Deposits of Eosinophil Granule Proteins in Cardiac Tissues of Patients With Eosinophilic Endomyocardial Disease

Tai, Phang C.; Spry, C. J. F.; Olsen, E. G. J.; Ackerman, Steven J.; Dunnette, Sandra L.; Gleich, Gerald J.

doi:10.1016/s0140-6736(87)90412-0

Cited by 256 publications

(147 citation statements)

References 20 publications

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“…Eosinophilic granule proteins, such as ECP and MBP, play important roles in the pathogenesis of eosinophilic myocarditis. 7) As with our patient, elevated ECP during active disease and subsequent reductions in ECP with immunosuppressive therapy suggest that ECP may be responsible for the degranulation of eosinophils. Therefore, monitoring of serum ECP levels, which are derived from degranulation of eosinophils, is one of the valuable parameters with which to make a diagnosis of eosinophilic myocarditis.…”

Section: Discussionsupporting

confidence: 77%

Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

et al. 2013

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SummaryA 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/μL), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infi ltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these fi ndings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered. (Int Heart J 2013; 54: 51-53) Key words: Heart failure, Infl ammation E osinophilic myocarditis is characterized by predominantly eosinophilic infiltration. Eosinophilic granule proteins, such as eosinophil cationic protein (ECP) and major basic protein (MBP), play important roles in the pathogenesis of eosinophilic myocarditis. It may occur in a variety of settings; allergic disease (eg, allergic rhinoconjunctivitis and asthma), drug reactions, parasitic infection, malignancies (eg, lymphoma), and systemic disorders (eg, idiopathic hypereosinophilic syndromes and vasculitis). Here we report a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome with markedly elevated ECP. Case ReportA 67-year-old woman with asthma presented to our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs ( Figure 1A). She had no history of hypertension or heart disease. Her arterial blood pressure was 120/84 mmHg, pulse rate 108 bpm, body temperature 37.1°C, and arterial saturation 97% (pernasal, 2L). A wheeze was present in the bilateral lung fi elds and gallop rhythm was audible. Bilateral pretibial edema and surroundin...

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Section: Discussionsupporting

confidence: 77%

Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

et al. 2013

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“…This disease is characterized by high levels of blood eosinophils and cardiac involvement associated with the formation of mural thrombi and emboli (4,5). MBP is deposited on the endocardium and intima of blood vessels at the sites where thrombus formation almost uniformly occurs (33) . Platelet activation by the deposited MBP may provide an explanation for the close association between eosinophil degranulation and thrombus formation in this disease .…”

Section: Resultsmentioning

confidence: 99%

Activation of platelets by eosinophil granule proteins.

Rohrbach

Wheatley

Slifman

et al. 1990

The Journal of Experimental Medicine

178

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Two of the four principal cationic proteins of the eosinophil granule, major basic protein (MBP) and eosinophil peroxidase (EPO), were shown to be platelet agonists. Both MBP and EPO evoked a dose-dependent nonlytic secretion of platelet 5-hydroxytryptamine in unstirred platelet suspensions even in the presence of 10 microM indomethacin. MBP also evoked secretion of platelet alpha granule and lysosome components. Secretion by MBP and EPO was inhibited by 1 microM PGE1, but the nature of the inhibition differed from that observed with thrombin. Thus, MBP and EPO can be classified as strong platelet agonists with a distinct mechanism of activation.

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“…Tissue eosinophilia and its degranulation in situ have been suggested to be a major contribution to development of tissue injury (Hällgren et al, 1991;Sano et al, 2001). A number of studies have reported the ability of various eosinophilic components to cause tissue damage (Grantham et al, 1986;Leiferman et al, 1985;Sano et al, 2001;Tai et al, 1987); however, relatively little attention has been given to tissue reaction within the lesions in SD rats. Eosinophilic abscesses with granulomatous inflammation have been reported.…”

Section: Discussionmentioning

confidence: 99%

The spectrum of eosinophilic infiltration of the cecum and its relationship to other disorders of multiple granulomas and arteritis in Sprague-Dawlay rat

Li¹,

Bae

Kim³

et al. 2014

J. Toxicol. Sci.

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-Spontaneous multiple granulomas were present in the animal under the SPF condition and without chemical treatment, in a 19-week-old male Sprague-Dawley control-group rat. Here we describe multiple granulomas and prominent diffuse infiltration by eosinophils in the cecal submucosa, and arteritis in the mesenteric arteries. The multiple granulomas were characterized by central eosinophilic degeneration or necrosis, prominent eosinophils, many multi-nucleated giant cells and abundant fibroblasts. They were restricted to the cecal submucosa. The mesenteric arteritis consisted of fibrinoid necrosis of the intima and media, intense inflammatory cell infiltration and fibrosis in the arterial wall. An affected artery in the cecum was continuous with the mesenteric artery. The foregoing tissue changes in this rat correlate with the high absolute blood eosinophil count found in this animal.

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Deposits of Eosinophil Granule Proteins in Cardiac Tissues of Patients With Eosinophilic Endomyocardial Disease

Cited by 256 publications

References 20 publications

Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

Eosinophilic Myocarditis due to Churg-Strauss Syndrome With Markedly Elevated Eosinophil Cationic Protein

Activation of platelets by eosinophil granule proteins.

The spectrum of eosinophilic infiltration of the cecum and its relationship to other disorders of multiple granulomas and arteritis in Sprague-Dawlay rat

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