病態】急性心筋炎：病態の主座はどこにあるのか?
「はじめに」 心筋炎は心筋を主座とする炎症性疾患と定義され, 臨床像が多彩であるため診断は必ずしも容易でない. 最近は病因による分類がよく用いられ, 感染, 自己免疫やアレルギー, 中毒などがある. 感染による心筋炎において, 以前はリウマチ熱やジフテリアの頻度が高かったが, 最近はウイルスによる頻度が最も高く, 原因が不明の場合(特発性)も多い. 代表的な起因ウイルスにピコナウイルス科のエンテロウイルス属に属するコクサッキーB群ウイルスがあり, 心臓親和性が高く心筋炎のみならず心膜炎の原因として重要である. これまで, 急性心筋炎における心筋細胞傷害機序についてウイルス感染動物や自己免疫性心...
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| Published in | Shinzo Vol. 41; no. 11; pp. 1183 - 1187 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
2009
日本心臓財団 Japan Heart Foundation |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.41.1183 |
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| Abstract | 「はじめに」 心筋炎は心筋を主座とする炎症性疾患と定義され, 臨床像が多彩であるため診断は必ずしも容易でない. 最近は病因による分類がよく用いられ, 感染, 自己免疫やアレルギー, 中毒などがある. 感染による心筋炎において, 以前はリウマチ熱やジフテリアの頻度が高かったが, 最近はウイルスによる頻度が最も高く, 原因が不明の場合(特発性)も多い. 代表的な起因ウイルスにピコナウイルス科のエンテロウイルス属に属するコクサッキーB群ウイルスがあり, 心臓親和性が高く心筋炎のみならず心膜炎の原因として重要である. これまで, 急性心筋炎における心筋細胞傷害機序についてウイルス感染動物や自己免疫性心筋炎動物などのモデルを用いて解明が行われてきた. 本稿では, ウイルス性心筋炎における心筋細胞傷害機序を経時的に明らかにし, その病態の主座について述べる. 「心筋炎の病態生理」 ウイルス性心筋炎の病態は経時的に図のごとく, (1)ウイルスの心筋細胞への感染, (2)自然免疫(innate immunity)による防御, (3)獲得免疫(adaptive immunity)による防御, (4)炎症の消退の4期に分けることができる. |
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| AbstractList | 「はじめに」 心筋炎は心筋を主座とする炎症性疾患と定義され, 臨床像が多彩であるため診断は必ずしも容易でない. 最近は病因による分類がよく用いられ, 感染, 自己免疫やアレルギー, 中毒などがある. 感染による心筋炎において, 以前はリウマチ熱やジフテリアの頻度が高かったが, 最近はウイルスによる頻度が最も高く, 原因が不明の場合(特発性)も多い. 代表的な起因ウイルスにピコナウイルス科のエンテロウイルス属に属するコクサッキーB群ウイルスがあり, 心臓親和性が高く心筋炎のみならず心膜炎の原因として重要である. これまで, 急性心筋炎における心筋細胞傷害機序についてウイルス感染動物や自己免疫性心筋炎動物などのモデルを用いて解明が行われてきた. 本稿では, ウイルス性心筋炎における心筋細胞傷害機序を経時的に明らかにし, その病態の主座について述べる. 「心筋炎の病態生理」 ウイルス性心筋炎の病態は経時的に図のごとく, (1)ウイルスの心筋細胞への感染, (2)自然免疫(innate immunity)による防御, (3)獲得免疫(adaptive immunity)による防御, (4)炎症の消退の4期に分けることができる. |
| Author | 大塚, 薫 寺崎, 文生 北浦, 泰 |
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| References | 4) Chau DH, Yuan J, Zhang H, et al: Coxsackievirus B3 proteases 2A and 3C induce apoptotic cell death through mitochondrial injury and cleavage of eIF4GI but not DAP5/p97/NAT1. Apoptosis 2007; 12: 513-524 2) Martino TA, Petric M, Brown M, et al: Cardiovirulent coxsackieviruses and the decay-accelerating factor(CD55)receptor. Virology 1998; 244: 302-314 20) Seko Y, Matsuda H, Kato K, et al: Expression of intercellular adhesion molecule-1 in murine hearts with acute myocarditis caused by coxsackievirus B3. J Clin Invest 1993; 91: 1327-1336 7) Kawai C, Doi Y, Mckenna WJ, Liu PP, Matsumori A: Cardiomyopathy Update. Chapter 4. Dilated cardiomyopathy: A spectrum of conditions linking to viral myocarditis and cardiac remodeling. Tokyo: Elsevier Japan. p.80-110 6) Huang CH, Vallejo JG, Kollias G, Mann DL: Role of the innate immune system in acute viral myocarditis. Basic Res Cardiol 2009; 104: 228-237 15) Lowenstein CJ, Hill SL, Lafond-Walker A, et al: Nitric oxide inhibits viral replication in murine myocarditis. J Clin Invest 1996; 97: 1837-1843 12) Yamada T, Matsumori A, Sasayama S: Therapeutic effect of anti-tumor necrosis factor-alpha antibody on the murine model of viral myocarditis induced by encephalomyocarditis virus. Circulation 1994; 89: 846-851 17) Mikami S, Kawashima S, Kanazawa K, et al: Expression of nitric oxide synthase in a murine model of viral myocarditis induced by coxsackievirus B3. Biochem Biophys Res Commun 1996; 220: 983-989 8) Fairweather D, Frisancho-Kiss S, Rose NR: Viruses as adjuvants for autoimmunity: evidence from Coxsackievirus-induced myocarditis. Rev Med Virol 2005; 15: 17-27 23) Kaya Z, Katus HA, Rose NR: Cardiac troponins and autoimmunity: Their role in the pathogenesis of myocarditis and of heart failure. Clin Immunol 2009(in press 26) Tsukada B, Terasaki F, Shimomura H, et al: High prevalence of chronic myocarditis in dilated cardiomyopathy referred for left ventriculoplasty: expression of tenascin C as a possible marker for inflammation. Hum Pathol 2009; 40: 1015-1022 3) Badorff C, Lee GH, Lamphear BJ, et al: Enteroviral protease 2A cleaves dystrophin: evidence of cytoskeletal disruption in an acquired cardiomyopathy. Nat Med 1999; 5: 320-326 21) Maisch B, Trostel-Soeder R, Stechemesser E, et al: Diagnostic relevance of humoral and cell-mediated immune reactions in patients with acute viral myocarditis. Clin Exp Immunol 1982; 48: 533-545 14) Yajima T, Yasukawa H, Jeon ES, et al: Innate defense mechanism against virus infection within the cardiac myocyte requiring gp130-STAT3 signaling. Circulation 2006; 114: 2364-2373 27) 和泉 徹，磯部光章，河合祥雄，ほか：循環器病の診断と治療に関するガイドライン(2002-2003年度合同研究班報告) 急性および慢性心筋炎の診断・治療に関するガイドライン．Circ J 2004; 68(Suppl VI): 1231-1263 1) Bergelson JM, Cunningham JA, Droguett G, et al: Isolation of a common receptor for Coxsackie B viruses and adenoviruses 2 and 5. Science 1997; 275: 1320-1323 28) Gupta S, Markham DW, Drazner MH, Mammen PP: Fulminant myocarditis. Nat Clin Pract Cardiovasc Med 2008; 5: 693-706 16) Hiraoka Y, Kishimoto C, Takada H, et al: Role of oxygen derived free radicals in the pathogenesis of coxsackievirus B3 myocarditis in mice. Cardiovasc Res 1993; 27: 957-961 22) Caforio AL, Mahon NJ, Tona F, McKenna WJ: Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance. Eur J Heart Fail 2002; 4: 411-417 5) Silver MA, Kowalczyk D: Coronary microvascular narrowing in acute murine coxsackie B3 myocarditis. Am Heart J 1989; 118: 173-174 18) Yajima T, Knowlton KU: Viral myocarditis: from the perspective of the virus. Circulation 2009; 119: 2615-2624 11) Bryant D, Becker L, Richardson J, et al: Cardiac failure in transgenic mice with myocardial expression of tumor necrosis factor-alpha. Circulation 1998; 97: 1375-1381 19) Kishimoto C, Kuribayashi K, Masuda T, et al: Immunologic behavior of lymphocytes in experimental viral myocarditis: significance of T lymphocytes in the severity of myocarditis and silent myocarditis in BALB/c-nu/nu mice. Circulation 1985; 71: 1247-1254 10) Wada H, Saito K, Kanda T, et al: Tumor necrosis factor-alpha(TNF-alpha)plays a protective role in acute viralmyocarditis in mice: A study using mice lacking TNF-alpha. Circulation 2001; 103: 743-749 9) Kawai C: From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999; 99: 1091-1100 24) Fuse K, Kodama M, Ito M, et al: Polarity of helper T cell subsets represents disease nature and clinical course of experimental autoimmune myocarditis in rats. Clin Exp Immunol 2003; 134: 403-408 13) Darnell JE Jr: STATs and gene regulation. Science 1997; 277: 1630-1635 25) Kanzaki Y, Terasaki F, Okabe M, et al: Myocardial inflammatory cell infiltrates in cases of dilated cardiomyopathy as a determinant of outcome following partial left ventriculectomy. Jpn Circ J 2001; 65: 797-802 |
| References_xml | – reference: 6) Huang CH, Vallejo JG, Kollias G, Mann DL: Role of the innate immune system in acute viral myocarditis. Basic Res Cardiol 2009; 104: 228-237 – reference: 3) Badorff C, Lee GH, Lamphear BJ, et al: Enteroviral protease 2A cleaves dystrophin: evidence of cytoskeletal disruption in an acquired cardiomyopathy. Nat Med 1999; 5: 320-326 – reference: 11) Bryant D, Becker L, Richardson J, et al: Cardiac failure in transgenic mice with myocardial expression of tumor necrosis factor-alpha. Circulation 1998; 97: 1375-1381 – reference: 28) Gupta S, Markham DW, Drazner MH, Mammen PP: Fulminant myocarditis. Nat Clin Pract Cardiovasc Med 2008; 5: 693-706 – reference: 16) Hiraoka Y, Kishimoto C, Takada H, et al: Role of oxygen derived free radicals in the pathogenesis of coxsackievirus B3 myocarditis in mice. Cardiovasc Res 1993; 27: 957-961 – reference: 2) Martino TA, Petric M, Brown M, et al: Cardiovirulent coxsackieviruses and the decay-accelerating factor(CD55)receptor. Virology 1998; 244: 302-314 – reference: 19) Kishimoto C, Kuribayashi K, Masuda T, et al: Immunologic behavior of lymphocytes in experimental viral myocarditis: significance of T lymphocytes in the severity of myocarditis and silent myocarditis in BALB/c-nu/nu mice. Circulation 1985; 71: 1247-1254 – reference: 21) Maisch B, Trostel-Soeder R, Stechemesser E, et al: Diagnostic relevance of humoral and cell-mediated immune reactions in patients with acute viral myocarditis. Clin Exp Immunol 1982; 48: 533-545 – reference: 5) Silver MA, Kowalczyk D: Coronary microvascular narrowing in acute murine coxsackie B3 myocarditis. Am Heart J 1989; 118: 173-174 – reference: 12) Yamada T, Matsumori A, Sasayama S: Therapeutic effect of anti-tumor necrosis factor-alpha antibody on the murine model of viral myocarditis induced by encephalomyocarditis virus. Circulation 1994; 89: 846-851 – reference: 20) Seko Y, Matsuda H, Kato K, et al: Expression of intercellular adhesion molecule-1 in murine hearts with acute myocarditis caused by coxsackievirus B3. J Clin Invest 1993; 91: 1327-1336 – reference: 18) Yajima T, Knowlton KU: Viral myocarditis: from the perspective of the virus. Circulation 2009; 119: 2615-2624 – reference: 24) Fuse K, Kodama M, Ito M, et al: Polarity of helper T cell subsets represents disease nature and clinical course of experimental autoimmune myocarditis in rats. Clin Exp Immunol 2003; 134: 403-408 – reference: 9) Kawai C: From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation 1999; 99: 1091-1100 – reference: 22) Caforio AL, Mahon NJ, Tona F, McKenna WJ: Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance. Eur J Heart Fail 2002; 4: 411-417 – reference: 1) Bergelson JM, Cunningham JA, Droguett G, et al: Isolation of a common receptor for Coxsackie B viruses and adenoviruses 2 and 5. Science 1997; 275: 1320-1323 – reference: 25) Kanzaki Y, Terasaki F, Okabe M, et al: Myocardial inflammatory cell infiltrates in cases of dilated cardiomyopathy as a determinant of outcome following partial left ventriculectomy. Jpn Circ J 2001; 65: 797-802 – reference: 8) Fairweather D, Frisancho-Kiss S, Rose NR: Viruses as adjuvants for autoimmunity: evidence from Coxsackievirus-induced myocarditis. Rev Med Virol 2005; 15: 17-27 – reference: 10) Wada H, Saito K, Kanda T, et al: Tumor necrosis factor-alpha(TNF-alpha)plays a protective role in acute viralmyocarditis in mice: A study using mice lacking TNF-alpha. Circulation 2001; 103: 743-749 – reference: 13) Darnell JE Jr: STATs and gene regulation. Science 1997; 277: 1630-1635 – reference: 27) 和泉 徹，磯部光章，河合祥雄，ほか：循環器病の診断と治療に関するガイドライン(2002-2003年度合同研究班報告) 急性および慢性心筋炎の診断・治療に関するガイドライン．Circ J 2004; 68(Suppl VI): 1231-1263 – reference: 4) Chau DH, Yuan J, Zhang H, et al: Coxsackievirus B3 proteases 2A and 3C induce apoptotic cell death through mitochondrial injury and cleavage of eIF4GI but not DAP5/p97/NAT1. Apoptosis 2007; 12: 513-524 – reference: 14) Yajima T, Yasukawa H, Jeon ES, et al: Innate defense mechanism against virus infection within the cardiac myocyte requiring gp130-STAT3 signaling. Circulation 2006; 114: 2364-2373 – reference: 15) Lowenstein CJ, Hill SL, Lafond-Walker A, et al: Nitric oxide inhibits viral replication in murine myocarditis. J Clin Invest 1996; 97: 1837-1843 – reference: 23) Kaya Z, Katus HA, Rose NR: Cardiac troponins and autoimmunity: Their role in the pathogenesis of myocarditis and of heart failure. Clin Immunol 2009(in press) – reference: 26) Tsukada B, Terasaki F, Shimomura H, et al: High prevalence of chronic myocarditis in dilated cardiomyopathy referred for left ventriculoplasty: expression of tenascin C as a possible marker for inflammation. Hum Pathol 2009; 40: 1015-1022 – reference: 17) Mikami S, Kawashima S, Kanazawa K, et al: Expression of nitric oxide synthase in a murine model of viral myocarditis induced by coxsackievirus B3. Biochem Biophys Res Commun 1996; 220: 983-989 – reference: 7) Kawai C, Doi Y, Mckenna WJ, Liu PP, Matsumori A: Cardiomyopathy Update. Chapter 4. Dilated cardiomyopathy: A spectrum of conditions linking to viral myocarditis and cardiac remodeling. Tokyo: Elsevier Japan. p.80-110 |
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| Snippet | 「はじめに」 心筋炎は心筋を主座とする炎症性疾患と定義され, 臨床像が多彩であるため診断は必ずしも容易でない. 最近は病因による分類がよく用いられ, 感染, 自己免疫やアレルギー, 中毒などがある. 感染による心筋炎において, 以前はリウマチ熱やジフテリアの頻度が高かったが, 最近はウイルスによる頻度が最も高く,... |
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| Title | 病態】急性心筋炎：病態の主座はどこにあるのか? |
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