Immunopathologic studies in myocardial biopsies of patients with Chagas' disease and idiopathic cardiomyopathy

Higuchi, Maria de Lourdes; Lopes, Edgard Augusto; Saldanha, Luis Balthazar; Barretto, Antonio Carlos Pereira; Stolf, Noedir A. G.; Bellotti, Giovanni; Pileggi, Fulvio

doi:10.1590/S0036-46651986000200004

Abstracts

Right ventricular endomyocardial biopsies were studied in 30 patients, 15 with myocardiopathy from chronic Chagas'disease and 15 with idiopathic congestive myocardiopathy; five other myocardial samples were taken at necropsies of patients with chronic Chagas' disease. The authors tried to establish by means of direct immunofluorescence techniques whether there were immunoglobulins G, A and M, fibrinogen and C3 complement deposition in the myocardium; only one of these 30 patients exhibited a positive reaction to IgG, it was a patient with idiopathic congestive myocardiopathy. All fragments from patients with Chagas' disease showed no response to any of the fluorescent conjugates. These findings do not support the idea that anti-myoeardial antibodies have pathogenic importance in the evolution of dilated or chagasic myocardiopathies.

Chagas' disease; myocardial biopsy; idiopathic cardiomyopathy; immunopathology

Foram estudadas biópsias de ventrículo direito de 30 pacientes, 15 com doença crônica de Chagas e 15 com miocardiopatia congestiva idiopática. Analisou-se também cinco fragmentos miocárdicos obtidos de pacientes chagásicos com menos de duas horas de óbito. Os Autores tentaram estabelecer, por meio de técnica de imunofluorescência direta, a presença de imunoglobulina G, A, e M, fibrinogênio e C3. Somente uma das 30 biópsias exibiu reação positiva para IgG que era de um paciente com miocardiopatia congestiva idiopática. Toods os fragmentos provenientes de pacientes chagásicos não apresentaram qualquer fluorescência com nenhum dos conjugados. Esses achados falam contra o conceito de que anticorpos antimiocárdio teriam importância patogenética na evolução das miocardiopatias chagásica ou dilatada idiopática.

ORIGINAL ARTICLES

Immunopathologic studies in myocardial biopsies of patients with Chagas' disease and idiopathic cardiomyopathy

Estudos imunopatológicos de biópsias de pacientes chagásicos crônicos ou com miocardiopatia dilatada idiopática

Maria de Lourdes Higuchi; Edgard Augusto Lopes; Luis Balthazar Saldanha; Antonio Carlos Pereira Barretto; Noedir A. G. Stolf; Giovanni Bellotti; Fulvio Pileggi

Heart Institute of Clinical Hospital São Paulo University School of Medicine

^{Address for reprints} Address for reprints: Maria de Lourdes Higuchi Instituto do Coração Hospital das Clinicas FMUSP São Paulo Brasil CEP 05403

SUMMARY

Right ventricular endomyocardial biopsies were studied in 30 patients, 15 with myocardiopathy from chronic Chagas'disease and 15 with idiopathic congestive myocardiopathy; five other myocardial samples were taken at necropsies of patients with chronic Chagas' disease. The authors tried to establish by means of direct immunofluorescence techniques whether there were immunoglobulins G, A and M, fibrinogen and C₃ complement deposition in the myocardium; only one of these 30 patients exhibited a positive reaction to IgG, it was a patient with idiopathic congestive myocardiopathy. All fragments from patients with Chagas' disease showed no response to any of the fluorescent conjugates. These findings do not support the idea that anti-myoeardial antibodies have pathogenic importance in the evolution of dilated or chagasic myocardiopathies.

Key words: Chagas' disease myocardial biopsy idiopathic cardiomyopathy immunopathology.

RESUMO

Foram estudadas biópsias de ventrículo direito de 30 pacientes, 15 com doença crônica de Chagas e 15 com miocardiopatia congestiva idiopática. Analisou-se também cinco fragmentos miocárdicos obtidos de pacientes chagásicos com menos de duas horas de óbito. Os Autores tentaram estabelecer, por meio de técnica de imunofluorescência direta, a presença de imunoglobulina G, A, e M, fibrinogênio e C₃. Somente uma das 30 biópsias exibiu reação positiva para IgG que era de um paciente com miocardiopatia congestiva idiopática. Toods os fragmentos provenientes de pacientes chagásicos não apresentaram qualquer fluorescência com nenhum dos conjugados.

Esses achados falam contra o conceito de que anticorpos antimiocárdio teriam importância patogenética na evolução das miocardiopatias chagásica ou dilatada idiopática.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

ACKNOWLEDGEMENT

The Authors gratefully acknowledge Prof. Maurício Rocha e Silva, M.D., for his generous cooperation and the revision of this article.

Recebido para publicação em 16/5/1985.

This study was supported in part by FINEP.

1. BOLTE, H. D.; FISCHER, S. & LUDWIG, B. Immunological examinations in dilated cardiomyopathies. Z. Kardiol., 71: 517-521, 1982.
2. BOLTE, H. D. & SCHULTHEISS, P. Immunological results in myocardial diseases. Postgrad. med. J., 54: 500-503, 1978.
3. COSSIO. P. M.; DIEZ, C; SARFMAN, A.; KREUTZER. E.; CANDIOLO, B. & ARANA, K. M. Chagasic cardiopathy: demonstration of serum gammaglobulin factor which reacts with endocardium and vascular structures. Circulation, 49: 13-21, 1974.
4. COSSIO, P. M.; LAGUENS, R. P.; DIEZ, C.; SZARFMAN, A.; SEGAL, A. & ARANA, R. M. Chagasic cardiopathy: antibodies reacting with plasma membrane of striated muscle and endothelial cells. Circulation, 50: 12524259, 1974.
5. COSSIO, P. M.; LAGUENS, R. P.; KREUTZER, E.; DIEZ, C; SEGAL, A. & ARANA, R. M. Chagasic cardiopathy: immunopathologic and morphologic studies in myocardial biopsies. Amer. J. Path., 86: 533-539, 1977.
6. DAS, S. K.; CALLE, J. P.; DODSON, V. N. & CASIDY, J. T. Immunoglobulin binding in cardiomyopathy hearts. Circulation, 44: 612-616, 1971.
7. FLETCHER, P. G. & WENGER, N. K. Autoimmune studies in patients with primary myocardial disease. Circulation, 37: 1032-1035, 1968.
8. KHOURY, E. L.; DIEZ, C; COSSIO, P. M. & ARANA, R. N. Heterophil nature of EVI antibody in Trypanosoma cruzi infection. Clin. Immunol. Immunopath., 27: 283-288, 1983.
9. KLAJMÁN, A-; KAMIN- BELSKY, N.; FELDMAN, S. & KARIV, I. Immunologic studies in familial cardiomyopathy. Amer. J. Cardiol. 28: 707-711, 1971.
10. KOMAJDA, M; BEAUFILS, H.; MOULIAS, R.; MARESCOT, M. R.; BROBINSKY, G. & GROSGOGEAT, Y. Etude immunologique dans les myocardiopathies primitives non obstructives. A propôs de 37 observations. Ann. Méd. intern., 130: 547-551, 1979.
11. KOMAJDA, M.; BEAUFILS, H.; SCHMELCK, P. H.; MUNICH, A.; DROBINSKI, G.; THOMAS, D.; MOULIAS, R. & GROSGOGEAT, Y. Étude immunologique dans les myocardiopathies dilatées. Arch. Mal. Coeur., 75: 29-35, 1982.
12. MAISCH, B.; BERG, P. A. & KOCHSIEK, K. Immunological parameters in patients with congestive cardiomyopathy. Basic Res. Cardiol, 75: 221-222, 1980.
13. MASON, J. N. Techniques for right and left ventricular endomyocardial biopsy. Amer. J. Cardiol., 41: 887-892, 1978.
14. MOLINA, H. A.; MILE I, J. & STORINO, R. Chronic Chagas' myocardiopathy. Demonstration of "in vivo" bound immunoglobulins in heart structures by the immunoperoxidase technique. Cardiology, 71: 297-206, 1984.
15. PERALTA, J. M.; MANIGOT, D. A.; MUSCELLI, E. O. A.; MAGALHÃES, T. C. R.; ALMEIDA, E. A. & BASTOS, A. Anticorpo EVI e-NP na infecção chagásica crônica. Estudo em pacientes com diferentes formas clínicas. Rev. Inst. Med. trop. S. Paulo, 24: 6-10, 1982.
16. SANDERS, V. & RITS, R. E. Ventricular localization of bound gamma globulin in idiopathic disease of the myocardium. J. Amer. med. Ass. 194: 171-173, 1965.
17. SZARFMAN, A.; LUQUETTI, A.; RASSI, A.; REZENDE, J. M. & SCHMURIS, G. A. Tissue-reacting immunoglobulins in patients with different clinical forms of Chagas' disease. Amer. J. trop. Med. Hyg., 30: 43-46, 1981.
18. THOMPSON, R. A.; TRUEMAN, T.; HAENEY, M. R.; HATCHETT, M-; LITTLER, W. A. & RETIEF, L. Immunological mechanisms and cardiomegaly. Lancet, 5: 7-48, 1980.

Address for reprints:

Maria de Lourdes Higuchi

Instituto do Coração

Hospital das Clinicas FMUSP

São Paulo Brasil CEP 05403

Publication Dates

Publication in this collection
16 Oct 2012
Date of issue
Apr 1986

History

Received
16 May 1985

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BOLTE, H. D.; FISCHER, S. & LUDWIG, B. Immunological examinations in dilated cardiomyopathies. Z. Kardiol., 71: 517-521, 1982.

[2] 2. BOLTE, H. D. & SCHULTHEISS, P. Immunological results in myocardial diseases. Postgrad. med. J., 54: 500-503, 1978.

[3] 3. COSSIO. P. M.; DIEZ, C; SARFMAN, A.; KREUTZER. E.; CANDIOLO, B. & ARANA, K. M. Chagasic cardiopathy: demonstration of serum gammaglobulin factor which reacts with endocardium and vascular structures. Circulation, 49: 13-21, 1974.

[4] 4. COSSIO, P. M.; LAGUENS, R. P.; DIEZ, C.; SZARFMAN, A.; SEGAL, A. & ARANA, R. M. Chagasic cardiopathy: antibodies reacting with plasma membrane of striated muscle and endothelial cells. Circulation, 50: 12524259, 1974.

[5] 5. COSSIO, P. M.; LAGUENS, R. P.; KREUTZER, E.; DIEZ, C; SEGAL, A. & ARANA, R. M. Chagasic cardiopathy: immunopathologic and morphologic studies in myocardial biopsies. Amer. J. Path., 86: 533-539, 1977.

[6] 6. DAS, S. K.; CALLE, J. P.; DODSON, V. N. & CASIDY, J. T. Immunoglobulin binding in cardiomyopathy hearts. Circulation, 44: 612-616, 1971.

[7] 7. FLETCHER, P. G. & WENGER, N. K. Autoimmune studies in patients with primary myocardial disease. Circulation, 37: 1032-1035, 1968.

[8] 8. KHOURY, E. L.; DIEZ, C; COSSIO, P. M. & ARANA, R. N. Heterophil nature of EVI antibody in Trypanosoma cruzi infection. Clin. Immunol. Immunopath., 27: 283-288, 1983.

[9] 9. KLAJMÁN, A-; KAMIN- BELSKY, N.; FELDMAN, S. & KARIV, I. Immunologic studies in familial cardiomyopathy. Amer. J. Cardiol. 28: 707-711, 1971.

[10] 10. KOMAJDA, M; BEAUFILS, H.; MOULIAS, R.; MARESCOT, M. R.; BROBINSKY, G. & GROSGOGEAT, Y. Etude immunologique dans les myocardiopathies primitives non obstructives. A propôs de 37 observations. Ann. Méd. intern., 130: 547-551, 1979.

[11] 11. KOMAJDA, M.; BEAUFILS, H.; SCHMELCK, P. H.; MUNICH, A.; DROBINSKI, G.; THOMAS, D.; MOULIAS, R. & GROSGOGEAT, Y. Étude immunologique dans les myocardiopathies dilatées. Arch. Mal. Coeur., 75: 29-35, 1982.

[12] 12. MAISCH, B.; BERG, P. A. & KOCHSIEK, K. Immunological parameters in patients with congestive cardiomyopathy. Basic Res. Cardiol, 75: 221-222, 1980.

[13] 13. MASON, J. N. Techniques for right and left ventricular endomyocardial biopsy. Amer. J. Cardiol., 41: 887-892, 1978.

[14] 14. MOLINA, H. A.; MILE I, J. & STORINO, R. Chronic Chagas' myocardiopathy. Demonstration of "in vivo" bound immunoglobulins in heart structures by the immunoperoxidase technique. Cardiology, 71: 297-206, 1984.

[15] 15. PERALTA, J. M.; MANIGOT, D. A.; MUSCELLI, E. O. A.; MAGALHÃES, T. C. R.; ALMEIDA, E. A. & BASTOS, A. Anticorpo EVI e-NP na infecção chagásica crônica. Estudo em pacientes com diferentes formas clínicas. Rev. Inst. Med. trop. S. Paulo, 24: 6-10, 1982.

[16] 16. SANDERS, V. & RITS, R. E. Ventricular localization of bound gamma globulin in idiopathic disease of the myocardium. J. Amer. med. Ass. 194: 171-173, 1965.

[17] 17. SZARFMAN, A.; LUQUETTI, A.; RASSI, A.; REZENDE, J. M. & SCHMURIS, G. A. Tissue-reacting immunoglobulins in patients with different clinical forms of Chagas' disease. Amer. J. trop. Med. Hyg., 30: 43-46, 1981.

[18] 18. THOMPSON, R. A.; TRUEMAN, T.; HAENEY, M. R.; HATCHETT, M-; LITTLER, W. A. & RETIEF, L. Immunological mechanisms and cardiomegaly. Lancet, 5: 7-48, 1980.