IMMUNOLOGICAL TREATMENT
This part of the treatment of myocarditis is already used in clinical practise, but it is still being researched. The mechanisms of the effect of these substances, which influence the activity of the immune system are sometimes not completely explained in the case of myocarditis and research into this topic have sometimes produced different results in a question of effectivity of these drugs in the treatment of myocarditis. It is also very important note that everyone reacts to the treatment differently (not just in case of immunological treatment). You can find news from research of these substances in category Research – subcategory News.
A major part of the researches is identical in the result that the use of so called nonsteroidal anti-inflammatory drugs (indometacin, phenylbutazone, ibuprofen) is not recommended in acute phase of the disease, because it could increase the amount of fibrosis (scars) and inflammation in the heart muscle.
IMMUNOGLOBULINS
Immunoglobulins are a huge group of substances and structures, important for the right function of the immune system, including antibodies. Antibodies block the connection of microorganisms in cells and support their destruction. Immunoglobulins modulate (modify) or alternatively strengthen the function of the immune system.
They are indicated individually in myocarditis, depanding on the general state of health. They are often administrated intravenously (into veins) in high doses. These high doses of immunoglobulins cause immunoppression (attenuation) of immune system activity. Their effectiveness is different in every patient. Positives effect have been described mostly in children.
Picture 26: Immunoglobuline (author: Database Center for Life Science -DBCLS)
IMMUNOSUPPRESSION AND CORTICOSTEROIDS
Immunosuppressive treatment reduces the reaction and function of the immune system. It influences the function of white blood cells, antibodies and the production of substances which are parts of the immune system (for example – interleukin 2, which is responsible for the stimulation of some parts of the immune system). Corticosteroids are hormones of the adrenal glands. They are divided in 2 groups – glucocorticoids and mineralocorticoids.
Immunosuppressive therapy and corticosteroids are noly used in myocarditis in patients without the presence of the myocarditis cause in the heart muscle, which is confirmed by endomyocardial biopsy (see this link). They are indicated also in inflammatory cardiomyopathy if the cause of the disease is not present in the myocardium. In viral myocarditis where a virus is present in the myocardium, the use of immunosuppressive therapy and corticosteroid may have an unfavourable effect on the patient. Therefore, they are used only in above mentioned situations and primarily in giant cell or eosinophilic myocarditis (see this link) or when myocarditis is caused by another autoimmune disorder (SLE etc.).
If corticosteroids and immunosuppression are indicated, they are very often combined. The most often used samples are prednisone, azathioprine and cyclosporine.
The use of immunosuppression and corticosteroids in myocarditis is still a subject of research and clinical studies.
Picture 27: Immunosuppressive treatment (authors: SubDural12, Brenton, Ph.David)
IMMUNOADSORPTION AND PLASMAPHERESIS
Plasmapheresis is a method in which undesirable substances (autoantibodies and others) are removed from the fluid part of blood – blood plasma. Blood is run through special plasma filters or a centrifuge. This causes separation of the cells from the fluid plasma, which contains undesirable substances. The plasma is then returned the patient in the form of a solution.
Immunoadsorption is actually an advanced form of plasmapheresis. In the first phase, cells are separated from fluid plasma (as in plasmapheresis). Immunoadsorption in addition catches all the immunoglobulins and antigens from the plasma. Antigens are substances which the human body can recognize and according to their structure it can react with them producing antibodies. Antigens are even microorganisms that cause disease and the immune system destroys them. Antigens are contained also in human body, but in normal situation, our immune system does not create antibodies against them.
In patients with (chronic) myocarditis, immunoadsorption catches all the antibodies against heart cells, but in contrast to plasmapheresis, “cleared” blood plasma is returned into patient´s body.
Plasmapheresis or immunoadsorption are repeated several times in a short period of time. It is better known and used at patients with a kidney disease and transplantation, or during blood donations. In the case of myocarditis, these methods are used only in specialized centres and their effectivity is still being researched.
INTERFERON BETA
Interferons, including interferon beta, are a part of antiviral and anticancer immunity. They reduce viral reproduction and cause the death of cells infected by a virus.
Treatment with interferon beta is still the subject of research, however present results are quite favourable. Interferon beta is researched primarily in association with the treatment of chronic myocarditis (inflammatory cardiomyopathy).
The best effect was observed in myocarditis caused by enteroviruses and adenoviruses (see this link), when the virus was completely “cleared” out of the heart muscle. More information are on this page.
The effectivity and mechanism of interferon beta treatment is still research and it is needed to complete other studies that would deal with treatment with interferon beta.
Picture 29: Interferon-β (author: Nevit Dilmen)
Author of the opening picture: Nevit Dilmen