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Delayed-type Hypersensitivity to Metals in Newly Diagnosed Patients with Nonischemic Dilated Cardiomyopathy


The causes of nonischemic dilated cardiomyopathy are classified as genetic or nongenetic, but environmental factors such as metal pollutants may interact with genetic susceptibility. The presence of metal particles has been detected in the myocardium, including in those patients with dilated cardiomyopathy. It is also known that hypersensitivity reactions can induce inflammation in tissue. The present study aimed to verify if metal-induced delayed-type hypersensitivity is present in patients with nonischemic dilated cardiomyopathy. The patient group consisted of 30 patients with newly diagnosed dilated cardiomyopathy; the control group comprised 41 healthy subjects. All patients and control subjects provided blood samples for lymphocyte transformation testing (MELISA®) to assess possible hypersensitivity to seven common metals. Specific exposure to metals was based on interview data. Results showed that exposure to cadmium and lead (p = 0.0002), aluminum (p = 0.0006), nickel (p = 0.0012), and chromium (p = 0.0065) was more often reported by patients than controls. The patients also had significantly more frequent hypersensitivity reactions to mercury (26.7% vs. 7.3%, p = 0.014624), nickel (40% vs. 12.2%, p = 0.02341), and silver (20% vs. 4.8%, p = 0.025468) than the control group. Patients with dilated cardiomyopathy had greater exposure to certain metals compared with healthy controls. Hypersensitivity to metals was more frequent in patients with dilated cardiomyopathy, suggesting a possible association that warrants further investigation.

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The present study was supported by a grant of the Czech Society of Cardiology, by a project of the Ministry of Health of the Czech Republic—conceptual development of research organisation (Grant Nos. FNBr, 65269705 and FNPl, 00669806), and by RECETOX Research Infrastructure (Grant No. LM2018121) funded by the Czech Ministry of Education, Youth and Sports and CETOCOEN EXCELLENCE Teaming 2 project supported by Horizon 2020 (Grant No. 857560) and the Czech Ministry of Education, Youth and Sports (Grant No. 02.1.01/0.0/0.0/18_046/0015975). The authors cordially dedicate the present work to the memory of Assoc. Prof. Vera Stejskal (1944–2017), D.Sc., PhD., an immunologist of Czech origin who was a dedicated researcher of delayed-type hypersensitivity in various clinical settings. Also, the staff of Laboratoire M.G.D. in Switzerland is thanked for their excellent cooperation in the MELISA testing.

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All authors contributed to the intellectual content of this paper and met the following three requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

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Correspondence to Roman Miklik or Geir Bjørklund.

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Manousek, J., Felsoci, M., Miklik, R. et al. Delayed-type Hypersensitivity to Metals in Newly Diagnosed Patients with Nonischemic Dilated Cardiomyopathy. Cardiovasc Toxicol 20, 571–580 (2020).

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  • Dilated cardiomyopathy
  • Metal exposure
  • Delayed-type hypersensitivity
  • Lymphocyte transformation test
  • Inflammation