Sheng Jizhang, Zhang Yang, Dong Lintao, Yao Jinpeng
Department of Cardiology, Yantai Yeda Hospital, Yantai, Shandong, China.
The First Clinical Medical College of Ningxia Medical University, Ningxia, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e42496. doi: 10.1097/MD.0000000000042496.
Previous studies have suggested a link between viral infections and myocarditis, but the causal nature of this relationship remains unclear. The antibody-mediated immune responses generated after such infections reflect an individual's infection history and immune status, offering insights into disease mechanisms and potential therapeutic targets. We used 46 antibody-mediated immune responses as exposures, with European myocarditis and Finnish nonischemic cardiomyopathy as outcomes. The overlapping results were then identified and further validated using Mendelian randomization based on generalized summary data to ensure accuracy. Our Mendelian randomization based on generalized summary data analysis showed that Epstein-Barr virus-related antibody levels, including EBNA-1 (OR = 1.7225, 95% CI: 1.2692-2.3376, P < .001) and VCA p18 (OR = 1.8108, 95% CI: 1.1919-2.7511, P = .0054), were significantly associated with an increased risk of myocarditis. In addition, polyomavirus-related antibody levels, including anti-polyomavirus 2 IgG seropositivity (OR = 0.5762, 95% CI: 0.4521-0.7344, P < .001), anti-Merkel cell polyomavirus IgG seropositivity (OR = 0.6924, 95% CI: 0.5522-0.8682, P = .0014), and Merkel cell polyomavirus VP1 antibody levels (OR = 0.6093, 95% CI: 0.3989-0.9307, P = .0219), were significantly associated with a reduced risk of myocarditis. Similarly, antibody levels against varicella zoster virus glycoproteins E and I were also inversely associated with myocarditis risk (OR = 0.4478, 95% CI: 0.3035-0.6606, P < .001). We identified 6 antibody-mediated immune responses associated with myocarditis, along with multiple genetic variants linked to these responses. These findings may help prioritize future research directions and guide drug development.
先前的研究表明病毒感染与心肌炎之间存在联系,但这种关系的因果性质仍不清楚。此类感染后产生的抗体介导的免疫反应反映了个体的感染史和免疫状态,为疾病机制和潜在治疗靶点提供了见解。我们将46种抗体介导的免疫反应作为暴露因素,以欧洲心肌炎和芬兰非缺血性心肌病作为结局。然后识别出重叠结果,并使用基于广义汇总数据的孟德尔随机化进一步验证以确保准确性。我们基于广义汇总数据分析的孟德尔随机化表明,与爱泼斯坦-巴尔病毒相关的抗体水平,包括EBNA-1(比值比[OR]=1.7225,95%置信区间[CI]:1.2692-2.3376,P<.001)和VCA p18(OR=1.8108,95%CI:1.1919-2.7511,P=0.0054),与心肌炎风险增加显著相关。此外,与多瘤病毒相关的抗体水平,包括抗多瘤病毒2 IgG血清阳性(OR=0.5762,95%CI:0.4521-0.7344,P<.001)、抗默克尔细胞多瘤病毒IgG血清阳性(OR=0.6924,95%CI:0.5522-0.8682,P=0.0014)以及默克尔细胞多瘤病毒VP1抗体水平(OR=0.6093,95%CI:0.3989-0.9307,P=0.0219),与心肌炎风险降低显著相关。同样,针对水痘带状疱疹病毒糖蛋白E和I的抗体水平也与心肌炎风险呈负相关(OR=0.4478,95%CI:0.3035-0.6606,P<.001)。我们确定了6种与心肌炎相关的抗体介导的免疫反应,以及与这些反应相关的多个基因变异。这些发现可能有助于确定未来的研究方向优先级并指导药物开发。
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