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Infectious agents in heart of patients with idiopathic dilated cardiomyopathy: potential relation with rejection of cardiac transplantation

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Author(s):
Jaqueline de Jesus Pereira
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
Defense date:
Examining board members:
Maria de Lourdes Higuchi; Adriano Mendes Caixeta; Felix José Alvarez Ramires
Advisor: Maria de Lourdes Higuchi
Abstract

Dilated cardiomyopathy (DCM) is characterized by progressive dilation with reduction of contractile function of the left ventricle or both ventricles, which may be viral and/or immune, genetic or idiopathic. Because of countless variables involved in the DCM, currently there is no definitive therapeutic option for its treatment, being heart transplant the treatment for choice of refractory heart failure. A previous study hypothesized that symbiosis between microorganisms may interfere in immune system in myocardial tissue. Thus, the present study had the objective to determine if presence of antigens or DNA of infectious agents associated with inflammation in explanted hearts of patients with idiopathic DCM is related to the development of moderated/severe rejection in donor\'s heart after cardiac transplantation. Myocardial samples from patients transplanted by Idiopathic DCM were studied, grouped in: PMR (n=6) persistent moderate rejection, MR (n=7) rejection resolved after pulse therapy and NR (n=5) no rejection, without moderate rejection, in which inflammation was quantified by immunohistochemistry and infectious agents by immunohistochemistry, molecular biology, in situ hybridization technique and transmission electron microscopy. There was higher amount of macrophages in PMR group, and more B cells (p=0.0001) and higher HLA class II expression (p= < 0.0001) in NR group. Immunohistochemistry showed M. pneumoniae (p=0.003) and HBc (p=0.0009) antigens in PMR and MR groups. NR showed positive correlation between amount of Bb genes and enterovirus antigens. Molecular biology demonstrated the presence of M. pneumoniae, Borrelia burgdorferi, HHV6 and PVB19 genes in all studied groups. Electron microscopy revealed the presence of structures compatible with mycoplasma, borrelia, enterovirus, herpesvirus 6 and parvovirus. Infectious agents may be the causal and/or perpetuating factor of myocardial injury in patients with Idiopathic DCM, since these initial findings suggest that the microorganisms in symbiosis in the myocardium of these patients is associated with worst prognosis after transplantation (AU)

FAPESP's process: 15/25786-2 - Identification of infectious agents in post-heart transplant endomyocardial biopsy of patients with idiopathic dilated cardiomyopathy and lymphocytic myocarditis
Grantee:Jaqueline de Jesus Pereira
Support type: Scholarships in Brazil - Master