氧化应激与病毒性心肌炎

病毒性心肌炎是指由柯萨奇病毒、埃可(ECHO)、脊髓灰质炎、腺病毒,流感病毒等病毒感染引起的心肌局限性或弥漫性的急性或慢性炎症病变,属于感染性心肌疾病。重症易发生恶性心率失常、急性心衰、心源性猝死等,在临床及法医尸检中常常得到证实。在病毒所致的心肌损伤中包括病毒的直接损伤、免疫应答反应、炎细胞的浸润等。近年对于氧化应激与急性病毒性心肌炎的相关性研究越来越深入,已证实活性氧和细胞抗氧化防御机制之间的失衡在病毒性心肌炎的心肌损伤过程中起到了重要作用。本文将综述氧化应激的来源及其在病毒性心肌炎发病机制中的作用和当前抗氧化治疗的现状。     

柯萨奇B3病毒性心肌炎的免疫抗炎症研究

病毒性心肌炎(viral myocarditis,VMC)属感染性心肌疾病,可由多种病毒诱导,其中以柯萨奇B组3型病毒(Coxsackie virus B3,CVB3)最为常见。由CVB3引起的VMC典型表现为心肌细胞炎症反应所导致的心肌损伤和坏死,并最终发展为慢性炎症或扩张性心肌病,在人类有很高的发病率和致死率。目前,柯萨奇B3病毒性心肌炎抗炎症治疗措施仍不完善,且相关免疫抗炎症治疗机理未完全阐明,因此探索其免疫抗炎症治疗机理和作用可能成为治疗柯萨奇B3病毒性心肌炎的重要靶点。现主要从Wnt11基因、巨噬细胞、半乳糖凝集素3、锌指抗病毒蛋白、蜂毒素和丙戊酸6个免疫抗炎症相关方面,对柯萨奇B3病毒性心肌炎的最新免疫抗炎症研究予以综述。     

IL-1及家族成员在心肌炎中的作用研究

心肌炎是多种因素引起心肌局限性或弥漫性的炎症病变,近年来许多专家学者对该病进行了大量的研究,但是它的发病机制一直尚未明确。随着心肌炎动物模型试验的基础研究与临床诊疗的不断深入,目前认为心肌炎的发病主要与病毒损伤心肌细胞、免疫机制有关,在此过程中细胞因子IL-1及其家族成员起着重要的作用,本文就IL-1及家族成员在心肌炎的作用机制的研究进展综述如下。     

急性重症病毒性心肌炎的临床特征分析

目的:探讨急性重症病毒性心肌炎的临床特征及心脏彩超和血清心肌损伤标志物对重症病毒性心肌炎的早期临床诊断价值。方法:回顾性分析2013年6月至2015年8月入住我院心脏科的临床诊断为急性心肌炎的患者27例,其中符合急性重症心肌炎诊断标准的患者10例,其余17例为非重症心肌炎,另选取10例入院检查后排除心血管疾病的患者为健康对照组。对三组患者的一般临床资料、心脏彩超结果及心肌损伤标志物结果进行分析,选取有统计学差异的指标行ROC曲线分析得出预测重症心肌炎的效能。结果:重症心肌炎组左室室间隔厚度、左室后壁厚度、左房内径、血浆B型尿钠肽较其余两组显著增高,进一步行ROC曲线分析提示左室室间隔厚度、左室后壁厚度预测重症心肌炎的敏感性分别为80%、70%,特异性均为94%,临界值分别为0.855 cm、0.875 cm。结论:急性心肌炎患者室壁厚度增加,当左室室间隔厚度0.855 cm或左室后壁厚度0.875 cm时需引起重视,警惕患者可能进展至重症病毒性心肌炎。     

心肌肌钙蛋白T在病毒性心肌炎心肌组织中的表达及意义

目的:了解病毒性心肌炎心肌组织中肌钙蛋白T的表达情况,探讨病毒性心肌炎时心肌结构蛋白损伤的机制及意义。方法:运用免疫组化和计算机图像分析技术,观察13例明确性病毒性心肌炎和17例界限性病毒性心肌炎尸检心脏标本中心肌肌钙蛋白T的表达与分布。结果:在正常对照的心肌组织中,蛋白成强阳性表达,分布均匀,未见缺染。在明确性心肌炎及14例界限性心肌炎心肌组织中都存在着不同程度的蛋白表达缺染或脱失。缺染的范围及分布与病毒性心肌炎病变特点基本一致,但其范围往往小于炎症细胞浸润范围。计算机图像分析和数据统计结果显示缺染区域的心肌肌钙蛋白T表达量要明显小于其周边区域和正常心肌细胞(P＜0．01)。结论:病毒性心肌炎患者的心肌损害要早于炎症细胞的浸润,病毒的作用可能是心肌肌钙蛋白T脱失的主要因素。心肌肌钙蛋白T的免疫组化检查可以作为一种有效的手段,来辅助病毒性心肌炎的病理学诊断。     

30例病毒性心肌炎法医病理学分析

目的:回顾性分析30例病毒性心肌炎的法医病理学特点,为病毒性心肌炎的法医学鉴定提供依据。方法:采用昆明医科大学司法鉴定中心2003年至2014年的30例病毒性心肌炎法医病理鉴定案例进行回顾性分析。结果:30例死亡原因均为病毒性心肌炎致急性心功能障碍死亡,大多为重型病毒性心肌炎,均累及心肌损害,心肌细胞水肿,基质溶解坏死;心肌肌间多量淋巴细胞浸润;局部心肌束排列紊乱,间质纤维组织增生,同时不同程度伴有肺、脑、扁桃体等器官组织的损害。结论:重型病毒性心肌炎起病急,临床症状不典型,进程快,易造成误诊误治,死亡率高,产生医疗纠纷,需要法医学鉴定。病毒性心肌炎法医学鉴定时,以心脏大体所见和组织学观察为主要依据,同时还要特别注意其他机械性损伤,辨别每个死亡原因之间的关系,必要时结合特殊检查,例如对趋化因子MCP-1的检测。     

甲基苯丙胺对心血管系统的影响及其机制的研究进展

甲基苯胺(Methamphetamine,MA)不但影响神经系统,而且对心血管系统也会产生影响.急性MA中毒可以引起心动过速、心律不齐、心肌缺血及高血压,最终导致心脏的损伤;慢性MA中毒可以引起心肌炎性细胞浸润、心肌肥厚、心肌纤维化甚至心脏破裂.本文就MA滥用对心血管系统的影响及其机制的研究进展进行综述.     

病毒性心肌炎所致小鼠心力衰竭心肌组织内质网应激相关的凋亡关系的研究

目的：探讨病毒性心肌炎心力衰竭小鼠心肌组织内质网应激介导的凋亡途径。方法：40只雄性Balb／c小鼠分为病毒性心肌炎组和正常对照组（n=20）,病毒性心肌炎组应用柯萨奇B3病毒制作BALB／c小鼠病毒性心肌炎模型,观察小鼠的一般情况,7d行血流动力学检查后处死取心脏标本,用TUNEL法检测心肌细胞凋亡,RT-PCR检测心肌细胞内质网伴侣蛋白葡萄糖调节蛋白（GAP）78和GRP04的mRNA表达水平。结果：①与正常对照组相比,病毒性心肌炎组小鼠血流动力学指标明显降低（P〈0．01）;②TUNEL染色显示病毒性心肌炎心力衰竭小鼠心肌组织凋亡明显增多（P〈0．01）;③病毒性心肌炎组小鼠内质网伴侣蛋白GRP78和GRP94的mRNA表达水平均明显高于对照组（P〈0．01）。结论：病毒性心肌炎心力衰竭小鼠内质网应激可能介导了心肌细胞凋亡。     

三七总黄酮通过miR-223-3p/FOXO1分子轴缓解病毒性心肌炎炎症反应和细胞损伤

病毒性心肌炎严重影响患者身体健康,中药材中黄酮类物质被证实对病毒性心肌炎有治疗作用,但其中三七总黄酮对柯萨奇B3病毒导致的心肌炎发挥治疗作用的分子机制尚不明确.以探讨三七总黄酮缓解病毒性心肌炎炎症反应及细胞损伤的作用机制.采用RT-qPCR检测心肌细胞中miR-223-3p的表达水平;Western blotting检测心肌细胞中转录因子叉头框蛋白O1(Forkhead box O1,FOXO1)蛋白表达水平;MTT实验检测心肌细胞存活率;流式细胞术检测心肌细胞凋亡率;ELISA检测炎症因子肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)和白细胞介素1β(Interleukin-1β,IL-1β)、心肌酶谱磷酸肌酸激酶(Creative kinase,CK)和乳酸脱氢酶(Lactic dehydrogenase,LDH)、心肌损伤标志物心肌肌钙蛋白T(Cardiac troponin T,cTnT)和B型尿钠肽(Brain natriuretic peptide,BNP)的水平;双荧光素酶报告基因检验miR-223-3p和FOXO1之间的靶向关系.实验结果显示,三七总黄酮能够缓解病毒性心肌炎模型细胞的炎症反应及细胞损伤,并显著上调模型细胞中miR-223-3p的水平.敲除模型细胞中的miR-223-3p能够逆转三七总黄酮对病毒性心肌炎的治疗作用.通过双荧光素酶报告基因实验验证miR-223-3p靶向负调控FOXO1蛋白的表达.进一步研究发现,过表达FOXO1可抑制三七总黄酮对病毒性心肌炎的治疗作用;但同时过表达miR-223-3p后,过表达FOXO1对三七总黄酮疗效的抑制作用被逆转.由此得出结论,三七总黄酮可缓解病毒性心肌炎模型细胞的炎症反应及细胞损伤,其作用机制是通过调控miR-223-3p/FOXO1分子轴实现的.     

柯萨奇病毒B3基因组及其变异与心肌损伤的关系

肠道病毒感染是人类急性和慢性心肌炎的常见病因之一,而且也与人类扩张 型心肌病(DCM)的发生发展有密切关系 [1]}.病毒分离,血清学研究,免疫组化技术 、原位核酸杂交技术以及聚合酶链反应技术(PCR)均提示肠道病毒与心肌炎关系密切.最近 ,LI等 [2]}用肠道病毒特异性单克隆抗体,采用改良的免疫组化技术对心肌炎或DCM病人心 肌切片中肠道病毒抗原进行检测,此法直接证明了心肌炎或DCM病人体内确实有子代病毒产 生.但是,肠道病毒究竟通过怎样的机制引起心肌损伤还未阐明,推测可能有多种机制参与 .本文仅就肠道病毒(柯萨奇病毒B3,CVB3)基因组结构及其基因变异与心肌损伤的关系方面加以综述.     

免疫系统在病毒性心肌炎发病中的作用

心肌炎通常由病毒感染引起,有证据表明心肌炎最终发展成扩张性心肌病,是发达国家主要致死的原因,越来越多的人认为细胞因子在心肌炎和心肌病发病中起重要作用,心力衰竭病人血循环中细胞因子水平较正常人高。已证明多种细胞因子能在体内外抑制心肌收缩,细胞因子由活化的免疫细胞产生,它可诱生NO合酶,继而产生NO,已证明NO既有利又有害,关键在于产生NO量的多少,NO能抑制病毒复制,而保护心脏抗柯萨奇B病毒感染,无论是病毒感染对心脏的直接作用,还是免疫应答的利弊平衡,对此两者分子机制的了解都将是掌握人类心肌炎发病的关键。     

流感病毒感染介导的免疫病理损伤研究进展

流感病毒感染(如暴发性流行或高致病性禽流感H5N1感染)可以造成广泛的病理损伤及严重的并发症,其肺部病理损伤以肺水肿及广泛的炎性渗出为特点,并伴有大量的中性粒细胞、巨噬细胞、淋巴细胞浸润及促炎因子和趋化因子的产生．组织学及病理学研究表明,过度的宿主应答反应是介导病理损伤的主要原因之一,而这些在流感病毒感染过程中介导组织损伤的免疫分子与细胞,在病毒的有效清除过程中同样至关重要．主要对甲型流感病毒感染过程中免疫系统的多种效应成分如何引发及加重病理性损伤等有害方面加以综述．为深入了解流感病毒感染防御机制及寻找并设计出既无害又能有效地治疗流感病毒感染的策略提供理论指导．     

Cytotoxic T-lymphocyte escape monitoring in simian immunodeficiency virus vaccine challenge studies

Several vaccine studies have ameliorated disease progression in simian-human immunodeficiency virus (SHIV) infections. The successes of these vaccines have been largely attributed to protective effects of cytotoxic T-lymphocyte (CTL) responses, although the precise correlates of immune protection remain poorly defined. It is now well established that vigorous CTL and antibody responses can rapidly select for viral escape variants after HIV and SIV infection. Here we suggest that viral variation analyses should be performed on viruses derived from vaccinated, SIV-, or SHIV-challenged animals as a routine component of vaccine evaluation to determine the contribution of immune responses to the success (or failure) of the vaccine regimen. To illustrate the importance of escape analysis, we show that rapid emergence of escape variants postchallenge contributed to the failure of a DNA prime/MVA boost vaccine regimen encoding SIV Tat.     

Pancreatic expression of interferon-gamma protects mice from lethal coxsackievirus B3 infection and subsequent myocarditis

Cardiovascular disease is one of the leading causes of death worldwide, and has been associated with many environmental risk factors. Recent evidence has indicated the involvement of pathogens such as viruses as causative agents, and specifically identified the coxsackievirus B serogroup as the leading culprit. Not only has coxsackievirus B3 (CB3) been identified from patients with cardiovascular disease, but also infection of mice with CB3 strains can reproduce human clinical heart disease in rodents. Several mechanisms have been proposed in an attempt to distinguish between pathology mediated by direct viral destruction of cardiac muscle cells or by the virus-induced immune response directed at infected myocytes or at 'mimicked' epitopes shared between viral and cardiac antigens. To distinguish between these mechanisms, we infected a unique mouse that diminishes the extent of infection and spread of the virus, but allows complete immunity to the virus. Transgenic mice expressing interferon-gamma in their pancreatic beta cells failed to develop CB-3-induced myocarditis. This work challenges the idea of the function of the immune response and 'molecular mimicry' in the CB-3-induced autoimmune myocarditis model, and instead favors the idea of virus-mediated damage. These results emphasize the benefit of reducing the level of viremia early during infection, thereby reducing the incidence of virus-mediated heart damage and autoimmunity.     

SARS-CoV-2 in patients with cancer: possible role of mimicry of human molecules by viral proteins and the resulting anti-cancer immunity

A few reports suggest that molecular mimicry can have a role in determining the more severe and deadly forms of COVID-19, inducing endothelial damage, disseminated intravascular coagulation, and multiorgan failure. Heat shock proteins/molecular chaperones can be involved in these molecular mimicry phenomena. However, tumor cells can display on their surface heat shock proteins/molecular chaperones that are mimicked by SARS-CoV-2 molecules (including the Spike protein), similarly to what happens in other bacterial or viral infections. Since molecular mimicry between SARS-CoV-2 and tumoral proteins can elicit an immune reaction in which antibodies or cytotoxic cells produced against the virus cross-react with the tumor cells, we want to prompt clinical studies to evaluate the impact of SARS-CoV-2 infection on prognosis and follow up of various forms of tumors. These topics, including a brief historical overview, are discussed in this paper.     

A modular framework for multiscale,multicellular, spatiotemporal modeling of acute primary viral infection and immune response in epithelial tissues and its application to drug therapy timing and effectiveness

Simulations of tissue-specific effects of primary acute viral infections like COVID-19 are essential for understanding disease outcomes and optimizing therapies. Such simulations need to support continuous updating in response to rapid advances in understanding of infection mechanisms, and parallel development of components by multiple groups. We present an open-source platform for multiscale spatiotemporal simulation of an epithelial tissue, viral infection, cellular immune response and tissue damage, specifically designed to be modular and extensible to support continuous updating and parallel development. The base simulation of a simplified patch of epithelial tissue and immune response exhibits distinct patterns of infection dynamics from widespread infection, to recurrence, to clearance. Slower viral internalization and faster immune-cell recruitment slow infection and promote containment. Because antiviral drugs can have side effects and show reduced clinical effectiveness when given later during infection, we studied the effects on progression of treatment potency and time-of-first treatment after infection. In simulations, even a low potency therapy with a drug which reduces the replication rate of viral RNA greatly decreases the total tissue damage and virus burden when given near the beginning of infection. Many combinations of dosage and treatment time lead to stochastic outcomes, with some simulation replicas showing clearance or control (treatment success), while others show rapid infection of all epithelial cells (treatment failure). Thus, while a high potency therapy usually is less effective when given later, treatments at late times are occasionally effective. We illustrate how to extend the platform to model specific virus types (e.g., hepatitis C) and add additional cellular mechanisms (tissue recovery and variable cell susceptibility to infection), using our software modules and publicly-available software repository.     

The role of nutrition in viral disease

Malnutrition has been associated with a decrease in immune function. Impairment of immune function may lead to increased susceptibility to infection with viruses. Although there are many studies documenting the effect of host nutritional status on immune functions, fewer studies have examined the effect of host nutritional status on viral pathogenesis. This review examines the relationship between viral infection and the nutritional status of the host, and documents that not only can the nutritional status of the host affect immune function, but can have profound effects on the virus itself. One mechanism by which nutritional status affects the virulence of the viral pathogen involves selection for virulent viral genotypes. Other mechanisms remain to be elucidated.     

γ/δ T细胞与丙型肝炎病毒、乙型肝炎病毒感染

病毒性肝炎的发病机制迄今尚未完全明确,诸多证据表明,乙型肝炎病毒(HBV)及丙型肝炎病毒(HCV)所致肝炎可能是肝脏细胞免疫防御反应病毒入侵的结果。γ/δT细胞是新近认识的一个T细胞亚群,是机体抵抗外来病原微生物入侵的重要天然免疫细胞之一。近年研究发现,肝内富含γ/δT细胞,而病毒性肝炎肝内γ/δT细胞数量显著增高。目前有关γ/δT细胞与肝炎病毒感染的研究主要集中在HCV感染领域,即γ/δT细胞通过分泌多种细胞因子抑制体内HCV的复制。目前,有关γ/δT细胞与HBV感染的报道甚为少见。慢性HBV感染体内可能导致γ/δT细胞免疫学功能异常,这可能是导致体内病毒性乙型肝炎慢性化的主要原因之一。