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Pentraxin 3 in Myocarditis: Proof-of-Principle Assessment as a Diagnostic and Prognostic Biomarker

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Abstract

Pentraxin 3 (PTX3) is an acute phase protein produced in various tissues in response to microbial and sterile stimuli, which regulates the inflammation outcomes. PTX3 has not been investigated in myocarditis. Our aim was to assess circulating and cardiac tissue expression of PTX3 in 55 patients with myocarditis proven by magnetic resonance and/or endomyocardial biopsy. A major proportion of patients with myocarditis displayed significantly increased plasma PTX3 levels as compared with controls (26/30 vs. 0/10), with higher diagnostic yield than conventional biomarkers in the study group. Cardiac tissue analysis revealed PTX3 expression in all patients (40/40), with viral myocarditis exhibiting higher signal intensity than autoimmune myocarditis, and with a predominant localization in cardiomyocytes. Abnormal plasma PTX3 was associated with systolic dysfunction and heart failure at presentation. Interestingly, patients who recovered by 12 months had higher baseline PTX3 levels. Our preliminary data support the potential use of PTX3 as a biomarker in myocarditis.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ACS-like:

Acute coronary syndrome-like

AF:

Atrial fibrillation

AI:

Autoimmune

ANA:

Antinuclear antibodies

AHA:

Anti-heart antibodies

CD:

Cluster of differentiation

CT:

Computed tomography

CMR:

Cardiac magnetic resonance

CRP:

C-reactive protein

ECG:

Electrocardiogram

EMB:

Endomyocardial biopsy

ESR:

Erythrocyte sedimentation rate

FU:

Follow-up

HF:

Heart failure

IHC:

Immunohistochemistry

IQR:

Interquartile range

IST:

Immunosuppressive therapy

LLC:

Lake Louise criteria

LGE:

Late gadolinium enhancement

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

NLR:

Neutrophil-to-lymphocyte ratio

NSAIDs:

Nonsteroidal anti-inflammatory drugs

NSVT:

Non-sustained ventricular tachycardia

NT-proBNP:

N-terminal pro B-type natriuretic peptide

PCR:

Polymerase chain reaction

PTX3:

Pentraxin 3

PVC:

Premature ventricular complex

RAASI:

Renin-angiotensin-aldosterone system inhibitors

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

STIR:

Short-tau inversion recovery

SVT:

Supraventricular tachycardia

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

WBC:

White blood cells

WMA:

Wall motion abnormalities

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Acknowledgements

Anti-PTX3 antibodies were a kind gift of Dr. Barbara Bottazzi, IRCCS Humanitas Research Hospital, Rozzano, Italy.

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Authors and Affiliations

  1. Disease Unit for Myocarditis and Arrhythmogenic Cardiomyopathies, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Andrea Villatore, Simone Sala & Giovanni Peretto

  2. School of Medicine, Vita-Salute San Raffaele University, 20132, Milan, Italy

    Andrea Villatore, Patrizia Rovere-Querini, Domenico Cianflone, Angelo A. Manfredi & Giovanni Peretto

  3. Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Antonella Monno, Clara Sciorati, Patrizia Rovere-Querini & Angelo A. Manfredi

  4. Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Davide Carino & Michele De Bonis

  5. Department of Cardiac Rehabilitation, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy

    Domenico Cianflone

Authors
  1. Andrea Villatore
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  2. Antonella Monno
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  3. Clara Sciorati
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  4. Patrizia Rovere-Querini
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  5. Simone Sala
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  6. Davide Carino
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  9. Angelo A. Manfredi
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  10. Giovanni Peretto
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Contributions

All the authors contributed to the study conception and design. All the authors read and approved the final manuscript. Conceptualization: Giovanni Peretto, Angelo A. Manfredi, and Antonella Monno; methodology: Patrizia Rovere Querini and Domenico Cianflone; formal analysis and investigation: Andrea Villatore, Antonella Monno, Clara Sciorati, Michele De Bonis, and Davide Carino; writing — original draft preparation: Andrea Villatore and Giovanni Peretto; writing — review and editing: Giovanni Peretto and Simone Sala; supervision: Giovanni Peretto, Angelo A. Manfredi, Michele De Bonis, Simone Sala, and Domenico Cianflone.

Corresponding author

Correspondence to Andrea Villatore.

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Ethics Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local institutional review board (IRCCS Ospedale San Raffaele).

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Informed consent was obtained from all the individual participants included in the study.

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The authors declare no competing interests.

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Associate Editor Rupak Mukherjee oversaw the review of this article

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Giovanni Peretto and Angelo Andrea Manfredi share the senior authorship.

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Villatore, A., Monno, A., Sciorati, C. et al. Pentraxin 3 in Myocarditis: Proof-of-Principle Assessment as a Diagnostic and Prognostic Biomarker. J. of Cardiovasc. Trans. Res. (2024). https://doi.org/10.1007/s12265-024-10506-w

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