Delayed-Type Hypersensitivity to Metals of Environmental Burden in Patients with Takotsubo Syndrome - Is There a Clinical Relevance?

• Published in: PloS one Vol. 11; no. 11; p. e0164786
• Main Authors: Manousek, Jan, Stejskal, Vera, Kubena, Petr, Jarkovsky, Jiri, Nemec, Petr, Lokaj, Petr, Dostalova, Ludmila, Zadakova, Andrea, Pavlusova, Marie, Benesova, Klara, Kala, Petr, Miklik, Roman, Spinar, Jindrich, Parenica, Jiri
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.11.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Allergies; Allergy; Antigens; Arthritis; Arthritis, Rheumatoid - immunology; Asthma; Biology and Life Sciences; Cancer; Cardiology; Cardiomyopathy; Care and treatment; Catecholamines; Cell division; Chronic illnesses; Chronic obstructive pulmonary disease; Comorbidity; Contact dermatitis; Dermatitis; Drug Hypersensitivity - immunology; Ecology and Environmental Sciences; Environment; Female; Heart; Heavy metals; Hospitals; Humans; Hypersensitivity; Hypersensitivity (delayed); Hypersensitivity, Delayed - immunology; Hypotheses; Internal medicine; Lymphocyte Activation - immunology; Lymphocyte transformation; Lymphocytes; Male; Medical research; Medicine; Medicine and Health Sciences; Mercury; Mercury (metal); Mercury - immunology; Metals; Metals (Materials); Metals - immunology; Middle Aged; Oxidative stress; Patients; Physical Sciences; Pilot Projects; Reactivity; Rheumatoid arthritis; Rheumatoid factor; Statistical analysis; Takotsubo Cardiomyopathy - immunology; Thyroid; Thyroid diseases; Transformation; Ventricle; United States > US; Czech Republic; Indianapolis Indiana
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164786

Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA®. A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA®); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029). Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity to metals (mercury in particular) evaluated by LTT-MELISA®. We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.