Differential expression of coxsackievirus and adenovirus receptor in endomyocardial tissue of patients with myocarditis

García‑Becerril,Gustavo  E.; Cruz‑Montalvo,Aníbal  E.; De La Cruz,Miguel  A.; Ares,Miguel  A.; Moreno‑Ruiz,Luis  A.; García‑Chequer,Adda  J.; Maldonado‑Bernal,Carmen; Gómez‑Jiménez,Luz  M.; Flores‑García,Cesar  A.; Garrido‑Garduño,Martín   H.; Cárdenas‑Mondragón,María  G.

doi:10.3892/mmr.2019.10444

Differential expression of coxsackievirus and adenovirus receptor in endomyocardial tissue of patients with myocarditis

Authors:
- Gustavo E. García‑Becerril
- Aníbal E. Cruz‑Montalvo
- Miguel A. De La Cruz
- Miguel A. Ares
- Luis A. Moreno‑Ruiz
- Adda J. García‑Chequer
- Carmen Maldonado‑Bernal
- Luz M. Gómez‑Jiménez
- Cesar A. Flores‑García
- Martín H. Garrido‑Garduño
- María G. Cárdenas‑Mondragón
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Affiliations: Clínica de Insuficiencia Cardiaca, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo‑XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico, Unidad de Cuidados Intensivos Cardiovasculares, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo‑XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico, Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, UMAE Hospital de Pediatría ‘Dr. Silvestre Frenk Freund’, Centro Médico Nacional Siglo‑XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico, Servicio de Hospitalización Adultos, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo‑XXI, IMSS, Mexico City 06720, Mexico, Laboratorio en Biología del Desarrollo, Unidad de Hemato‑Oncología e Investigación del Hospital Infantil de México, ‘Federico Gómez’, Secretaria de Salud, Mexico City 06720, Mexico, Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México, ‘Federico Gómez’, Secretaria de Salud, Mexico City 06720, Mexico, Servicio de Patología UMAE Hospital de Especialidades del Centro Médico Nacional Siglo‑XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico, Servicio de Patología, UMAE Hospital de Cardiología del Centro Médico Nacional Siglo‑XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
Published online on: June 28, 2019 https://doi.org/10.3892/mmr.2019.10444
Pages: 2189-2198
Copyright: © García‑Becerril et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Recent studies demonstrated that the expression of coxsackievirus and adenovirus receptor (CAR) is implicated in the pathophysiology of myocarditis. The aim of the present study was to assess the association between active and borderline myocarditis and CAR expression in endomyocardial tissues, and analyze the association between CAR expression and treatment response. An analytic, cross‑sectional, retrospective study was performed in 26 patients with myocarditis and 10 control subjects without heart disease. Myocardial biopsies were obtained and CAR transcription was measured by reverse transcription‑quantitative polymerase chain reaction analysis. The association between CAR mRNA levels and the response to immunosuppressive or conventional therapy (treatment responders, n=17; non‑responders, n=9) or with the type of histological myocarditis (active myocarditis, n=16; borderline myocarditis, n=10) was analyzed. CAR transcription levels were significantly lower (P=0.012) in patients with myocarditis compared with controls, and a significant decrease was observed (P=0.023) in CAR mRNA levels among patients with borderline myocarditis compared with the no myocarditis group. Patients responding to therapy exhibited higher CAR mRNA levels (P=0.036) compared with patients not responding to treatment, as evaluated based on clinical and echocardiographic criteria (immunosuppressive therapy, n=8; conventional therapy, n=1). Myocarditis in non‑responders was associated with fewer clinical manifestations and lower CAR mRNA levels. A significant difference was only found regarding the use of oral steroids in patients with active myocarditis who responded to treatment (P=0.02), with no difference in borderline myocarditis. In conclusion, the transcriptional level of CAR is low in the endomyocardial tissue of patients with myocarditis, and it is lower in borderline myocarditis and in non‑responder patients. These findings may enable early identification of patients who may benefit from treatment and timely determination of prognosis.

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