自身免疫性心肌炎中Th17/Treg细胞及其相关因子的动态变化

目的研究Th17与Treg细胞相关因子在实验性自身免疫性心肌炎(EAM)中的动态变化,探讨EAM发病机制。方法注射心肌肌球蛋白免疫Balb/C小鼠构建EAM模型(EAM组,n=18),随机分成7d、21d、56d不同时间段3个亚组;正常对照组18只,用PBS代替心肌肌球蛋白皮下注射。取各组心肌组织行HE染色观察病理变化,RT-PCR法检测心肌组织RORγt、Foxp3、IL-17和TGF-β的mRNA表达水平,ELISA方法检测血清IL-17和TGF-β的变化。结果 EAM各组小鼠出现不同程度心肌炎症改变;EAM 21d组心肌组织RORγt、Foxp3、IL-17和TGF-βmRNA表达水平较正常对照组明显升高(P0.01),血清IL-17和TGF-β水平也显著高于正常对照组(P0.05);EAM 56d组血清IL-17和TGF-β含量比21d组有所降低,但仍高于正常对照组(P0.05)。结论 Th17与Treg细胞及其相关因子参与自身免疫性心肌炎的发生与发展。     

MMP-2抑制剂治疗自身免疫性心肌炎大鼠的实验研究

目的：观察基质金属蛋白酶-2（MMP-2）抑制剂TISAM对实验性自身免疫性心肌炎（EAM）Lewis大鼠模型的治疗效果,并探索可能的治疗机理。方法t口服5mg／kg TISAM,每日一次,连续14d治疗EAM Lewis大鼠动物。根据治疗方案不同,分3组,分别为早、中和晚期治疗组（n=20）。治疗结束后,处死动物,心脏取材,进行心肌炎症分级、心肌胶原纤维含量,心肌巨噬细胞和T细胞浸润,MMP-2和MMP-9的mRNA表达,以及明胶酶活性测定。结果：TISAM早期治疗（在模型建立同时开始治疗,持续14d）无效,中、后期治疗（在模型建立后第7～14天开始治疗,持续14d）有效。在治疗有效方案中,治疗组与对照组相比,心肌炎症级别下降,心肌间质纤维化级别下降,巨噬细胞和T淋巴细胞浸润数目减少,MMP-2mRNA表达降低,明胶酶活性降低。结论：MMP-2抑制剂抑制EAM中期的病理发展过程,其机制可能与降低心肌炎症细胞浸润,延缓心肌间质纤维化,从转录水平降低MMP-2 mRNA的表达,同时从蛋白水平降低明胶酶活性表达有关。     

TLR/MyD88信号通路与自身免疫性疾病

Toll样受体(Toll-like receptor,TLR)是近年来发现的一类模式识别受体,通过识别病原相关分子模式(pathogen-associated molecular pattern,PAMP),激活天然免疫.TLR信号还通过上调抗原提呈细胞(antigen presenting cells,APC)表面共刺激分子及APC分泌的炎症细胞因子调节获得性免疫.TLR/MyD88信号在自身免疫性疾病的发病过程中起重要作用.本文介绍了TLR/MYD88信号通路及其在自身免疫病如实验性自身免疫脑脊髓膜炎、类风湿性关节炎、实验性自身免疫性葡萄膜炎、实验性自身免疫性心肌炎和自身免疫性肾小球肾炎等发生发展中的作用.     

贯叶连翘提取物对小鼠免疫性心肌炎的作用

目的:探讨贯叶连翘提取物对小鼠免疫性心肌炎的治疗作用。方法:猪心肌球蛋白免疫BALB/C小鼠,建立免疫性心肌炎模型。结果:贯叶连翘提取物能抑制小鼠脾脏组织,降低外周血T淋巴细胞CD4/CD8比例和血清肌球蛋白自身抗体滴度,减轻心肌内淋巴细胞浸润。结论:贯叶连翘提取物对小鼠免疫性心肌炎有治疗作用。     

MiRNA在自身免疫性心肌炎中的研究进展

自身免疫性心肌炎(autoimmune myocarditis,AMC)常因机体的细胞和体液免疫功能障碍，引发心肌组织周围炎症细胞浸润，诱发自身免疫反应，进而逐渐发展为慢性损伤和扩张性心肌病，严重影响患者的预后。微小核糖核酸(microRNA,miRNA)常在自身免疫性心肌炎中表达失调，调控基因表达或免疫细胞激活与分化，参与调节心肌细胞的生长和凋亡。本文分别从miRNA在自身免疫性心肌炎中的潜在作用机制、诊断及预后的生物标志物及治疗方面，对miRNA在自身免疫性心肌炎中的研究进展及存在的问题进行简要阐述。     

IL-6单克隆抗体对自身免疫性心肌炎的保护作用及其机制

目的：观察白介素-6（interleukin,IL-6）单克隆抗体（IL-6 mAb）治疗Lewis大鼠自身免疫心肌炎（EAM）的疗效。探讨IL-6与辅助性T细胞17（Th17）、调节性T细胞（Treg）在EAM发病中的机制。方法：将34只8-10周龄Lewis大鼠随机分为正常对照组（n=6）,EAM组（n=12）,IL-6mAb干预组（n=16）。对EAM组和干预组注射心肌肌凝蛋白,干预组于免疫注射后第1、7至第20天腹腔注射IL-6 mAb1nlg,分别于急性峰值期（第21天）、慢性持续期（第84天）取材,观察心肌炎症浸润、纤维化、细胞凋亡以判断IL-6mAb疗效。检测脾脏TH17、Treg细胞数量和功能,比较各组血清中IL-6、IL-10、IL-17和转化生长因子．β（TGF-β）的浓度,实时定量PCR测定外周血STAT3、RORγt、Foxp3mRNA水平,对EAM源性脾细胞进行体外IL-6mAb刺激,并用ELISA法测定IL-10、IL-17和TGF-β的浓度。结果：炎症积分、纤维化积分、凋亡指数IL-6mAb干预组较EAM组明显下降（P〈0．01）。急性峰值期（21d组）EAM组TH17和Treg细胞数量上调,干预组则受明显抑制（P〈0．01）;21d干预组血清IL-6、IL-10、IL-17和TGF-β的浓度较EAM组明显下降（P〈0．01）;21d干预组外周血STAT3、RORγt、Foxp3mRNA水平下降（P〈0．01）;体外IL-6mAb刺激EAM源性脾细胞,IL-10、IL-17和TGF-β表达明显增加。结论：IL6mAb对EAM有明显的保护作用,IL6mAb通过抑制Th17、Treg细胞的数量和功能,实现对EAM的保护作用。     

白细胞介素-18在部分自身免疫性疾病中的作用

白细胞介素-18(interleukin-18,IL-18)是一个多肽片段,具有促进T细胞增殖、增强细胞毒性T细胞和自然杀伤细胞活性等功能。自身免疫性疾病是指机体对自身抗原发生免疫反应而导致自身组织损害所引起的疾病。IL-18在免疫调节中有着高效、广泛的作用,部分自身免疫性疾病发病与免疫系统的异常会伴随IL-18的高表达,且不同病程IL-18表达量会有规律性变化,因此IL-18可作为一种自身免疫性疾病较敏感的标志物。现对IL-18在常见自身免疫性疾病如系统性红斑狼疮、成人Still病、自身免疫性心肌炎和类风湿关节炎中的作用作一综述。     

小鼠外周血心肌特异性microRNAs 的变化与病毒性心肌炎 相关关系初探

目的:通过识别病毒性心肌炎小鼠和正常小鼠血浆中miR-1,miR-133,miR-206表达量的差异,分析外周血中心肌特异性microRNAs的变化与病毒性心肌炎相关关系,为探索miRNAs作为病毒性心肌炎诊断的生物标志物提供可行性的研究资料。方法:在小鼠病毒性心肌炎模型的基础上,采用荧光定量PCR方法,检测病毒性心肌炎急性期小鼠组和正常小鼠组血浆中相关miRNAs含量,并进行统计学分析。再于病毒注射后1d,3d,5d,7d,9d,11d,分别处死病毒小鼠,观察血浆miRNAs的动态变化规律。同时用Elisa检测心肌肌钙蛋白的变化,对目的 miRNAs与心肌肌钙蛋白进行相关性分析。结果:急性期时三种miRNAs血浆含量显著上调。病毒注射后3d开始上升明显,并持续保持在较高水平到7d,于9d时开始下降。发病期间,血浆miRNAs含量与心肌肌钙蛋白呈现良好的正相关性。结论:小鼠外周血中心肌特异性microRNAs在病毒性心肌炎发病过程中的呈现明显上调并与病程和相应指标存在相关关系,为miRNAs作为病毒性心肌炎诊断的生物标志物提供了重要线索。     

肾血管性高血压大鼠发病过程中心血管AT1-受体自身抗体的变化

实验观察了肾血管性高血压（RVH）大鼠血浆中抗AT1－受体自身抗体在发病过程中的作用及其变化规律。采用两肾一夹Goldblatt RVH模型,以合成的大鼠AT1－受体细胞外第二环165－191位氨基酸序列作为特慢性抗原,用SA－ELISA法检测大鼠血清中抗AT1-受体自身抗体。结果表明,RVH模型组术后2周时大鼠血清中抗AT1－受体自身抗体的阳性率和平均滴度与术前相比明显增高,较高的阳性率和平均滴度持续几周后逐渐下降,12周时下降到正常水平。结果提示,自身免疫机制参与了高血压的形成,抗AT1－受体自身抗体可能与心肌肥厚有关。     

自身免疫病的分子遗传学

自身免疫病影响着大约5％的人口,这类疾病的特点是患者体内存在大量的针对自身抗原的自身抗体,这些自身抗体通过不同的模式引起机体的损伤。一些严重的自身免疫病如类风湿性关节炎、系统性红斑狼疮可引起致残和死亡。总之,自身免疫病的发病率和致残率呈现出一个全球性的健康问题。由于这种健康问题巨大的严重性和广泛性,引起了全球性的自身免疫病病因学的研究热潮。多代家系和大量双胞胎的流行病学调查清晰的显示自身免疫病遗传因素的存在。至少有20多个疾病易感基因被认为与环境因素相互作用引起自身免疫病的发生和发展。基于这种遗传研究热潮,多个遗传研究小组采用基因组范围的易感基因的扫描工作,在人类和鼠模型中鉴定出多个遗传易感位点,这些位点可能含有自身免疫病的致病基因。本文就人类和鼠模型中定位的易感基因位点作一综述。     

Cardioprotective effects of carvedilol on acute autoimmune myocarditis: anti-inflammatory effects associated with antioxidant property

Carvedilol, a new beta-blocker with antioxidant properties, has been shown to be cardioprotective in experimental models of myocardial damage. We investigated whether carvedilol protects against experimental autoimmune myocarditis (EAM) because of its suppression of inflammatory cytokines and its antioxidant properties. We orally administered a vehicle, various doses of carvedilol, racemic carvedilol [R(+)-carvedilol, an enantiomer of carvedilol without beta-blocking activity], metoprolol, or propranolol to rats with EAM induced by porcine myosin for 3 wk. Echocardiographic study showed that the three beta-blockers, except R(+)-carvedilol, suppressed left ventricular fractional shortening and decreased heart rates to the same extent. Carvedilol and R(+)-carvedilol, but not metoprolol or propranolol, markedly reduced the severity of myocarditis at the two different doses and suppressed thickening of the left ventricular posterior wall in rats with EAM. Only carvedilol suppressed myocardial mRNA expression of inflammatory cytokines and IL-1beta protein expression in myocarditis. In addition, carvedilol and R(+)-carvedilol decreased myocardial protein carbonyl contents and myocardial thiobarbituric acid-reactive substance products in rats with EAM. The in vitro study showed that carvedilol and R(+)-carvedilol suppressed IL-1beta production in LPS-stimulated U937 cells and that carvedilol and R(+)-carvedilol, but not metoprolol or propranolol, suppressed thiobarbituric acid-reactive substance products in myocardial membrane challenged by oxidative stress. It was also confirmed that probucol, an antioxidant, ameliorated EAM in vivo. Carvedilol protects against acute EAM in rats, and the superior cardioprotective effect of carvedilol compared with metoprolol and propranolol may be due to suppression of inflammatory cytokines associated with the antioxidant properties in addition to the hemodynamic modifications.     

Cardioprotective effects of carvedilol on acute autoimmune myocarditis

We investigated whether carvedilol protects against experimental autoimmune myocarditis (EAM) attributing to antioxidant properties. Acute EAM was induced by porcine cardiac myosin in Lewis rats. We orally administered a vehicle, various dosages of carvedilol, metoprolol, or propranolol to rats with EAM for 3 weeks. Three beta-blockers decreased heart rates to the same extent. Carvedilol, but not metoprolol or propranolol, markedly reduced the severity of myocarditis at the two different dosages. Only carvedilol decreased the myocardial protein carbonyl contents, and also decreased the myocardial thiobarbituric acid reactive substance products in rats with EAM. Accordingly, carvedilol protects against acute EAM in rats, and this superior cardioprotective effect of carvedilol to metoprolol and propranolol may be due to the antioxidant properties in addition to the hemodynamic modifications.     

MCI-186 (edaravone), a novel free radical scavenger, protects against acute autoimmune myocarditis in rats

In this study, we tested the hypothesis that MCI-186 (3-methyl-1-phenyl-2-pyrazolin-5-one; edaravone), a novel free radical scavenger, protects against acute experimental autoimmune myocarditis (EAM) in rats by the radical scavenging action associated with the suppression of cytotoxic myocardial injury. Recent evidence suggests that oxidative stress may play a role in myocarditis. We administered MCI-186 intraperitoneally at 1, 3, and 10 mg.kg(-1).day(-1) to rats with EAM for 3 wk. The results were compared with untreated rats with EAM. MCI-186 treatment did not affect hemodynamics. MCI-186 treatment (3 and 10 mg.kg(-1).day(-1)) reduced the severity of myocarditis as assessed by comparing the heart-to-body weight ratio and pathological scores. Myocardial interleukin-1beta (IL-1beta)-positive cells and myocardial oxidative stress overload with DNA damage in rats with EAM given MCI-186 treatment were significantly less compared with those of the untreated rats with EAM. In addition, MCI-186 treatment decreased not only the myocardial protein carbonyl contents but also the myocardial thiobarbituric acid reactive substance products in rats with EAM. The formation of hydroxyl radicals in MCI-186-treated heart homogenates was decreased compared with untreated heart homogenates. Furthermore, cytotoxic activities of lymphocytes of rats with EAM treated with MCI-186 were significantly lower compared with those of the untreated rats with EAM. Hydroxyl radicals may be involved in the development of myocarditis. MCI-186 protects against acute EAM in rats associated with scavenging hydroxyl free radicals, resulting in the suppression of autoimmune-mediated myocardial damage associated with reduced oxidative stress state.     

Cryptic epitope identified in rat and human cardiac myosin S2 region induces myocarditis in the Lewis rat

Myocarditis is a common cause of dilated cardiomyopathy leading to heart failure. Chronic stages of myocarditis may be initiated by autoimmune responses to exposed cardiac Ags after myocyte damage. Cardiac myosin, a heart autoantigen, induced experimental autoimmune myocarditis (EAM) in susceptible animals. Although cardiac myosin-induced myocarditis has been reported in Lewis rats, the main pathogenic epitope has not been identified. Using overlapping synthetic peptides of the S2 region of human cardiac myosin, we identified an amino acid sequence, S2-16 (residues 1052-1076), that induced severe myocarditis in Lewis rats. The myocarditic epitope was localized to a truncated S2-16 peptide (residues 1052-1073), which contained a sequence identical in human and rat cardiac myosin. The S2-16 peptide was not myocarditic for three other strains of rats, in which the lack of myocarditis was accompanied by the absence of strong S2-16-specific lymphocyte responses in vitro. For Lewis rats, S2-16 was characterized as a cryptic epitope of cardiac myosin because it did not recall lymphocyte and Ab responses after immunization with cardiac myosin. Lymphocytes from S2-16 immunized rats recognized not only S2-16, but also peptides in the S2-28 region. Furthermore, peptide S2-28 was the dominant epitope recognized by T cells from cardiac myosin immunized rats. S2-16 was presented by Lewis rat MHC class II molecules, and myocarditis induction was associated with an up-regulation of inflammatory cytokine production. S2-16-induced EAM provides a defined animal model to investigate mechanisms of EAM and modulation of immune responses to prevent autoimmune myocarditis.     

甲状腺素对大鼠实验性自体免疫心肌炎的作用

实验选用清洁级F344/NSIc大鼠,腹腔内注射甲状腺素（10μg/100g体重）,观察甲状腺素对肌球蛋白诱导的实验性自体免疫心肌炎的作用,并用免疫荧光技术结合流式细胞仪分析甲状腺素对免疫反应的影响。结果显示,甲状腺素对肌球蛋白免疫所致的心肌坏死,炎性细胞浸润和纤维化没有明显的改善作用;甲状腺素可诱导外周血B淋巴细胞比例升高。但对辅助T细胞和抑制T细胞比例。辅助T细胞/抑制T细胞比率没有影响。     

A DPP-4 Inhibitor Suppresses Fibrosis and Inflammation on Experimental Autoimmune Myocarditis in Mice

Myocarditis is a critical inflammatory disorder which causes life-threatening conditions. No specific or effective treatment has been established. DPP-4 inhibitors have salutary effects not only on type 2 diabetes but also on certain cardiovascular diseases. However, the role of a DPP-4 inhibitor on myocarditis has not been investigated. To clarify the effects of a DPP-4 inhibitor on myocarditis, we used an experimental autoimmune myocarditis (EAM) model in Balb/c mice. EAM mice were assigned to the following groups: EAM mice group treated with a DPP-4 inhibitor (linagliptin) (n = 19) and those untreated (n = 22). Pathological analysis revealed that the myocardial fibrosis area ratio in the treated group was significantly lower than in the untreated group. RT-PCR analysis demonstrated that the levels of mRNA expression of IL-2, TNF-α, IL-1β and IL-6 were significantly lower in the treated group than in the untreated group. Lymphocyte proliferation assay showed that treatment with the DPP-4 inhibitor had no effect on antigen-induced spleen cell proliferation. Administration of the DPP-4 inhibitor remarkably suppressed cardiac fibrosis and reduced inflammatory cytokine gene expression in EAM mice. Thus, the agents present in DPP-4 inhibitors may be useful to treat and/or prevent clinical myocarditis.     

Inhibition of cardiac oxidative and endoplasmic reticulum stress-mediated apoptosis by curcumin treatment contributes to protection against acute myocarditis

Curcumin is used anecdotally as an herb in traditional Indian and Chinese medicine. In the present study, the effects and possible mechanism of curcumin in experimental autoimmune myocarditis (EAM) rats were further investigated. They were divided randomly into a treatment and vehicle group, and orally administrated curcumin (50 mg/kg/day) and 1% gum arabic, respectively, for 3 weeks after myosin injection. The results showed that curcumin significantly suppressed the myocardial protein expression of inducible nitric oxide synthase (iNOS) and the catalytic subunit of nicotinamide adenine dinucleotide phosphate reduced (NADPH) oxidase. In addition, curcumin significantly decreased myocardial endoplasmic reticulum (ER) stress signaling proteins and improved cardiac function. Furthermore, curcumin significantly decreased the key regulators or inducers of apoptosis. In summary, our results indicate that curcumin has the potential to protect EAM by modulating cardiac oxidative and ER stress-mediated apoptosis, and provides a novel therapeutic strategy for autoimmune myocarditis.     

Quercetin offers cardioprotection against progression of experimental autoimmune myocarditis by suppression of oxidative and endoplasmic reticulum stress via endothelin-1/MAPK signalling

In order to test the hypothesis that treatment with quercetin at a dose of 10 mg/kg protects from the progression of experimental autoimmune myocarditis (EAM) to dilated cardiomyopathy (DCM), we have used the rat model of EAM induced by porcine cardiac myosin. Our results identified that the post-myocarditis rats suffered from elevated endoplasmic reticulum (ER) stress and adverse cardiac remodelling in the form of myocardial fibrosis, whereas the rats treated with quercetin have been protected from these changes as evidenced by the decreased myocardial levels of ER stress and fibrosis markers when compared with the vehicle-treated DCM rats. In addition, the myocardial dimensions and cardiac function were preserved significantly in the quercetin-treated rats in comparison with the DCM rats treated with vehicle alone. Interestingly, the rats treated with quercetin showed significant suppression of the myocardial endothelin-1 and also the mitogen activated protein kinases (MAPK) suggesting that the protection offered by quercetin treatment against progression of EAM involves the modulation of MAPK signalling cascade. Collectively, the present study provides data to support the role of quercetin in protecting the hearts of the rats with post myocarditis DCM.     

TLR ligands act directly upon T cells to restore proliferation in the absence of protein kinase C-theta signaling and promote autoimmune myocarditis

The serine/threonine kinase, protein kinase C-theta (PKC-theta), plays a central role in the activation and differentiation of Th2 cells while being redundant in CD4+ and CD8+ antiviral responses. Recent evidence indicates that PKC-theta may however be required for some T cell-driven autoimmune responses. We have investigated the role of PKC-theta in the induction of autoimmune myocarditis induced by either Coxsackie B3 virus infection or immunization with alpha-myosin/CFA (experimental autoimmune myocarditis (EAM)). PKC-theta-deficient mice did not develop EAM as shown by impaired inflammatory cell infiltration into the heart, reduced CD4+ T cell IL-17 production, and the absence of a myosin-specific Ab response. Comparatively, PKC-theta was not essential for both early and late-phase Coxsackie virus-induced myocarditis. We sought to find alternate pathways of immune stimulation that might reconcile the differential requirements for PKC-theta in these two disease models. We found systemic administration of the TLR ligand CpG restored EAM in PKC-theta-deficient mice. CpG could act directly upon TLR9-expressing T cells to restore proliferation and up-regulation of Bcl-x(L), but exogenous IL-6 and TGF-beta was required for Th17 cell differentiation. Taken together, these results indicate that TLR-mediated activation of T cells can directly overcome the requirement for PKC-theta signaling and, combined with the dendritic cell-derived cytokine milieu, can promote the development of autoimmunity.     

Inhibition of cardiac oxidative and endoplasmic reticulum stress-mediated apoptosis by curcumin treatment contributes to protection against acute myocarditis

Abstract

Curcumin is used anecdotally as an herb in traditional Indian and Chinese medicine. In the present study, the effects and possible mechanism of curcumin in experimental autoimmune myocarditis (EAM) rats were further investigated. They were divided randomly into a treatment and vehicle group, and orally administrated curcumin (50 mg/kg/day) and 1% gum arabic, respectively, for 3 weeks after myosin injection. The results showed that curcumin significantly suppressed the myocardial protein expression of inducible nitric oxide synthase (iNOS) and the catalytic subunit of nicotinamide adenine dinucleotide phosphate reduced (NADPH) oxidase. In addition, curcumin significantly decreased myocardial endoplasmic reticulum (ER) stress signaling proteins and improved cardiac function. Furthermore, curcumin significantly decreased the key regulators or inducers of apoptosis. In summary, our results indicate that curcumin has the potential to protect EAM by modulating cardiac oxidative and ER stress-mediated apoptosis, and provides a novel therapeutic strategy for autoimmune myocarditis.