Chapter 8 Myocarditis © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease.

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Chapter 8 Myocarditis © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.1 Histological subtypes of myocarditis: (A) lymphocytic; (B) polymorphous; (C) eosinophilic; (D) giant cell; (E) sarcoid (hematoxylin eosin stain). © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.2 Chronic myocarditis: note the spotty replacementtype fibrosis associated with few focal inflammatory infiltrates ((A), hematoxylin eosin stain; (B), trichrome stain. In (A), positive T lymphocytes (CD3)). Fibrosis stains blue on trichrome stain. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.3 Histological and immunohistochemical diagnosis of lymphocytic myocarditis on endomyocardial biopsy. (A) Active lymphocytic myocarditis with interstitial edema and inflammatory infiltrates (hematoxylin eosin stain). (B) Immunophenotypic characterization of inflammatory cells as active T lymphocytes (CD3 antibody). © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.4 Histological and molecular diagnosis of lymphocytic viral myocarditis on endomyocardial biopsy. (A) Active myocarditis with lymphocytic infiltrates and foci of myocyte injury (arrow) (hematoxylin eosin stain). (B) Gel electrophoresis, positive PCR for enterovirus. Line 1, DNA marker (factor VIII); line 2, positive control for enterovirus (180 bp); line 3, EMB positive for enterovirus; line 4, negative control.4 © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.5 Pathophysiological phases of experimental viral myocarditis. DCM, dilated cardiomyopathy; GM-CSF, Granulocyte-macrophage colony-stimulating factor; IFN, interferon; IL, interleukin; M-CF, macrophage colony-stimulating factor; TNF-α, tumor necrosis factor-alpha. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.6 Myocardial tissue injury during different phases of infectious myocarditis, from direct virus-associated and/or immune-mediated tissue injury to recovery or persistent cardiomyopathy. DCM, dilated cardiomyopathy; IFN, interferon; IL, interleukin; LV, left ventricular; MMP, matrix metalloproteinase; TNF-α, tumor necrosis factor-alpha. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.7 Differentiation of effector T-cells in infective myocarditis. DC, dendritic cell; CTL, cytotoxic T lymphocytes; IL, interleukin; INF, interferon; MΦ, macrophage; NKT, natural killer T-cell; TGF, transforming growth factor; TNF, tumor necrosis factor. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.8 Effects of Toll-like receptor signaling pathway in viral myocarditis. IL, interleukin; INF, interferon; IRF, interferon regulatory factor; IRAK, Interleukin-1 associated kinase; MyD88, myeloid differentiation primary response gene 88; NFκB, nuclear factor kappa B; SOCS, suppressor of cytokine signaling; TLR, Toll-like receptor; TN-Fα, tumor necrosis factor-alpha; TRAF, TNF receptor associated factor; TRIF, TIR domain-containing adapter-inducing interferon β. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease

FIGURE 8.9 Endomyocardial biopsy protocol in patients with clinically suspected myocarditis. AV, adenovirus; CMV, cytomegalovirus; EBV, Epstein-Barr virus; EV, enterovirus; HCV, hepatitis C virus; HHV6, human herpes virus 6; HHV8, human herpes virus 8; HSV, herpes simplex virus; MUMPS, paramyxovirus; PV B19, Parvovirus B19; RSV, respiratory syncytial virus; VZV, varicella zoster virus; PV B19, parvovirus B19. © 2014, Elsevier Inc., Willis, et.al., Cellular and Molecular Pathobiology of Cardiovascular Disease