokarditiden persistierend vorkommen können.

Summary

54 patients with acute and “chronic” myocarditis were tested for autoantibodies and serum inhibition factors. 11 patients had a viral myocarditis, 17 a “chronic” myocarditis. By comparing the antibody pattern of sera of patients with defined viral myocarditis with those of patients with myocarditis of unknown etiology we could demonstrate that antisarcolemmal (ASA) and antiendothelial antibodies (AEA) are markers of a viral involvement in heart disease. 10 of the 11 patients with Coxsackie B and Influenza virus myocarditis demonstrated this pattern.

15 out of 26 patients with undefined myocarditis showed the same antibody pattern, in sera of 17 patients with features suggestive of “chronic” myocarditis antiendothelial and antisarcolemmal antibodies occurred less frequently. The latter patients showed antinuclear antibodies in 65% with titres up to 1:40.

Whereas SIF could be demonstrated in all patients with acute viral myocarditis, and in 11 out of 26 patients with acute undefined myocarditis in the early period and only in 3 patients with “chronic” myocarditis, SIF persisted in these 3 patients with chronic myocarditis in whom we suspected an autoimmune process.

Our investigation demonstrates that an etiological classification of undefined myocarditis can be obtained by serological markers and that serum inhibition factors occur transiently in acute and continuously in autoimmune myocarditis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abbreviations

AEA:

antiendothelial antibodies

AFA:

antifibrillary antibodies

AHA:

antiheart antibodies

AMA:

antimitochondrial antibodies

ANA:

antinuclear antibodies

ASA:

antisarcolemmal antibodies

CFT:

complement fixation test

DNA:

des-oxy-ribonucleic acid

ECG:

electrocardiogram

IFA:

antiinterfibrillary antibodies

IRA:

immune regulatory alpha-globulin

PHA:

phytohaemagglutinin

SIF:

serum inhibition factors

SMA:

smooth muscle antibodies

References

  1. Berg, P.A., Brandt, H., Märker, A.: Nachweis und Bedeutung von Antikörpern gegen homologes Gefäßendothel bei Leberund anderen Krankheiten. Verh. Dtsch. Ges. Inn. Med.79, 649–650 (1973)

    Google Scholar 

  2. Berg, P.A., Binder, T., Lindner, H., Bannaski, H., Mass, D., Henning, H., Brügel, H.: Heterogenität mitochondrialer Autoantikörper. Dtsch. Med. Wochenschr.100, 1123–1127 (1975)

    PubMed  Google Scholar 

  3. Bertrams, J., Kuwert, E., Selmair, H., Reis, H.E., Wiese, W.: Autoantikörper gegen Lymphozyten (CoCoCy) bei Patienten mit verschiedenen Formen der Hepatitis und Cirrhose. Klin. Wochenschr.54, 227–233 (1976)

    PubMed  Google Scholar 

  4. Bolte, H.D.: Diagnostische Wertigkeit des indirekten Immunfluoreszenztestes zum Nachweis humoraler Antikörper gegen Myokard. Internist16, 180–184 (1975)

    PubMed  Google Scholar 

  5. Brattig, N., Berg, P.A.: Serum inhibitory factors (SIF) in patients with acute and chronic hepatitis and their clinical significance. Clin. Exp. Immunol.25, 40–49 (1976)

    PubMed  Google Scholar 

  6. Burch, G.E., De Pasquale, N.P.: Cardiomyopathies. Viral myocarditis. pp. 376–405. London: J. & A. Churchill Ltd. 1964

    Google Scholar 

  7. Burch, G.E., Giles, T.D.: The role of viruses in the production of heart disease. Am. J. Cardiol.29, 231–240 (1972)

    PubMed  Google Scholar 

  8. Burch, G.E., Giles, T.D.: Viral cardiomyopathy, in: Recent advances in studies on cardiac structure and metabolism. Vol. 2 Cardiomyopathies. Bajusz, E., Rona, G. (eds.). pp. 121–139. München: Urban & Schwarzenberg 1976

    Google Scholar 

  9. Chisari, F.V., Edgington, T.S.: Lymphocyte E rosette inhibitory factor: A regulatory serum lipoprotein. J. Exp. Med.142, 1092–1107 (1975)

    PubMed  Google Scholar 

  10. Chiu, K.M., Mortensen, R.F., Osmand, A.P., Gewurz, H.: Interactions of alpha-acid glycoprotein with the immune system. I. Purification and effects upon lymphocyte responsiveness. Immunology32, 997–1005 (1977)

    PubMed  Google Scholar 

  11. Coons, A.H., Kaplan, M.M.: Localization of antigens in tissue cells. I. Improvements in a method for the detection of antigen by means of fluorescent antibody. J. Exp. Med.91, 1–13 (1950)

    PubMed  Google Scholar 

  12. Cooperband, S.R., Badger, A.M., Mannick, J.A.: Non-hormonal serum suppressive factors. In: Mitogens in Immunobiology. Oppenheim, J.J., Rosenstreich, D.L. (eds.), pp. 555–572. New York, London: Academic Press 1976

    Google Scholar 

  13. Cooperband, S.R., Niberg, R., Schmid, K. et al.: Humoral immunosuppressive factors. Transplant. Proc.8, 225–242 (1976)

    PubMed  Google Scholar 

  14. De Horatius, R.J., Henderson, C., Strickland, R.G.: Lymphocytotoxins in acute and chronic hepatitis. Characterization and relationship to changes in circulating T lymphocytes. Clin. Exp. Immunol.26, 21–27 (1976)

    PubMed  Google Scholar 

  15. Fitzgerald, M.G., Hosking, C.S.: Plasma inhibitors of lymphocyte response to phytohaemagglutinin in children with recurrent infections. Immunol.30, 33–42 (1976)

    Google Scholar 

  16. Gluckman, J.C., Bonfils, H., Sanchez, F.: Inhibition of complement-dependant rosette information by sera of patients with chronic glomerulonephritis. Clin. Exp. Immunol.26, 247–252 (1976)

    PubMed  Google Scholar 

  17. Goldstein, I.J., So, L.L., Yand, Y., Callies, Q.C.: Proteincarbohydrate interaction. XIX. The interaction of concanavalin A with IgM and the glycoprotein phytohaemagglutinins of waxbean and the soybean. J. Immunol.103, 695–698 (1969)

    PubMed  Google Scholar 

  18. Gorcezynski, R., Kontiainen, S., Mitchison, N.A., Tigelaar, R.E.: Antigen-antibody complexes as blocking factors on the T lymphocyte surface. In: Cellular selection and regulation in the immune response. Edelman, G.M. (ed.), pp. 143–154. New York: Raven Press 1974

    Google Scholar 

  19. Havemann, K., Bürger, S., Dosch, H.M.: Phytohämagglutinin (PHA) und Serumproteine in der Lymphozytenkultur. II. Die Präzipitation von Serumproteinen durch PHA. Z. Ges. Exp. Med.153, 308–323 (1970)

    Google Scholar 

  20. Hawkins, B.R., McDonald, M., Dawkins, R.C.: Characterization of immunofluorescent heterophil antibodies which may be confused with autoantibodies. J. Clin. Pathol.30, 299–307 (1977)

    PubMed  Google Scholar 

  21. Kaplan, M.H., Meyeserian, M.: An immunological reaction between group A streptococcal cells and human heart tissue. Lancet1962 I, 706–710

  22. Kaplan, M.H., Frengley, J.D.: Autoimmunity to the heart in cardiac disease. Current concepts of the relation of autoimmunity to rheumatic fever, post-cardiotomy and post-infarction syndromes and cardiomyopathies. Am. J. Cardiol.24, 459–473 (1969)

    PubMed  Google Scholar 

  23. Keller, R.H., Tomasi, T.B.: Alpha-fetoprotein synthesis by murine lymphoid cells in allogeneic reactions. J. Exp. Med.143, 1140–1153

  24. Kuch, J.: Autoantibodies directed against heart antigens and endocrine reactivity in patients with recent myocardial infarction. Cardiovasc. Res.7, 649–654 (1973)

    PubMed  Google Scholar 

  25. Lyon, E.: Virus disease and the cardiovascular system: A survey. New York, London: Grune & Stratton 1956

    Google Scholar 

  26. Maisch, B., Berg, P.A., Kochsiek, K.: Clinical significance of immunopathological findings in patients with postpericardiotomy syndrome. Part I: Relevance of antibody pattern in patients with complete and incomplete postpericardiotomy syndrome. Clin. Exp. Immunol.38, 189–197 (1979)

    PubMed  Google Scholar 

  27. Maisch, B., Berg, P.A., Kochsiek, K.: Immunologische Differenzierung der Perikarditis nach Myokardinfarkt. Intensivmedizin16, 28–32 (1979)

    Google Scholar 

  28. McCabe, J.C., Ebert, P.A., Engle, M.A., Zabriskie, J.B.: Circulating heart — reactive antibodies in the post-pericardiotomy syndrome. J. Surg. Res.14, 158–164 (1973)

    PubMed  Google Scholar 

  29. McFarland, H.F.: The effect of measles virus infection on T and B lymphocytes in the mouse. I. Suppression of helper cell activity. J. Immunol.113, 1978–1983 (1974)

    PubMed  Google Scholar 

  30. Miller, F.: Serum-derived immunosuppressive substances. I. Partial purification and range of action. Transplantation21, 179–187 (1976)

    PubMed  Google Scholar 

  31. Moorthy, A.V., Zimmermann, S.W., Burkholder, P.M.: Inhibition of lymphocyte blastogenesis by patients with minimal change-nephrotic syndrome. Lancet1976 I, II, 1160–1163

  32. Morse, J.H.: Immunological studies of phytohaemagglutinin. I. Reaction between phytohaemagglutinin and normal sera. Immunology14, 713–724 (1968)

    PubMed  Google Scholar 

  33. Mortensen, R.F., Gewurz, H.: Effects of C-reactive protein on the lymphoid system. II. Inhibition of mixed lymphocyte reactivity and generation of cytotoxic lymphocytes. J. Immunol.116, 1244–1250 (1976)

    PubMed  Google Scholar 

  34. Murgita, R.A., Tomasi, T.B.: Suppression of the immune response by alpha fetoprotein. II. The effect of mouse alpha-fetoprotein on mixed lymphocyte reactivity and mitogeninduced lymphocyte transformation. J. Exp. Med.141, 440–452 (1975)

    Google Scholar 

  35. Nakao, M., Mizoguchi, Y., Monna, T., Yamamoto, S., Morisawa, S.: Studies on an inhibitory factor to phytohemagglutinin-induced lymphocyte transformation found in the serum of patients with various liver diseases. Acta Hepato-Gastroenterol.25, 335–343 (1978)

    Google Scholar 

  36. Nelson, D.S., Catti, R.A.: Humoral factors influencing lymphocyte transformation. Prog. Allergy21, 261–341 (1976)

    PubMed  Google Scholar 

  37. Nelson, D.S., Schneider, C.N., Penrose, J.M.: Inhibition of lymphocyte transformation by products of macrophages and other cells. In: Mitogens in immunobiology. Oppenheim, J.J., Rosenstreich, D.L. (eds.), pp. 477–494. New York, London: Academic Press 1976

    Google Scholar 

  38. Newberry, M.W., Shorey, J.W., Sanford, J.P., Combes, B.: Depression of lymphocyte reactivity to phytohemagglutinin by serum from patients with liver disease. Cellular Immunology6, 87–97 (1973)

    PubMed  Google Scholar 

  39. Panky, G.A.: Effect of viruses on the cardiovascular system. Am. J. Med. Sci.250, 103–114 (1965)

    PubMed  Google Scholar 

  40. Penhale, W.J., Farmer, A., Maccuish, A.C., Irvine, W.J.: A rapid micro-method for the phytohaemagglutinin-induced human lymphocyte transformation test. Clin. Exp. Immunol.18, 155–167 (1974)

    PubMed  Google Scholar 

  41. Rosenberg, B.J., Erlanger, B.F., Beiser, S.M.: Radioimmunochemical studies on nucleoside-specific antibodies using iodinated DNA. J. Immunol.108, 271–279 (1972)

    PubMed  Google Scholar 

  42. Sachs, L.: Statistische Auswertungsmethoden. Berlin, Heidelberg, New York: Springer 1972

    Google Scholar 

  43. Tomasi, T.B.: Serum factors which suppress the immune response. In: Regulatory mechanisms in lymphocyte activation. pp. 219–250. Lucas, D.O. (eds.). London, New York: Academic Press 1977

    Google Scholar 

  44. Waksman, B.H., Namba, Y.: On soluble mediators of immunologic regulation. Cell. Immunol.21, 161–176 (1976)

    PubMed  Google Scholar 

  45. Wands, J.R., Perrotto, J.L., Alpert, E., Isselbacher, K.J.: Cellmediated immunity in acute and chronic hepatitis. J. Clin. Invest.55, 921–929 (1975)

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Universitätsklinik (Abt. III und II), Tübingen

    B. Maisch, P. A. Berg & K. Kochsiek

Authors
  1. B. Maisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. A. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Kochsiek
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maisch, B., Berg, P.A. & Kochsiek, K. Autoantibodies and serum inhibition factors (SIF) in patients with myocarditis. Klin Wochenschr 58, 219–225 (1980). https://doi.org/10.1007/BF01476967

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01476967

Schlüsselwörter

Key words

Search

Navigation