[Serum neopterin, bacteremia and viral antibodies in dilated cardiomyopathy]. / Syvorotochnyni neopterin, bakteriemiia i virusnye antitela pri dilatatsionnoi kardiomiopatii.

Quantitation of neopterin and morphological examination of bacteria circulating in the blood of 28 patients with dilated cardiomyopathy gave evidence for elevated neopterin concentrations in 22 of the examinees (> 10 nM/l). The highest neopterin levels occurred in patients with L-form bacteria. Concentrations of neopterin and antibodies to cytomegalovirus, herpes simplex were related. The above antibodies were associated with high neopterin levels in the serum. It is suggested that high amounts of serum neopterin may result from combination of viral and bacterial infection in dilated cardiomyopathy sufferers.

[Cardiolipin antibodies in non-specific aortic arteritis]. / Antitela k kardiolipinu pri nespetsificheskom aortoarteriite.

Cardiolipin antibodies are detected in the sera from patients having a wide range of clinical manifestations, including venous and arterial thrombosis, obstetric abnormality, damaged CHS and diseased vascular wall. To clarify the clinical value of cardiolipin antibodies, 21 patients with non-specific aortic arteritis were studied. The antibodies were determined by enzyme immunoassay. Their higher levels were found in 5 (24%) patients. The patients who were positive for cardiolipin antibodies showed a significant increase in the incidence of occlusive lesions (p less than 0.001) and a moderate increase in that of valvular heart diseases. The findings suggest that cardiolipin antibodies might contribute to the pathogenesis of non-specific of aortic arteritis.

[Serum neopterin in dilated cardiomyopathy]. / Syvorotochnyi neopterin pri dilatatsionnoi kardiomiopatii.

RIA was used to measure the level of neopterine and beta 2-microglobulin in the sera of 43 patients with a verified diagnosis of dilated cardiomyopathy (DCMP). In DCMP patients, the mean level of neopterine was 11.25 +/- 1.05 nM/l and was significantly higher than in donors (5.6 +/- 0.5 nM/l). The concentration of neopterine exceeding 9 nM/l was discovered in 55% of DCMP patients. The rise of neopterine concentration was particularly marked in patients with inflammatory reaction in the myocardium according to endomyocardial biopsy. In that patients' group, the mean level of neopterine was 12.9 +/- 2.02 nM/l while the rise of its concentration over 9 nM/l was recorded in 9 (81%) of 11 patients examined. The correlation was established between the rise of the concentration of neopterine and beta 2-microglobulin. In patients with the concentration of neopterine over 9 nM/l, the mean level of beta 2-microglobulin constituted 3.33 +/- 0.32 mg/l and in patients with the normal concentration of neopterine, it amounted to 1.91 +/- 0.18 mg/l. The growth of the concentration of beta 2-microglobulin in the groups of patients under comparison was seen in 79 and 14% of cases, respectively. It is concluded that neopterine measurements are advisable in the laboratory diagnosis of myocarditis in DCMP patients. Potential mechanisms of the rise of neopterine formation are discussed from the standpoint of hyperinterferonemia.

[Antibodies to the myelin major protein in patients with dilated cardiomyopathy. Determination and diagnostic significance]. / Antitela k osnovnomu belku mielina u bol'nykh dilatsionnoi kardiomiopatiei. Opredelenie i diagnosticheskoe znachenie.

IgG and IgM antibodies to the myelin major protein (MMP) have been measured by solid-phase enzyme immunoassay (EIA) in the blood sera of 31 patients with dilatation cardiomyopathy (DCMP), 4 ones with coronary disease (CD), and 20 normal subjects. Nonspecific binding of the native and aggregated human gamma-globulin with the MMP has been examined, as well as the correlation between the blood serum concentrations of circulating immune complexes, IgG and IgM, and the rheumatoid factor, and the titers of IgG and IgM antibodies to MMP; no correlation has been detected (p greater than 0.05). The activities of bovine and porcine MMP in EIA have been under study and found identical (p less than 0.001). No anti-MMP antibody has been detected in CD patients, whereas in DCMP IgG antibodies have been present in 55% and IgM ones in 49% of the cases, and 52% of the patients had both types of antibodies. Dynamic titration of anti-MMP antibody carried out in 9 DCMP patients has revealed a 4-fold and higher elevation of the titers in 4 patients and a reduction of these titers in other 4 patients. Comparison of the titers of IgG and IgM antibodies to MMP and the peripheral blood lymphocyte ability to spontaneous synthesis of immunoglobulins and Phytolacca mitogen-stimulated Ig synthesis by the MMP has revealed a correlation between these parameters. The findings permit a hypothesis on the involvement of the nerve fiber myelin-containing cells, possibly of the afferent system of the heart, in half the examinees with DCMP.

[Activation of the complement system in dilated cardiomyopathy]. / Aktivatsiia sistemy komplementa pri dilatatsionnoi kardiomiopatii.

The levels of anaphylatoxins (C3a, C5a) in blood, components of complements C3 and C4, antibodies to cardiolipin, IgG, IgA, IgM, IgE and circulating immune complexes were measured in 21 patients with dilated and hypertrophic cardiomyopathy (DCMP and HCMP) and in 11 donors. The mean level of C3a in DCMP patients (572 +/- 55 ng/ml) was significantly higher than in HCMP patients (344 +/- 30 ng/ml) and in donors (294 +/- 43 ng/ml) (p less than 0.001). On comparison of C5a concentrations in DCMP patients (2.2 +/- 0.52 ng/ml), HCMP patients (3.3 +/- 1.2 ng/ml) and in donors (1.6 +/- 0.82 ng/ml) no significant differences were found (p greater than 0.05). It has been established that in the group of DCMP patients with thromboembolic complications, the concentrations of C3a (736 +/- 95 ng/ml) were significantly higher than in those without such complications (334 +/- 14 ng/ml) (p less than 0.001). The data obtained permit discussing the role of anaphylatoxins in the development of thromboembolic complications in DCMP patients.

[Myocarditis and dilated cardiomyopathy (an analysis of questions of etiology, pathogenesis and differential diagnosis in a clinical example)]. / Miokardit i dilatatsionnaia kardiomiopatiia (analiz voprosov étiologii, patogeneza i differentsial'nogo diagnoza na klinichekom primere).

Development and clinical course of dilated cardiomyopathy is analysed in detail on one clinical case. Myocardial biopsy findings, immunologic data and autopsy findings are compared. The data obtained indicate that myocardial lymphocyte infiltration correlates with the rise in titres of antibodies to cytomegalovirus and the virus of herpes simplex as well as increase in serum alpha-interferon, neopterin and beta-2-microglobulin concentrations. Rise in the level of antibodies to cardiolipins is combined with thromboembolic syndrome. The roles of immunological control disturbances and immunity system activation in the pathogenesis of dilated cardiomyopathy as well as possible evolution of myocarditis into dilated cardiomyopathy are discussed.

[Clinical value of determining the levels of lupus anticoagulant and anti-cardiolipin antibodies]. / Klinicheskoe zhachenie opredeleniia volchanochnogo antikoagulianta i antitel k kardiolipinu.

The authors present some literature and their own data on the antiphospholipid syndrome (venous and arterial thromboses; obstetric pathology: spontaneous abortions and intrauterine death of a fetus; CNS involvement: from headaches and disorientation to psychic disorders and cerebral infarctions; thrombocytopenia, early aseptic osteonecrosis and pulmonary hypertension). Altogether 58 patients with lupus erythematosus and 20 patients with a complicated obstetric history were examined. Lupoid anticoagulant and antibodies to cardiolipin were revealed in 27 patients. The determination of antiphospholipid antibodies was shown to be of practical value from the view-point of the knowledge of humoral immunity disorders in systemic lupus erythematosus, more detailed clinico-laboratory characterization of patients, the diagnosis and prediction of disorders of the blood coagulation system, and the development of obstetric pathology.

[Immunoregulatory disorders and activation of the immune system in dilated cardiomyopathy]. / Narushenie immunoreguliatsii i aktivatsiia sistemy immuniteta pri dilatatsionnoi kardiomiopatii.

The level of immunoregulatory lymphocytic subpopulations (CD3-, CD4-, CD8-cells, CD4/SD8 ratio, IaDr-positive cells, SD16-cells), lymphocyte natural cytotoxicity (NCT), the concentration of serum interferon (IF), beta 2-microglobulin (beta 2-M) and neopterin were investigated in 30 patients with dilatative cardiomyopathy (DCMP). Immunoregulatory lymphocytic subpopulations were defined by indirect immunofluorescence using monoclonal antibodies to differentiating markers of BMA and OKT series. A decrease in SD4/SD8 ratio less than 1 was observed in 10 patients, an increase in SD4/SD8 ratio over 2.3 was observed in 5 patients. A significant rise of IaDr-positive cells, a decrease in NCT, an increase in the concentration of IF, beta 2-M and neopterin were observed. There was correlation of an increase in IF concentration, the number of IaDr-positive cells and an increase in the level of neopterin and beta 2-M. Signs of activation of the immune system were more frequently noted in patients with a decreased (less than 1) or increased CD4/CD8 ratio. The role of disorders of immunoregulation and activation of the immune system in DCMP pathogenesis was discussed.

[The immune system in coronary atherosclerosis]. / Immunnaia sistema pri koronarnom ateroskleroze.

A considerable imbalance in humoral and cellular factors of immunity characterized by high B-cell activity associated with a relative T-cell deficiency has been revealed in patients with coronary heart disease. Immunological imbalance is characteristic for all the clinically pronounced forms of coronary heart disease, forming long before obvious lesions of the coronary arteries. This makes it possible to regard patients without coronarographically documented atherosclerosis as having functional form of the process pathogenetically identical to atherosclerosis according to immunological criteria.

[Cellular immune response to myelin basic proteins in patients with dilated cardiomyopathy]. / Kletochnyi immunnyi otvet na osnovnoi belok mielina u bol'nykh dilatatsionnoi kardiomiopatiei.

Peripheral blood lymphocytes (PBL) of patients with dilatation cardiomyopathy (DCMP), CHD and healthy persons were investigated for the presence of sensitization to the protein basic myelin (PB) for characterization of an immunopathological process in DCMP. In half of the DCMP patients there was sensitization to MMP, the presence of cytotoxic MMP-specific lymphocytes, a decrease in PBL suppressor and proliferative activity, an increase in IgG and IgM biosynthesis and lack of the lymphocytic capacity for induction of specific suppressor activity to this protein. A conclusion of myelin damage in DCMP development was made on the basis of the data obtained. An assumption was made of the appearance of focal inflammatory demyelinization in the myocardium accompanied by an autoimmune process with disorder of cooperative links of T- and B-lymphocytes.

[Antibodies reacting with the antigens of the human immunodeficiency virus in systemic lupus erythematosus]. / Antitela, reagiruiushchie s antigenami virusa immunodefitsita cheloveka pri sistemnoi krasnoi volchanke.

A study was made of the level of anti-HTLV-111 using an enzyme immunoassay (Emzygnost-anti-HTLV-111) in 75 donors and 143 patients with various diseases including SLE (57), rheumatoid arthritis (9), Sjögren's disease (3), Bekhterev's disease (2), polymyositis (2), dilatation cardiomyopathy (30), and acute lymphocytic leukemia (40). Anti-HTLV-111 were detected in 26 SLE patients and in one patient with polymyositis. A study of positive sera using immunoblotting showed no interaction with virus antigens. A conclusion was made that the detection of anti-HTLV-111 in systemic rheumatoid diseases was a false-positive result.