CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Laurent Andréoletti, MD, PhD*
* Laboratoire de Virologie, Service de Microbiologie, Hôpital Robert Debré, et faculté de médecine de Reims, Avenue du Général Koenig, 51092 REIMS Cedex, France (Email: landreoletti{at}chu-reims.fr).
Our multicentric French case-control study demonstrates for the first time that enteroviruses (EVs) may significantly contribute to the pathogenesis of acute myocardial infarction (MI) (1). These results confirm previously published forensic evidence demonstrating that EVs could be significantly associated with sudden cardiac unexpected death cases (2). Evidently, it has been previously established that these EV cardiotropic strains did not respect national borders (2–5).
In this study (1), the endomyocardial detection of viral capsid protein 1 (VP1) by immunohistochemical technique was found to be the best tool for the diagnosis of EV-associated heart diseases as previously described (4,5), and no heart tissue control samples were VP1 positive using our improved immunohistological protocols (6). The VP1 results were confirmed by molecular assays and in some cases by the use, after cloning, of nucleic acid sequencing of the VP1 region (1). Moreover, none of the 20 EV-positive patients with acute MI and none of the 2 EV-positive subjects from the healthy heart control group were positive for the detection of other cardiotropic viruses, including Epstein-Barr virus, herpes simplex viruses, cytomegalovirus, varicella-zoster virus, adenoviruses, and parvovirus B19, in their myocardial tissues using previously published polymerase chain reaction techniques (1). However, 60% of the EV-negative heart tissues of MI patients were positive for the molecular detection of 1 or several of these cardiotropic viruses, including parvovirus B19 (not shown). These results support the previous published data on the potential role of myocardial virus persistence in differential aspects of endothelial function of the coronary microcirculation endothelial activation, and myocardial leukocyte infiltrates (7–9). By consequence, the role of other cardiotropic viruses including parvovirus B19-persistent infection in the development of coronary diseases remains to be explored, and it, therefore, is possible that other viruses may be associated to EV cardiovascular infections and may trigger the inflammatory process of chronic arteriosclerosis leading to acute MI (7).
Finally, there is no evidence of a new element of the "French paradox" related to the way of life including wine drinking, and which may concern a specific cardiovascular protection against common cardiotropic viruses (8). However, the French red wine is better than German beer for our arteries, but this drink remains to be consumed with moderation (10).
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References
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- Andréoletti L, Ventéo L, Douche-Aourik F, et al. Active coxsackieviral B infection is associated with disruption of dystrophin in endomyocardial tissue of patients who died suddenly of acute myocardial infarction J Am Coll Cardiol 2007;50:2207-2214.[Abstract/Free Full Text]
- Cioc AM, Nuovo GJ. Histologic and in situ viral findings in the myocardium in cases of sudden, unexpected death Mod Pathol 2002;9:914-922.[CrossRef]
- Yilmaz A, Mahrholdt H, Athanasiadis A, et al. Coronary vasospasm as the underlying cause for chest pain in patients with PVB19-myocarditis Heart 2008Jan 29;[Epub ahead of print].
- Andréoletti L, Bourlet T, Moukassa D, et al. Enteroviruses can persist with or without active viral replication in cardiac tissue of patients with end-stage ischemic or dilated cardiomyopathy J Infect Dis 2000;182:1222-1227.[CrossRef][ISI][Medline]
- Li Y, Bourlet T, Andréoletti L, et al. Enteroviral capsid protein VP1 is present in myocardial tissues from some patients with myocarditis or dilated cardiomyopathy Circulation 2000;101:231-234.[Abstract/Free Full Text]
- Zhang H, Li Y, Peng T, et al. Localization of enteroviral antigen in myocardium and other tissues from patients with heart muscle disease by an improved immunohistochemical technique J Histochem Cytochem 2000;48:5798.
- Vallbracht KB, Schwimmbeck PL, Kuhl U, Seeberg B, Schultheiss HP. Endothelium dependent flow-mediated vasodilation of systemic arteries is impaired in patients with myocardial virus persistence Circulation 2004;110:2938-2945.[Abstract/Free Full Text]
- Vallbracht KB, Schwimmbeck PL, Kuhl U, Rauch U, Seeberg B, Schultheiss HP. Differential aspects of endothelial function of the coronary microcirculation considering myocardial virus persistence, endothelial activation, and myocardial leukocyte infiltrates Circulation 2005;111:1784-1791.[Abstract/Free Full Text]
- Kuhl U, Pauschinger M, Bock T, et al. Parvovirus B19 infection mimicking acute myocardial infarction Circulation 2003;108:945-950.[Abstract/Free Full Text]
- Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease Lancet 1992;339:1523-1526.[CrossRef][ISI][Medline]
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A Geographical Mystery: Do Cardiotropic Viruses Respect National Borders?
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J. Am. Coll. Cardiol. 2008 52: 82.
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